Experiences of Female Athletes Engaged in High School Competitive Sports

EXPERIENCES OF FEMALE ATHLETES ENGAGED

IN HIGH SCHOOL COMPETITIVE SPORTS

PATRICE E. GRIFFIN-CODD

A dissertation submitted in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

WASHINGTON STATE UNIVERSITY College of Nursing

JULY 2019

To the Faculty of Washington State University:

The members of the Committee appointed to examine the dissertation of PATRICE E.

GRIFFIN-CODD find it satisfactory and recommend that it be accepted.

______Billie Marie Severtsen, Ph.D., Chair

Anita J. Hunter, Ph.D.

Mel R. Haberman, Ph.D.

ACKNOWLEDGMENT

I would like to thank Dr. Severtsen for her tremendous willingness to be chair of my research committee, and for her continued support through all phases of this dissertation process.

Additionally, I would like to thank Dr. Haberman for his valuable time on my committee, even as his job descriptions became more demanding along the way. I would also like to thank Dr.

Hunter for her expertise as a pediatric nurse practitioner. This was particularly helpful when the committee met for interview interpretations. I would also like to thank Rychelle Wagner for her help getting through all the details associated with the graduate school, in particular those associated with graduating.

Additionally, I would like to thank Mead High School for their willingness to allow me to do research at their school. In particular, I would like to thank coach Dori Whitford, who made it possible for the athletes to participate in the interviews.

iii

EXPERIENCES OF FEMALE ATHLETES ENGAGED IN HIGH SCHOOL COMPETITIVE SPORTS

Abstract

by Patrice E. Griffin-Codd, Ph.D. Washington State University July 2019

Chair: Billie Marie Severtsen

Ever since Title IX of the Educational Amendments was passed in 1972, female athletes have had greater opportunities to compete in sports and obtain the same scholarships or other funding as male athletes. Since then, however, the percentage of high school females participating in sports programs has remained around 50%, according to statistics from the years

2004- 2015. There is some evidence that sports participation by high school female athletes may continue to decline. This is a significant problem because research suggests that adolescents who do not participate in sports during high school remain inactive in adulthood. With increasing obesity levels seen in children and adults, it is imperative that we understand why young high school females do not engage in sports programs.

The purpose of this study was to understand the experiences of high school girls who are participating in competitive sports during one season. The specific aim was to describe and interpret the lived experiences of girls who participate in one season of the high school competitive sport of cross-country running. A Heideggerian Hermeneutic approach was used to interpret meaning in the experiences of these competitive athletes in order to develop a better

understanding of this phenomenon. Two overarching patterns emerged from this analysis:

The Culture of Running and Approval and Attention From Others. These results provide insight into both the challenges and the rewards that adolescent females face when participating in competitive cross-country running. These results provide ideas on how providers might support female youth athletes, with the ultimate goal being to retain their participation in physical activity, as well as ground work for further research among this population.

TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS……………………………………………………………………… iii

