Sports Science (A+ work, No plagarism, Quality Work)

Violence in youth sports: hazing, brawling and foul play

S K Fields,1 C L Collins,2 R D Comstock2,3

1 The Ohio State University, College of Education, School of Physical Activity and Educational Services, Columbus, Ohio, USA; 2 Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA; 3 The Ohio State University, College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology, Ohio, USA

Correspondence to: Dr R D Comstock, Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, College of Medicine, Department of Pediatrics, The Ohio State University, 700 Children’s Drive, Columbus, OH 43205, USA; dawn.comstock@ nationwidechildrens.org

Accepted 11 October 2009 Published Online First 25 October 2009

ABSTRACT By separating hazing, brawling, and foul play and failing to recognise that their connection to sport binds them together into a cohesive subset of sport injury and youth violence, past research has failed to show how sports- related violence is a broad example of interpersonal violence. The acceptance of violence within the sporting culture may, in part, explain why sports-related violence has not yet been widely recognised as a public health concern. This review shows that sports-related violence, including hazing, brawling and foul play, occurs among youth athletes of all ages and in a variety of different sports. The few studies to address this issue have all acknowledged the dangers of sports-related violence; however, no incident tracking method has been devel- oped. Future research must provide accurate national estimates of the incidence of sports-related violence among youth, identify associated risk factors, evaluate preventive interventions and identify effective methods of distributing and implementing evidence-based interven- tions. Monitoring the magnitude and distribution of the burden of sports-related violence and building the scientific infrastructure necessary to support the devel- opment and widespread application of effective sports- related prevention interventions are essential first steps toward a reduction in the incidence of sports-related violence.

Participation in sports is one of the most popular ways for adolescents to incorporate physical activity into a healthy lifestyle. Over 7.4 million adolescents participated in high school sports in the USA during the 2007–2008 academic year alone.1 Alongside the health benefits of school sports runs the potential for injury.2 3 Sports- related violence is a subset of sports injury that has, to date, gone largely unrecognised.

Sports-related violence, which includes incidents of hazing, foul play and brawling, can result in both physical and emotional injury. This unique subset of youth violence has been largely unac- knowledged as a public health problem. For example, behaviour that is readily identified as violence outside the sports arena is largely dis- missed as ‘‘part of the game’’ or ‘‘just boys being boys’’ when it occurs in the context of sporting competition. In addition to the direct morbidity and mortality resulting from incidents of sports- related violence, fear of sports-related violence (on the part of adolescents or their parents) may dissuade some individuals from participating in sports activities. Thus, the negative effects of sports-related violence could extend far beyond the initial injuries by decreasing adolescents’ physical activity level which, in turn, could have

a long-lasting impact on their general health and quality of life.

Because sports-related violence as defined here has not been extensively studied in the public health arena and because the problem and poten- tial solutions are linked to both medical and sociological concerns, we describe the current state of the epidemiological and the sociocultural litera- ture on the topic.

DEFINITIONS Youth violence is defined as ‘‘the intentional use of physical force or power, threatened or actual, exerted by or against children, adolescents or young adults which results in or has a high likelihood of resulting in injury, death, psycholo- gical harm, maldevelopment, or deprivation.’’4

Therefore, sports-related violence among youth can be defined as youth violence occurring in the sporting context, which includes violence between individuals or groups at both organised and informal sporting activities.

Sports-related violence encompasses three dis- tinct categories: hazing, foul play and brawling. Hazing among youth is sports-related violence perpetrated by member(s) of a sports-related group against individual(s) seeking inclusion within, admittance to, and/or acceptance by that group. Hazing may be perpetrated by and/or endorsed by parents, coaches or other non-athlete members of the sports-related group as well as by adolescent athletes. Foul play among youth is sports-related violence during the game that is perpetrated by member(s) of one sports-related group against member(s) of an opposing sports-related group that is identified as an illegal activity by the rules of the sport. Foul play may or may not be penalised by a referee/official during the sporting competi- tion or during subsequent disciplinary committee reviews by the sport’s governing body. Brawling among youth is sports-related violence that occurs before, during, or after a sporting event among individuals with interest in the sporting event. Brawling may occur among or between athletes and/or non-athlete participants (parents, coaches, referees, spectators, security personnel, etc) and may or may not disrupt the sporting event itself.

