Preferred Sources of Health-Risk Information About Cigarettes, e-Cigarettes, and Waterpipes Among Adolescents in Germany: A Cross-Sectional Analysis of a Large School-Based Survey.

In the United States, roughly 27 million individuals between the ages of 6 and 17 years participate in organized sports. However, the culture of youth sports has evolved over recent years: it is now less common for adolescent athletes to participate in multiple sports or unstructured free play. Instead, adolescent athletes may choose to specialize in a single sport year-round at the exclusion of other sports (sport specialization). Although participating in sports has many benefits, such as improved quality of life (QoL), physical health, and self-esteem, it comes with inherent risks, including sport-related injuries, fatigue, or burnout. Multiple studies have found that burnout, anxiety, depressive symptoms, and attrition are increased in youth athletes who specialize in their sport at early ages, as compared with those who specialize later (at 15 or 16 years) or are multisport athletes. Higher sport specialization levels have also been associated with worse mental health. A recently developed validated sport specialization questionnaire, the Wisconsin Sport Specialization Questionnaire (WISSQ), may provide additional clarity about the varying degrees of sport specialization that can be used to investigate associations with mental health and QoL among adolescent athletes. Anxiety and depressive symptoms are common among adolescents in the United States. In 2020, the lifetime prevalence of anxiety symptoms among adolescents was >30%, while the lifetime prevalence for depression in adolescents in 2021 was roughly 11%. Although it is not uncommon for adolescents to experience anxiety or depression, studies are mixed on whether sport participation during high school confers a protective effect against mental health conditions as compared with nonathletes. Some studies have found that participating in sports is protective against mental health conditions, noting that athletes reported less psychological stress and better mental, emotional, and physical well-being than nonathletes. However, others have noted that the prevalence of anxiety or depression was as high as 34% among elite adolescent athletes, which was higher than the general population. Previous studies have found that youth athletes who specialize in their sport are more likely to experience anxiety, depression, or burnout than adolescent athletes who are multisport athletes. Despite growing scientific and clinical interest in the potential consequences of sport specialization, limited research has examined its relationship with mental health among healthy adolescent athletes using the WISSQ. Although previous studies have used sport specialization scales such as the Jayanthi scale, the low, moderate, and high grouping nature of this approach may reduce the ability to identify more specific relationships between the degree of sport specialization and clinically relevant outcomes. Additionally, prior research indicates that the Jayanthi scale may misclassify athletes who have never played other sports as moderately specialized instead of highly specialized. Previous studies reported that sport specialization among adolescent athletes has been associated with higher rates of depression, anxiety, and burnout. In addition, athletes who specialized early tended to withdraw from their sports owing to burnout. Studies have found that in addition to depression, anxiety, and burnout, adolescent athletes who are pressured to perform to high standards are likely to internalize athletic failures and feelings of shame. These feelings may lead to disordered eating behaviors or other harmful behaviors that result in a decline in performance, physical health, and overall QoL. In addition to anxiety and depressive symptoms, evaluating the relationship between sport specialization and outcomes such as fatigue, peer relationships, and pain interference in adolescent athletes is important, as these factors are key indicators of physical and psychosocial well-being. Poor ratings may signal early risks associated with intensive single-sport focus. Furthermore, to the best of our knowledge, current evidence does not clearly demonstrate that mental health outcomes and QoL measures are worse in older specialized adolescent athletes as compared with younger adolescent athletes; however, studies have found that early sport specialization (at <12 years of age) has been associated with overuse injury, psychological fatigue, and burnout. Thus, clarifying the relationships among sport specialization, mental health, and QoL, in addition to age, is important to advance understanding of adolescent athlete health outcomes.