ABSTRACT……………………………………………………………………………………. iv

LIST OF TABLES…………………………………………………………………………...... viii

LIST OF FIGURES……………………………………………………………………………...ix

CHAPTER

1. INTRODUCTION………………………………………………………………………... 1

Women in Sports…………………………………………………………………..2

Background and Significance…………………………………………………….11

Statement of the Purpose…………………………………………………………14

Research Question………………………………………………………………. 15

Specific Aim……………………………………………………………………. 15

Summary………………………………………………………………………….15

2. REVIEW OF THE LITERATURE

Literature Review Tactics………………………………………………………...18

Literature Review…………………………………………………………………20

The Stress Response……………………………………………………………... 21

The Adolescent Stress Response………………………………………… 25

Gender Differences in The Adolescent Stress Response…………………………26

The Field of Sports Psychology………………………………………………… 28

The Adult Competitive Athlete…………………………………………………... 29

Adolescent Organized Sport and Physical Activity……………………………….32

Overtraining Syndromes………………………………………… 37

The Social Cognitive Theory……………………………………………………... 48

Cognitive Affective Processing System………………………… 45

Gaps in Knowledge……………………………………………………………... 47

References………………………………………………………………………... 54

3. RESEARCH DESIGN AND METHODOLOGY

Introduction……………………………………………………………………….49

Heideggerian Phenomenology…………………………………………………….51

Application of Heidegger’s Philosophy to Research……………………………...54

Sample…………………………………………………………………………….56

Data Collection……………………………………………………………………57

Data Analysis……………………………………………………………………. 60

Evaluation of Rigor and Trustworthiness…………………………………………62

Human Subjects Review…………………………………………………………. 64

4. RESULTS

Background and Demographics…………………………………………………66

Contextual Information………………………………………………………….67

Common Structures and Themes………………………………………………. 68

Pattern 1: The Culture of Running …………………………………70

Pattern 2: Approval and Attention From Others…………………....82

vii

Summary of Results……………………………………………………………....93

5. DISCUSSION AND IMPLICATIONS

Meaning of the Results…………………………………………………………. 96

Implications For Previsions of Clinical Care………………………………...... 100

Implications For Future Research………………………………………………105

References………………………………………………………………………110

APPENDIX

A. Parent Recruitment Letter………………………………………………...131

B. Parent Consent…………………………………………………………….131

D. Athlete Consent…………………………………………………………...114

viii

LIST OF TABLES

Page

Table 1 Summary of Demographic Information……………………………………………….67

LIST OF FIGURES

Page

1. Illustration of Athletes Interaction With School and Community………………………… 90

Dedication

This dissertation is dedicated to my husband who has stood by me for

many years, through sickness and health, as I worked on this dissertation. I also dedicate this dissertation to my children, Nicole and Evadine from whom I have learned so

much, and whose running careers inspired this research.

This dissertation is also dedicated to Lucille Woods, my first director

of nursing after graduating from nursing school. She instilled

within me a passion for nursing.

CHAPTER ONE

INTRODUCTION

According to the Women’s Sports Foundation (2015), 3,267,664 high school girls participated in varsity sports in 2013-2014. This was an increase in participation for the 25th consecutive year since the passing of Title IX of the Education Amendments of 1972 (Brown &

Connolly, 2010; Staurowsky et al., 2015). The intent of Title IX was to afford females the same opportunities in sport as males (Brown & Connolly, 2010). However, according to the National

Federation of State High School Associations, in 2004-2005, the percentage of high school females participating in varsity sports was 41.4%, with only a modest increase in participation in

2013-2014 of 41.9% (Staurowsky et al., 2015). There are indications that the percentage of high school girls participating in varsity sports is declining, in particular when compared to male high school athletes (Slater & Tiggemann, 2011; Staurowsky et al., 2015). This is important because research suggests that children and adolescents who develop habits of physical activity through participation in sports stay physically active into adulthood (Burner, 2019; Mehtala, 2014; Wall,

Carlson, Stein, Lee, & Fulton, 2011). Additionally, female adolescent athletes withdraw from competitive sports earlier than males, starting as early as age 10, which has been linked to adult inactivity (Grossbard, Smith, Smoll, & Cumming, 2009; Kirby, Levin, & Inchley, 2012;

Mehtala, 2014; M. Sharma, Nahar, V., 2018; Slater & Tiggemann, 2011; Staurowsky et al.,

2015; Wall et al., 2011). Inactive female adolescents and women are disproportionately at risk for physical problems such as metabolic syndrome, Type 2 diabetes, cardiovascular disease, and psychological problems such as depression and low self-esteem as well as slowed academic achievement (Greenleaf, Boyer, & Petrie, 2009; Staurowsky et al., 2015; Wall et al., 2011).

Participation in competitive sport, however, offers not only significant benefits of a decrease in

obesity and associated physical illnesses for young female athletes, but also in anxiety and depression (Harrist & Witt, 2015; Mehtala, 2014; Powell, 2019; Slater & Tiggemann, 2011;

Tamminen, Holt, & Crocker, 2012).

Given the numbers of young female athletes who do participate in competitive sport, there is a surprising dearth of “nuanced” literature examining the experiences of adolescent competitive athletes (Harrist & Witt, 2015; Worrell et al., 2016). A lot of the research is

“snapshot” correlational designs, or retrospective interviews where the predominant sample was adolescent males and where lists of stressors were documented (Harrist & Witt, 2015; Tamminen

& Holt, 2010; Thatcher & Day, 2008). Alternatively, research is needed that explores the young female athlete’s own interpretations of their competitive experiences. This research attempts to address this paucity by studying high school female athletes lived experiences during a single competitive running season.