Although scholars in a wide range of disciplines have addressed the three subsets of sports-related violence, they have done so by looking at hazing, brawling and foul play as independent problems.5

By separating hazing, brawling and foul play, and failing to recognise that their connection to sport binds them together into a cohesive subset of sport injury and youth violence, past research has failed

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to show how sports-related violence is a broad example of interpersonal violence.

HAZING Although there is a large body of literature examining bullying among youth and hazing in collegiate fraternities,6–10 very few studies have examined the hazing that occurs among youth, adolescents and young adults who participate in sporting activities. The most detailed examination of hazing and sport in the US especially can be found in descriptive, case-series examples of individual incidents, stories which are often first reported in the news media. Stories in the past several years have been published on and in espn.com, Sports Illustrated for Kids, People and Sports Illustrated.11–14 Hank Nuwer, a journalism instructor, is the most prolific of all hazing scholars, with four books.15–18 Nuwer’s descriptive stories of hazing incidents include non-sporting as well as athletic team related hazing on high school and collegiate levels. Nuwer advocates for strong antihazing policies and laws, and to support his position he tells poignant tales of young lives tragically lost or altered through hazing incidents. Athletes themselves have documented hazing by posting photographs online.19 Some examples of egregious behaviours in sport in the USA in the last 10 years are presented in table 1

Despite the lack of scholarly literature on sports and hazing, the problem appears to be widespread. One national study of hazing among NCAA sports teams found that 80% of collegiate athletes experienced some form of hazing.20 Of the athletes who experienced hazing, 42% reported also being hazed in high school, and 5% reported being hazed in middle school.20 More recently, researchers from the National Study of Student Hazing found that 47% of college freshmen reported being hazed in high school.21 Hazing among adolescent athletes compared with collegiate athletes may be particularly danger- ous for several reasons including youths’ increased need to belong to a group, vulnerability to peer pressure and lack of awareness of what constitutes hazing.17

One of the few US studies of youth hazing among athletes found that 17.4% of the 1105 sixth- to 12th-grade athletes

surveyed at three middle schools and five high schools in the New York City area had been hazed.22 A study conducted by researchers at Alfred University found that in a nationally representative sample of students, almost half (48%) were subjected to hazing.23 Furthermore, hazing was particularly common for high school athletes. Of the 67% of high school students who reported being involved in athletics, over half reported they were hazed. Based on these findings, researchers estimate that over 800 000 high school athletes in the USA experience some form of hazing each year.23 While this study gives us some idea of the incidence of hazing among high school athletes, there are limitations. Although this study used a national random sample of high school students, there was a very low response rate (8.28%) with only 1541 of 18 600 surveys returned. Additionally, the students who completed the survey were not representative of all high school students across the nation, as 90% of the respondent students attended public school, and 84% reported above average grades.

To our knowledge, the previous studies that have examined injuries associated with hazing have not focused specifically on adolescents or athletes.7 10 24 25

While many colleges and high schools have adopted antihaz- ing policies and educational awareness policies related to hazing, middle and grade schools have just begun to adopt similar policies. Standards have not been set for the appropriate level of punishment for the perpetrators of hazing. Past punishments have ranged from lesser punishments such as having to apologise or a one- or two-game suspension, to more severe punishments like forfeiting an entire season and being suspended from school.17

Because of the prevalence of hazing and the serious risk of injury and death (at least 30 college students died from hazing related incidents between 2000 and 2009), 43 states have enacted antihazing laws.26 27 Some of the legal scholarship argues that holding institutions liable for hazing is the most effective deterrent. The idea is that if the schools are held financially responsible, they will take a proactive stance and prevent hazing.28 Theoretically, the states with specific anti- hazing statutes are effectively establishing that hazing is not a

Table 1 Examples of egregious behaviours in sport in the USA in the last 10 years

Date Incident Category

2008 Older high school students at a preseason football camp sodomise younger players over multiple days with a broom

Hazing

2007 After his son is pinned in a wrestling match and the referee had blown his whistle, a man leaves the stands, rushes the mat and throws the 11-year-old opponent away

Brawling

2006 A high school lacrosse coach uses his finger to sodomise a player on the team bus while the team watches: another coach tells the team not to discuss the incident with outsiders

