Compliance with the national athletic trainers’ Association inter-association task force preseason heat-acclimatization guidelines in high school football

Zachary Y. Kerr*, Johna K. Register-Mihalik, Riana R. Pryor, Yuri Hosokawa, Samantha E. Scarneo-Miller, Douglas J. Casa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Context: In 2009, the National Athletic Trainers’ Association Inter-Association Task Force (NATA-IATF) released preseason heat-acclimatization guidelines for gradually acclimatizing high school (HS) athletes to the environment during the first 2 weeks of the preseason and reducing the risk of exertional heat illness. However, researchers who studied the 2011 preseason found a low level of overall compliance. Objective: To assess compliance with the NATA-IATF guidelines during the 2017 preseason and compare the findings with 2011 preseason data and between states mandating and not mandating the guidelines. Design: Cross-sectional study. Setting: Preseason HS football, 2017. Patients or Other Participants: A total of 1023 athletic trainers working with HS football (14.2% response rate). Main Outcome Measure(s): Using a survey, we acquired information from athletic trainers on their HS football programs, including location and compliance with 17 NATA-IATF guidelines during the 2017 football preseason. The outcome measures were full compliance with all 17 NATA-IATF guidelines and compliance with 10 NATA-IATF guidelines. Prevalence ratios (PRs) with 95% confidence intervals (CIs) compared findings between (1) the 2017 and 2011 preseasons and (2) states whose HS athletic associations imposed a full or partial or no mandate to follow the NATA-IATF guidelines. Results: Overall, 3.9% reported full compliance with NATA-IATF guidelines; 73.9% complied with 10 guidelines. The proportion reporting full compliance was higher in 2017 than in 2011 but not statistically different (3.9% versus 2.5%; PR ¼ 1.54; 95% CI ¼ 0.96, 2.46). However, the proportion reporting compliance with 10 guidelines was higher in 2017 (73.9% versus 57.9%; PR ¼ 1.28; 95% CI ¼ 1.20, 1.36). The proportion of respondents reporting their HSs were fully compliant was highest among the with-mandate group (9.4%), followed by the partial-mandate group (4.6%) and the without-mandate group (0.6%). Group differences retained significance when we examined compliance with 10 guidelines. Conclusions: Although full compliance with NATA-IATF guidelines remained low, many HS football programs complied with 10 guidelines.

Original languageEnglish
Pages (from-to)749-757
Number of pages9
JournalJournal of athletic training
Issue number7
Publication statusPublished - 2019 Jul


  • Exertional heat illness
  • Heat stroke
  • High school athletes
  • Injury prevention
  • Policy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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