Women in Sports

Women have participated in sporting competition for ages; however, recognition of the female athlete wasn’t globally acknowledged until the summer Olympics in 1948, where 385 women competed successfully in a handful of sports (O'Brien & Robertson, 2010). Since the

1984 Summer Olympics, there has continued to be a rise in female athlete participation. In the

2006 Turin Winter Olympics in Italy, 40% of the athletes were females. The International

Olympic committee is credited for working hard to increase female representation in Olympic competition (O'Brien & Robertson, 2010). Also of significant help to young female athletes was the passing of Title IX of the Education Amendments of 1972 which:

Mandated that no person in the United States shall, on the basis of sex, be

excluded from participation in, denied the benefits of, or be subjected to

discrimination under any education program or activity receiving federal financial

assistance (Brown & Connolly, 2010, p. 6).

After the passage of Title IX, girls’ physical activity levels increased by 24% through participation in sport (Staurowsky et al., 2015). However, according to the National Federation of High School Associations, the number of varsity students participating in sports leveled off unpredictably from 2013 to 2014 (Staurowsky et al., 2015).

Parents, educators, and national organizations such as the CDC, The National Institute of

Health (NIH), The Robert Wood Foundation, and the Institute of Medicine (IOM) have recognized the problem of increasing obesity in children and have found that 32 % of adolescents are currently overweight going into adulthood. (Adams, 2016; Burner, 2019).The

Institute of Medicine and the Department of Health and Human Services have recommended that children and adolescents get 60 minutes of moderately vigorous physical activity per day (Myer et al., 2015b; M. Sharma & Nahar, 2018; Staurowsky et al., 2009; Stearns & Glennie, 2010;

Suitor & Kraak, 2007). Participation in competitive sport, as a form of physical activity has been shown to have multiple benefits for children. Physical benefits include a reduction in risk for obesity, cardiovascular disease, osteoporosis, cancer, and other chronic diseases (Slater & Tiggemann, 2011; Staurowsky et al., 2015; Wall et al., 2011). Psychological benefits of participation in competitive sports are also numerous (Slater & Tiggemann, 2011).

These include development of leadership skills, self-discipline, coping skills in success and diversity, sportsmanship, and self -confidence in addition to improved body image (Greenleaf et al., 2009; Hoar, Crocker, Holt, & Tamminen, 2010; Slater & Tiggemann, 2011). More recently,

Powell, et al. (2019) reported that physical activity improves various cognitive functions in the

brain which include executive functions such as self-regulation and impulse control behaviors, memory, processing speed, and academic performance.

Research highlighting the developmental and health care outcomes of sport is readily available; however research involving youth athletes perspectives, interpretations, or the athlete’s “voice” is scant to nonexistent (Harrist & Witt, 2015). Research done by

Harrist and Witt, using a “phenomenological approach” in a study involving a girls’ high school basketball team, found that female adolescent athletes described two themes which served as motivation to play on the basketball team. These themes were developed during a focus group and included enjoyment and serving a purpose. Under enjoyment, the teens described the game of basketball as “fun,” and they enjoyed the competitive nature of the activity. In regard to “serving a purpose”, the girls recognized that playing on the basketball team was a wise use of their time and it prevented them from participating in less constructive activities. Other benefits described by these athletes were the sense of being part of a team or a family as well as providing stress relief.

Another theme was the players’ perception of growth attributed to their participation on the girls’ basketball team. The girls believed that they developed several key attributes not only necessary for adult living but may also be qualifiers for leadership in the future.

These include social competency skills, self-confidence, self-discipline and respect, conflict resolution and anger management, decision-making, and work ethics.

Until recently, schools have carried the burden of providing physical activity and competitive sports programs for children (Edwards, Mauch, & Winkelman, 2011; Rasberry et al.,

2011), primarily because this is where children spend the majority of their time (Kirby et al.,

2012). Schools, however, are finding it increasingly difficult to continue to provide opportunities

for physical education and competitive sports for children (Edwards et al., 2011; Rasberry et al.,