Hazing

2006 Pro football player Albert Haynesworth stomps on the head of an opponent whose helmet had come off: the opponent needed 30 stitches around his eye

Foul play

2004 After rough play and an on-court scuffle, several Indiana Pacers basketball players enter the stands and fight fans in Detroit, Michigan

Brawling

2004 The Clemson and South Carolina University football game is interrupted by a fight between players who use their helmets as weapons

Brawling

2004 College basketball coach John Cheney, frustrated that officials were not calling fouls he saw, sends in a large player to police game and foul opponents: the player breaks another’s arm

Foul play

2004 Pro hockey player Todd Bertuzzi punches an opponent in the back of head and tackles him to the ice, rendering his opponent unconscious and ending his career

Brawling/foul play

2003 At a ‘‘powderpuff’’ flag football game, high school girls haze newcomers by dumping disgusting liquids on them and beating them

Hazing

2000 The father of a youth ice hockey player kills the father of another player after a practice session where the perpetrator believed the victim’s son had played too rough

Brawling

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teambuilding experience.29 30 Antihazing statutes vary dramati- cally between states, and federal legislation might be necessary to establish a consistent antihazing policy.31

Hazing scholars generally argue that clear articulation and enforcement of antihazing policies along with increased adult supervision may reduce hazing. Victims are urged to report hazing incidents, and sports leaders are urged to take immediate action.32 Teams could replace hazing with positive teambuilding experiences like community service, mentoring, travel and outdoor recreation.33 Without changing the culture of sport, however, and ending the subtle tolerance of hazing, nothing will change, and the myth that hazing helps build team cohesion will prevail.34

BRAWLING While the USA has not seen the kind of organised football hooliganism observed in Europe and other parts of the world, physical fist-fights surrounding sporting events are not uncom- mon. This includes fights between participants before, during and after competitions as well as fights in the stands or just outside the venue. This article will describe some of the literature that explores violence directly connected to the sporting venue and not violence perpetrated by athletes away from the game (eg, athletes fighting in bars and athletes arrested for sexual assault).

Of the existing sociocultural literature, much explores the violence in and around the game of ice hockey. Perhaps more than any other sport, ice hockey, especially in the National Hockey League (NHL), seems to pride itself on the fights (unlike most other sports, fighting does not lead to automatic ejection from the game), and the attendance at NHL games between teams with a history of fighting increases.35 Organisers of pro sport may view punishment of fighting more as a public relations tool than a deterrent of future misconduct.36 Fighting can also be a demonstration of the players’ masculinity and toughness.37–39

Fights can be linked to perceived foul play. Players in ice hockey (a game predicated on speed and physical contact) may fight in part to protect themselves against fouls that the referee could not or did not see (table 1).40 Additionally, a study of undergraduate intramural participants found that the partici- pants were more likely to fight or to retaliate with foul play if they perceived the officiating to be poor.41 Fan violence during or immediately after a game can also be based on a sense that poor or unfair officiating wronged their team.42 Tragically, in 2000, a father of a youth ice hockey player killed the father of another player after a practice session where the perpetrator believed the victim’s son had played too rough.

To combat the conventional wisdom that sports-related brawls are on the rise, several communities have taken action. Some leagues have silent game days where parents are either excluded from the playing area or required to remain silent so as not to provoke the players into fights.43 Silence, however, may not be the solution because positive spectator behaviour has predicted positive player behaviour, at least among young children, and negative coach and spectator behaviour has predicted negative player behaviour.44 Thus, silent venues would not help promote positive play among the children. Other communities have required parents to attend sportsmanship clinics or to pledge good behaviour on pain of banishment, although one study suggests that communities with no- tolerance policies for violence will still see spectators yell at and humiliate players.45

FOUL PLAY Several studies have found that many youth and adolescent athletes have come to believe that some forms of violence are acceptable in sports.46–48 One study found that at least 59% of the surveyed high school athletic programmes had athletes who accepted physical intimidation, defined as pushing, shoving, bumping or other physical contact short of striking, including unnecessarily rough play, in an attempt to gain a psychological advantage over an opponent, as part of the game.47 Additionally, an estimated 29% of high school athletes accepted physical violence, defined as striking, punching, wrestling and other forms of physical assault with the intent to injury an opponent, as just part of the game. Another study found that of the 162 intercollegiate athletes surveyed, men found sports-related aggression more acceptable than women, and athletes in non- contact sports found sports-related aggression less acceptable than those in contact sports.49 The acceptance of intimidation and violence appears to be influenced by several factors including the contextual setting, athletes’ attitudes, pressure to win and coaching.47 50