2011). This is primarily because of programs such as the “No Child Left Behind Act,” which causes schools to utilize more resources on math, science, and English in an attempt to improve standardized test scores (Edwards et al., 2011; Rasberry et al., 2011). In the United States, it has been estimated by school administrators that 44% of physical education classes and recesses have been cut from school curriculums (Myer et al., 2015b). In a survey of 1,831 elementary schools in the United States, between the years 2009 and 2012, only 21% offered physical education classes every day (M. Sharma & Nahar, 2018). According to Sharma & Nahar (2018), the transition of school children from elementary to middle school represents the highest point of vulnerability for child sport decline and dropout, in particular in fifth and sixth grades, as previous research has demonstrated (M. Sharma & Nahar, 2018)

Despite attempts at continuing to provide opportunities for school children to remain physically active, there is marked sport attrition for both boys and girls between the ages of 9 and

18 years old, with girls starting sports later and withdrawing sooner (Slater & Tiggemann, 2011;

Wall et al., 2011). According to Staurowsky (2015), the gender gap in physical activity continues through high school, with fewer females competing on high school teams. Some researchers believe that gender plays a significant role in whether an athlete stays and plays sports through high school (Hoar et al., 2010; Slater & Tiggemann, 2011; Tamminen & Holt, 2010). Slater

(2011) cites body image concerns in girls 9 to 14 years old, which starts early because of the

Western culture of “thinness.” This is a problem particularly for adolescent girls who have heightened issues associated with body image (Slater & Tiggemann, 2011; Staurowsky et al.,

2015; Wall et al., 2011). Many children, sometimes at the urging of their parents, participate in

organized, competitive sports teams either extracurricular or outside of school (Myer et al., 2015b).

Research has shown that young female athletes are subject to stressors that are unique to their gender. For example, research done by the Women’s Sport Foundation found that girls who identified themselves as appearing attractive or “feminine” were sometimes discouraged from participating in competitive sports because competition was viewed as a masculine activity, and were encouraged instead to participate in recreational, non-competitive sport (Staurowsky et al.,

2015). Harrist and Witt’s (2014) research found that the negative experiences of female athletes included parental involvement that was critical or overbearing, intra-team cliques, and previous negative coaching experiences. In “Her Life Depends On It III” (2015), a progress report on the status of girls and women in sports, published yearly by the Women’s Sport Foundation, researchers reported a 26% attrition rate among high school female athletes. The majority, 18% of the athletes quit due to time constraints, 16% quit due to conflicts with coaches, and 14% quit from boredom (Staurowsky et al., 2015).

Organized sport can be a powerful advocate for positive youth growth and development

(Harrist & Witt, 2015). However, there is concern for youth in competitive sports, particularly when they start at an early age (Cosh & Tully, 2014). Several reasons for these concerns follow:

1. Children and parents are frequently motivated to pursue elite athlete status. An elite

athlete is one who has gained professional status and/or has been a world-class

competitor in any sport. A professional athlete is, by definition, paid to

compete and wear a company’s shoes and apparel (e.g., Nike, Brooks, etc.).

Athletes and parents are often motivated by the lure of the media that

focus

attention on elite athletes such as The Short Game (7-8-year-old golfers)

and Friday Night Tykes (Texas Youth Football); as well as the potential for

prestige and fame at school, opportunities for college scholarships, and the

possibility of someday competing in the Olympics. (Bergeron, 2010; Denham,

2009; Malina, 2010) .

2. It is generally believed by coaches and parents that the best way to turn a child

into an elite athlete is to start them in an early sport specialization program

(LaPrade et al., 2016; Myer et al., 2015a). Athlete specialization is a practice used

in many countries; however, it originated in Eastern Europe for Olympic sports

development in gymnastics, swimming, diving, and figure skating

(Malina, 2010; Myer et al., 2015b).

3. Deliberate practice requires repetition, and “highly effortful” practice of skills in

order to attain world class sports expertise (LaPrade et al., 2016). In addition to

high levels of skills attainment, specialized athletes compete more frequently, at

higher levels of competition, than non-specialized athletes

(LaPrade et al., 2016; Myer et al., 2015a).

Sports specialization has three major components: (a) the deliberate practice and training for the athlete greater than or equal to eight months per year; (b) the focus is primarily on a single main sport, but may play another sport during off-season; and, (c) the athlete stops all sports other than main sport (Myer et al., 2015a). Any combination of the above determines how highly an athlete is specialized (Myer et al., 2015a). For example, if an athlete meets all three requirements, the athlete is considered highly specialized (Myer et al., 2015a). If an athlete meets requirements, the athlete is considered highly specialized (Myer et al., 2015a). If an athlete meets

only one of the requirements (e.g., training greater than or equal to eight months per year), but not to the exclusion of other sports, he/she has a low degree of specialization (Myer et al.,

2015a). The higher the degree of specialization, the higher the risk for serious, overuse injury to the athlete (LaPrade et al., 2016; Myer et al., 2015a).