Although foul play is widespread across all cultures and levels of sport,5 to date, there have been a limited number of studies that have investigated the impact of foul play on sports injury rates. The majority of these studies have focused on foul play in individual sports such as rugby,51–61 soccer,62–72 gaelic football,73 74

hurling75 and ice hockey,76 77 finding that the proportion of injuries associated with foul play ranges from 41% for hurling,75

33% for ice hockey,76 5%54 to 33%60 for rugby, 10%72 to 50%70 for soccer and 6%73 to 35%74 for Gaelic football. The most comprehensive study of foul play, which used an internet-based surveillance system to capture exposure and injury data in a nationally representative sample of US high school athletes participating in nine sports, found that over 10% of injuries in four of the nine sports studied were directly related to illegal activity/foul play.78 Other research examining foul play in athletes across multiple sports has been limited to reviews of athletes presenting for treatment at emergency departments (foul play was blamed for 7%79 to 14%80 of injuries) as well as a 1-year prospective study of school children in which foul play was identified as a major risk factor for injury.81

Although very little peer-reviewed scientific research has examined the prevalence of foul play among US adolescent athletes, several non-profit organisations have funded research investigating sportsmanship and illegal conduct/foul play. For example, the Josephson Institute of Ethics conducted the 2006 Sportsmanship Survey to measure high school athletes’ atti- tudes and behaviours related to sportsmanship, cheating, and other illegal conduct in sports.82 Of the 5275 high school athletes who responded to the survey, 60% of males and 27% of females reported they thought it was acceptable to ‘‘deliberately inflict pain in football to intimidate an opponent.’’ Moreover, one in four males and one in 10 females reported they felt it was acceptable for a pitcher to follow a coach’s orders to throw at an opposing hitter intentionally.

Additionally, the National Alliance for Youth Sports (NAYS) asks visitors of their website each week to answer a question related to youth sports. Several of these questions have dealt with sports-related violence issues including brawling and foul play.83 For example, 70% (n = 268) of respondents felt that children would be negatively impacted by the Pistons–Pacers brawl, a large, widely televised brawl involving both US National Basketball Association (NBA) players and fans that occurred in November 2004. Additionally, 85% of respondents believed that pro-athletes’ behaviour impacts how children act

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while playing sports (n = 301). When asked what the biggest problem in youth sports was today, the number one answer was out-of-control parents/spectators (108 of 241 respondents). Though these studies have provided valuable information on the prevalence of sports-related violence among youth, the usefulness of this information is generally limited by the inability to generalise findings from small non-representative samples and relatively low response rates.

In 2000, the Henry J. Kaiser Family Foundation and Princeton Survey Research Associates conducted telephone interviews with a randomly selected national sample of 1500 children aged 10–17 and 1950 parents.84 The study, entitled ‘‘A National Survey of Kids (and their Parents) About Famous Athletes as Role Models,’’ found that nearly 60% of kids described incidents of poor-sportsmanship such as taunting and yelling at the referee or umpire as commonplace among their peers. Furthermore, almost half of all kids surveyed reported that taking cheap shots or hitting an opponent is common in youth sports. Unfortunately, while this study used a nationally representative sample, the survey included a limited number of questions related to the prevalence of foul play and no questions about other forms of sports-related violence including hazing and brawling.

Scholars and advocates have offered suggestions to minimise sports-related violence in the form of foul play. Some call for limiting or eliminating fans’ alcohol consumption at sporting events, certifying youth coaches and banning the use of painkillers and anti-inflammatory medications that allow youth to play injured.50 Several organisations are devoted to promoting sportsmanship, which they believe will lead to a decrease in poor behaviour. The Institute for International Sport sells a card game to promote good sportsmanship as well as promoting an annual National Sportsmanship Day in the USA. The Josephson Institute of Ethics publishes the ‘‘Character Counts’’ newsletter and has programme materials to promote sportsmanship.

CONCLUSION Sports-related violence among youth has been largely over- looked or ignored rather than being recognised as a subset of youth violence worthy of concern and attention. Because relatively few studies have examined the prevalence of sports- related violence among youth or measures of the resultant

morbidity and mortality, there are no reliable estimates of the magnitude of the problem. In addition, because hazing, brawling and foul play have been previously studied separately rather than collectively, seeing how sports-related violence may serve as a broad example of interpersonal violence can be difficult.

The acceptance of violence within the sporting culture may, in part, explain why sports-related violence has not yet been widely recognised as a public health concern. Other forms of popular culture like television and movies as well as video games and music recordings feature ratings or descriptions to warn parents and consumers that the medium contains violence. Parental controls like the v-chip on televisions even allow users to block televisions shows with ratings of excessive violence. No such ratings or warnings, however, exist for sporting events. When a brawl breaks out in the stands or a soccer player head butts another player, the cameras capture the moment live for the viewer and then the clip can be replayed extensively. While we do not necessarily advocate a violence rating for sport, we do argue that the lack of such a system represents how accepted violence in sport is. This social tolerance may in part be why sports-related violence continues and why it is not studied more extensively.

Little is known about potential preventative factors for sports-related violence among youth. Perpetrators of sports- related violence likely do not share the more common attributes/profiles of perpetrators of other youth interpersonal violence (poor academic performance, poor social skills, poor anger management skills, substance abuse problems, etc) because adolescents often must meet minimum academic and citizenship standards to be allowed to participate in athletics. Because of these differences, it is unknown whether or not interventions proven to be effective in preventing traditionally defined interpersonal youth violence will be similarly effective in preventing sports-related violence among youth. Figure 1, based on a social-ecological model of behaviour,85 shows how violence is influenced by both individual and social environ- mental factors.5 Effective interventions will likely require multifactoral approaches addressing diverse issues including peer-pressure, coaches’ influence, parental examples and expec- tations, media’s influence, sports figures’ influence, community and school legislation, referee enforcement of sporting rules, environmental design of sporting venues, etc.

Figure 1 Social-ecological model of sports-related violence.

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The few studies that have addressed hazing, brawling and foul play all acknowledged the dangers of sports-related violence; however, no incident-tracking method has been developed. Thus, the urgent need for future research to provide accurate national estimates of the incidence of sports-related violence among youth, identify associated risk factors, evaluate preventive interventions, and identify effective methods of distributing and implementing evidence-based interventions. Prior studies that called for education about hazing, brawling and foul play have not provided proven methods for effectively distributing and implementing educational interven- tions.22 43 86 87 Monitoring the magnitude and distribution of the burden of sports-related violence and building the scientific infrastructure necessary to support the development and widespread application of effective sports-related prevention interventions are essential first steps toward a reduction in the incidence of sports-related violence.

Competing interests: None.

Provenance and peer review: Commissioned; externally peer reviewed.

REFERENCES 1. National Federation of State High School Associations. 2007–08 High School

Athletics Participation Survey. 2008. 2. Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med

2001;37:301–8. 3. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the

US population, 1997–99. Inj Prev 2003;9:117–23. 4. Dahlberg LL, Krug EG. Violence: a global public health problem. In: Krug EG,

Dahlberg LL, Mercy JA, et al, eds. World report on violence and health. Geneva: World Health Organization, 2002:1–21.

5. Fields SK, Collins CL, Comstock RD. Conflict on the courts: a review of sports-related violence literature. Trauma Violence Abuse 2007;8:359–69.

6. Craig W, Harel-Fisch Y, Fogel-Grinvald H, et al. A cross-national profile of bullying and victimization among adolescents in 40 countries. Int J Public Health 2009;54(2 Suppl):216–24.

7. Finkel MA. Traumatic injuries caused by hazing practices. Am J Emerg Med 2002;20:228–33.

8. Lyznicki JM, McCaffree MA, Robinowitz CB. Childhood bullying: implications for physicians. Am Fam Physician 2004;70:1723–28.

9. Sodl JF, Bassora R, Huffman GR, et al. Traumatic myositis ossificans as a result of college fraternity hazing. Clin Orthop Relat Res 2008;466:225–30.