There is a paucity of research regarding sport specialization; however, it is clear that high specialization can cause repeated overuse physical injury in both male and female athletes

(Bergeron, 2010; LaPrade et al., 2016; Myer et al., 2015a, 2015b; Staurowsky et al., 2015;

Thomas-Fraser, Cote', & Deakin, 2007). Myer and colleagues (2015a), in a study that involved

1190 male and female athletes ages 7 to 18 seeking treatment after getting pre-participation exams at a sports medicine clinic, reported that those who were highly specialized were 2.25 times more likely to sustain a serious overuse injury than those who were less specialized or not specialized. There continues to be an increase in sport specialization in the United States (U.S.), with coaches and sometimes parents putting significant pressure on young athletes to specialize in a single sport despite evidence-based sports medicine cautioning against sport specialization

(Myer et al., 2015a, 2015b). Myer et al. (2015b) points out that in a sample of 1,200 U.S. competitive youth athletes, 30% were highly specialized.

Reasons for female child and adolescent sport attrition can vary and may include issues associated with gender as discussed earlier, interpersonal problems between teammates, interference by parents, and negative experiences with coaches. The most concerning reason for youth athlete attrition is the phenomenon of specialization because of its potential for causing lingering physical and mental health problems in young athletes (Thomas-Fraser et al., 2007).

Athlete anxiety and poor performance is associated with reduced enjoyment and contributes to burnout and attrition in athletes (Grossbard et al., 2009; Thomas-Fraser et al., 2007). Burnout,

sometimes referred to as “overtraining syndrome” or “overreaching,” develops as the result of excessive training loads; with minimal to no recovery time or periodization, in combination with high levels of psychological stress (Mackinnon, 2000; Mountjoy et al., 2008; Raedeke & Smith,

2004). Athletes who are suffering from burnout do not feel well (Raedeke & Smith, 2004). They experience physical and psychological exhaustion, and their performance in their sport is poor, often leading to devaluing the sport, and ultimately quitting (Capranica & Millard-Stafford,

2011; Grossbard et al., 2009; Myer et al., 2015a, 2015b; Raedeke & Smith, 2004). Burnout and untimely dropout from sport occurs in both male and female specialized athletes (LaPrade et al.,

2016; Myer et al., 2015a, 2015b; Thomas-Fraser et al., 2007). Burnout is a very individual process and is the result of chronic stress and minimal to poor coping resources in the young athlete. (Myer et al., 2015a; Raedeke & Smith, 2004). It is therefore difficult to quantify and compare statistically the burnout and dropout rates in young athletes.

Frequently, parents place a significant amount of pressure on the sports development of their child (Harwood & Knight, 2009; Holt, Tamminen, Black, Sehn, & Wall, 2008; Thomas-

Fraser et al., 2007; Ullrich-French & Smith, 2009). According to Harwood et al. (2009), this pressure can be irrational at times. Parents who overemphasize winning may criticize their child and have unrealistic expectations of their child’s sport performance (Harwood & Knight, 2009).

These actions contribute significantly to athlete burnout and sports attrition (Thomas-Fraser et al., 2007). Other contributing factors to sports attrition in adolescence include lack of supportive relationships with peers and the feelings of isolation (Thomas-Fraser et al., 2007; Ullrich-French

& Smith, 2009). Research could not be found that compared female adolescent sport specialization and attrition with male adolescent sports specialization and attrition.

Unfortunately, research shows that both boys and girls who drop out of sports prematurely tend

to adopt an inactive lifestyle for the remainder of their lives, contributing to the global problems of obesity, metabolic syndrome, cardiac disease, and depression (LaPrade et al., 2016; Myer et al., 2015a, 2015b; Staurowsky et al., 2015). Specialization is not only a problem in United States, but it is seen in the training of athletes in many countries (LaPrade et al., 2016; Myer et al.,

2015a, 2015b).