10. Srabstein J. Deaths linked to bullying and hazing. Int J Adolesc Med Health 2008;20:235–39.

11. Merrill E. A town torn apart. ESPN. 2009. http://sports.espn.go.com/espn/eticket/ story?page=wilsonhigh (accessed 16 July 2009).

12. Egan E. Kids speak out. Sports Illustrated for Kids 2004;16:55–65. 13. Fields-Meyer T. Too cruel for school. People 2003;60:68–70. 14. Wahl G, Wertheim LJ. A rite gone terribly wrong. Sports Illustrated

2003;99:68–75;77. 15. Nuwer H. Broken pledges. Atlanta: Longstreet Press, 1990. 16. Nuwer H. The wrongs of passage. Bloomington: Indiana University Press, 1999. 17. Nuwer H. High school hazing: When rites become wrongs. New York: Franklin

Watts, 2000. 18. Nuwer H. The hazing reader. Bloomington: Indiana University Press, 2004. 19. Wolverton B. Hazing photos spur debates on complicity of coaches. Chronicle

Higher Educ 2006;52. 20. Hoover NC. National survey: Initiation rites and athletics for NCAA sports teams. 1999.

http://www.alfred.edu/sports_hazing/docs/hazing.pdf (accessed 20 June 2009). 21. Allen EJ, Madden M. Hazing in view: college students at risk. 2008. http://www.

hazingstudy.org/publications/hazing_in_view_web.pdf (accessed 6 July 2009). 22. Gershel JC, Katz-Sidlow RJ, Small E, et al. Hazing of suburban middle school and

high school athletes. J Adolesc Health 2003;32:333–5. 23. Hoover NC, Pollard NJ. Initiation rites in American high schools: A national survey.

2000. http://www.alfred.edu/hs_hazing/ (accessed 24 June 2009). 24. Baker BA, Schwartz KA, Segan DJ, et al. Hemoglobinuria after fraternity hazing.

Am J Kidney Dis 1982;2:268–70. 25. Leslie J, Taff ML, Mulvihill M. Forensic aspects of fraternity hazing. Am J Forensic

Med Pathol 1985;6:53–67. 26. Nuwer H. Hazing statistics. 2009. http://www.hanknuwer.com/blog/ (accessed 24

July 2009). 27. Staurowsky EJ. Hazing. In: Cotton DJ, Wolohan JT, eds. Law for recreation and

sport managers 3rd edn. Dubuque: Kendall/Hunt Publishing, 2003:282–93. 28. Crow RB, Rosner SR. Institutional and organizational liability for hazing in

intercollegiate and professional team sports. St John’s Law Rev 2002;76:87–114. 29. Pelletier A. Note: Regulation of rites: the effect and enforcement of current anti-

hazing statutes. New Engl J Crim Civil Confine 2002;28:377–412. 30. Dixon M. Chalk talk: hazing in high schools: ending the hidden tradition. J Law Educ

2001;30:357–63. 31. Sussberg JA. Shattered dreams: hazing in college athletics. Cardozo Law Rev

2003;24:1421–91. 32. National Collegiate Athletic Association (NCAA). Handbook tackles culture of

hazing. 2008. http://www.ncaa.org/wps/ncaa?ContentID=13212 (accessed 20 July 2009).

33. Johnson JM, Miller P. Changing the initiation ceremony. In: Johnson J, Holman M, eds. Making the team: inside the world of sport initiations and hazing. Toronto: Canadian Scholars Press, 2004.

34. Van Raalte JL, Cornelius AE. The relationship between hazing and team cohesion. J Sport Behav 2007;30:491–507.

35. Paul RJ. Variations in NHL attendance. Am J Econ Sociol 2003;62:345–64. 36. Nagel MS, Southall RM, O’Toole T. Punishment in the Four Major North American

Professional Sports Leagues. Int Sports J 2004;8:15–27. 37. Pappas NT. Athlete aggression on the rink and off the ice. Men Mascul

2004;6:291–313. 38. Messner M. When bodies are weapons. Int Rev Sociol Sport 1990;25:203–21. 39. Weinstein MD, Smith DS, Wiesenthal DL. Masculinity and hockey violence. Sex

Roles 1995;33:831–47. 40. Colburn K. Deviance and legitimacy in ice hockey. Sociol Q 1986;27:63–74. 41. Lance LM, Ross CE. Views of violence in American sports: a study of college

students. College Student J 2000;34:191–200. 42. Kerr JH. Rethinking aggression and violence in sport. New York: Routledge, 2005. 43. Abrams DE. The challenge facing parents and coaches in youth sports: assuring children

fun and equal opportunity. Villanova Sports Entertain Law Forum 2002;8:253–92. 44. Arthur-Banning S, Wells MS, Baker BL, et al. Parents behaving badly? The

relationship between the sportsmanship behaviors of adults and athletes in youth basketball games. J Sport Behav 2009;32:3–18.

45. Hennessy DA, Schwartz S. Personal predictors of spectator aggression at little league baseball games. Violence Victims 2007;22:205–15.

46. Bredemeier BJ, Shields DL. Moral growth among athletes and nonathletes: a comparative analysis. J Genet Psychol 1986;147:7–18.

47. Shields EW. Intimidation and violence by males in high school athletics. Adolescence 1999;34:503–21.

48. Silva J. The perceived legitimacy of rule-violating behavior in sport. J Sport Psychol 1983;5:438–48.

49. Tucker LW, Parks JB. Effects of gender and sport type on intercollegiate athlete’s perception of the legitimacy of aggressive behaviors in sport. Sociol Sport J 2001;18:403–13.

50. Miedzian M. Boys will be boys. New York: Doubleday, 1991. 51. Bird YN, Waller AE, Marshall SW, et al. The New Zealand Rugby Injury and

Performance Project: V. Epidemiology of a season of rugby injury. Br J Sports Med 1998;32:319–25.

52. Brooks JH, Fuller CW, Kemp SP, et al. Epidemiology of injuries in English professional rugby union: part 1 match injuries. Br J Sports Med 2005;39:757–66.

What is already known on the topic

c Sports-related violence, including hazing, brawling and foul play, occurs among youth athletes of all ages and in a variety of different sports and can result in both physical and emotional injury.

c Despite this knowledge, sports-related violence among youth has been largely overlooked or ignored rather than being recognised as a subset of youth violence worthy of concern and attention.

What this paper adds

c This paper demonstrates the urgent need for future research to provide accurate national estimates of the incidence of sports- related violence among youth, identify associated risk factors, evaluate preventive interventions and identify effective methods of distributing and implementing evidence-based interventions.

c Effective interventions for sports-related violence will likely require multifactoral approaches addressing diverse issues.

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36 Br J Sports Med 2010;44:32–37. doi:10.1136/bjsm.2009.068320

53. Chalmers DJ, Simpson JC, Depree R. Tackling Rugby injury: lessons learned from the implementation of a five-year sports injury prevention program. J Sci Med Sport 2004;7:74–84.

54. Collins CL, Micheli LJ, Yard EE, et al. Injuries sustained by high school rugby players in the United States, 2005–2006. Arch Pediatr Adolesc Med 2008;162:49–54.

55. Comstock RD, Fields SK. The fair sex? Foul play among female rugby players. J Sci Med Sport 2005;8:101–10.

56. Davies JE, Gibson T. Injuries in Rugby Union football. BMJ 1978;2:1759–61. 57. Inglis GS, Stewart ID. Rugby injury survey 1979. N Z Med J 1981;94:349–50. 58. Jakoet I, Noakes TD. A high rate of injury during the 1995 Rugby World Cup. S Afr

Med J 1998;88:45–7. 59. Kemp SP, Hudson Z, Brooks JH, et al. The epidemiology of head injuries in English

professional rugby union. Clin J Sport Med 2008;18:227–34. 60. Lewis ER, George KP. An initial investigation of injuries in women, men, and youths

playing rugby union football at the same club. Sports Exercise and Injury 1996;2:186–91. 61. Roy SP. Nature and frequency of rugby injuries: a pilot study of 300 injuries at

Stellenbosch. S Afr Med J 1974;48:2321–7. 62. Andersen TE, Engebretsen L, Bahr R. Rule violations as a cause of injuries in male

norwegian professional football: are the referees doing their job? Am J Sports Med 2004;32(1 Suppl):62–8S.

63. Chomiak J, Junge A, Peterson L, et al. Severe injuries in football players. Influencing factors. Am J Sports Med 2000;28(5 Suppl):58–68S.

64. Fauno P, Wulff Jakobsen B. Mechanism of anterior cruciate ligament injuries in soccer. Int J Sports Med 2006;27:75–9.

65. Giza E, Fuller C, Junge A, et al. Mechanisms of foot and ankle injuries in soccer. Am J Sports Med 2003;31:550–4.

66. Hawkins RD, Fuller CW. Risk assessment in professional football: an examination of accidents and incidents in the 1994 World Cup finals. Br J Sports Med 1996;30:165–70.

67. Hawkins RD, Fuller CW. An examination of the frequency and severity of injuries and incidents at three levels of professional football. Br J Sports Med 1998;32:326–32.

68. Junge A, Chomiak J, Dvorak J. Incidence of football injuries in youth players. Comparison of players from two European regions. Am J Sports Med 2000;28(5 Suppl):47–50S.

69. Junge A, Dvorak J, Graf-Baumann T. Football injuries during the World Cup 2002. Am J Sports Med 2004;32(1 Suppl):23S–7S.

70. Junge A, Dvorak J, Graf-Baumann T, et al. Football injuries during FIFA tournaments and the Olympic Games, 1998–2001: development and implementation of an injury- reporting system. Am J Sports Med 2004;32(1 Suppl):80–9S.

71. Peterson L, Junge A, Chomiak J, et al. Incidence of football injuries and complaints in different age groups and skill-level groups. Am J Sports Med 2000;28(5 Suppl):51–7S.

72. Schwebel DC, McDaniel M, Banaszek MM. Ecology of player-to-player contact in boys’ youth soccer play. J Safety Res 2006;37:507–10.

73. Cromwell F, Walsh J, Gormley J. A pilot study examining injuries in elite gaelic footballers. Br J Sports Med 2000;34:104–8.

74. Watson AW. Sports injuries in school gaelic football: a study over one season. Ir J Med Sci 1996;165:12–16.

75. Watson AW. Sports injuries in the game of hurling. A one-year prospective study. Am J Sports Med 1996;24:323–8.

76. Bjorkenheim JM, Syvahuoko I, Rosenberg PH. Injuries in competitive junior ice- hockey. 1437 players followed for one season. Acta Orthop Scand 1993;64:459–61.

77. Finke RC, Goodwin Gerberich S, Madden M, et al. Shoulder injuries in ice hockey. J Orthop Sports Phys Ther 1988;10:54–8.

78. Collins CL, Fields SK, Comstock RD. When the rules of the game are broken: what proportion of high school sports-related injuries are related to illegal activity? Inj Prev 2008;14:34–8.

79. Smithers M, Myers PT. Injuries in sport. A prospective casualty study. Med J Aust 1985;142:457–61.

80. Watters DA, Brooks S, Elton RA, et al. Sports injuries in an accident and emergency department. Arch Emerg Med 1984;1:105–11.

81. Watson AW. Sports injuries during one academic year in 6799 Irish school children. Am J Sports Med 1984;12:65–71.

82. Josephson Institute of Ethics. What are your children learning? The impact of high school sports on the values and ethics of high school athletes. 2007. http:// josephsoninstitute.org/pdf/sports_survey_report_022107.pdf (accessed 22 July 2009).

83. National Alliance for Youth Sports (NAYS). National alliance web surveys: All survey results. 2005. http://www.nays.org/index.cfm (accessed 23 July 2009).

84. The Henry J. Kaiser Family Foundation. Children get mixed messages from famous athletes, both on and off the field. 2000. http://www.kff.org/kaiserpolls/ loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13552 (accessed 19 July 2009).

85. McLeroy KR, Bibeau D, Steckler A, et al. An ecological perspective on health promotion programs. Health Educ Q 1988;15:351–77.

86. Fiore DK. Comment: parental rage and violence in youth sports: how can we prevent ‘‘soccer moms’’ and ‘‘hockey dads’’ from interfering in youth sports and causing games to end in fistfights rather than handshakes? Villanova Sports Entertain Law Forum 2003;10:103.

87. Papaioannou A, Theodorakis Y. Sport involvement, sport violence, and health behaviours of Greek adolescents. Eur J Public Health 2004;14:168–73.

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