Much more research is needed to understand the physiological and psychological responses of competitive athletics, specialization, and sports attrition in young females. For example, female athletes in general are vulnerable to the development of eating disorders

(Staurowsky et al., 2015). Young female athletes have the highest incidence of eating disorders, with older female athletes and male adolescent athletes following not too far behind (Giel et al.,

2016; Staurowsky et al., 2015). The more weight dependent the sport is, i.e., where thinness may enhance the athlete’s performance (e.g., running, ballet, gymnastics, etc.), the higher the occurrence of eating disorders (Giel et al., 2016). In some elite groups of athletes, disordered eating behavior is normalized as a consequence of participation in the sport (Staurowsky et al.,

2015).

Staurowsky et al. (2015) reports that 86% of the eating disorders that occur in athletes are diagnosed between the ages of 7 and 20 and consist primarily of anorexia nervosa and bulimia nervosa, or a severe co-existence of both. Anorexia nervosa is the most lethal of all of the eating disorders, with about a 20% mortality rate (Staurowsky et al., 2015). Anorexia nervosa is a condition that occurs as a result of an alteration in body image and a fear of gaining weight

(Staurowsky et al., 2015). Individuals with anorexia voluntarily starve themselves in order to decrease their weight, or maintain their thinness (Staurowsky et al., 2015). Bulimia nervosa is also an attempt to decrease weight, or maintain thinness, but is characterized by binging,

sometimes eating large amounts of food, and then purging the food voluntarily (Staurowsky et al., 2015). Binging and purging behavior may also be accompanied by abuse of laxatives and diuretics, diet pills, and compulsive exercise which was greater than that required by their coach

(Staurowsky et al., 2015).

The presence of an eating disorder in an adolescent female athlete may be a sign of an even broader, more significant health concern called the female athlete triad, or FAT (Berz &

McCambridge, 2016; Staurowsky et al., 2015). FAT includes the symptoms of low energy availability (related to eating disorder), menstrual dysfunction, and low bone mineral density

(Berz & McCambridge, 2016; Staurowsky et al., 2015). There can be serious health consequences if FAT is not diagnosed and treated early (Berz & McCambridge, 2016). Athletes suffering from either part or all FAT symptoms may experience an increase in blood lipid levels, endothelial dysfunction, irreversible bone loss, stress fractures, and an increase in musculoskeletal injuries (Berz & McCambridge, 2016; Staurowsky et al., 2015).

Developing an understanding of adolescent girls’ lived experiences in the competitive sport environment may help healthcare providers understand the competitive sport environment more fully. Better understanding can lead to the ability to identify interventions which could make participation in a competitive sport more rewarding for young female athletes, minimize overuse physical injuries, as well as to facilitate continued physical activity into adulthood.

Background and Significance

There is little research that attests to the experiences of female athletes. However, listening to the voices of adolescent girls and their lived experiences in the competitive sports environment may help healthcare providers understand the stressors/hardships and benefits of the competitive sports environment more fully. Better understanding can lead to the ability to

identify interventions which could make participation in competitive sport more rewarding for young female athletes; minimize overuse physical injuries, enable early detection of anorexia nervosa and bulimia nervosa and symptoms of FAT, as well as to facilitate continued physical activity into adulthood. Encouraging and maintaining physical activity in childhood and adolescence is important for the reduction in chronic diseases such as diabetes, osteoporosis, and cardiovascular disease as well as optimizing mental health. Unfortunately, given the high rate of sport attrition in both girls and boys between the ages of 9 and 14 years, the aforementioned health benefits become a moot point. Girls tend to start participating in sport later, and quit sooner, than boys (Slater & Tiggemann, 2011) for the reasons mentioned earlier. It is possible that hearing young girls’ experiences related to sports participation may help health providers and educators understand the costs and benefits of early sport participation and develop measures to keep girls physically active longer, even in the absence of competitive sports.

Psychological stress during adolescence can be particularly intense because of the quantity and the simultaneous, uncontrollable nature of the transitions that normally occur during this stage of growth and development (Murray, Byrne, & Rieger, 2011). No research has been found that focuses exclusively on the adolescent females’ response to stressors associated with athletic competition. Research involving gender differences in coping with stressors in male and female athletes is limited (Tamminen & Holt, 2010; Tamminen et al., 2012). There is research however, on gender differences in coping in non-sport literature (Hoar et al., 2010). Gender differentiations may be studied by analyzing stressor sources and appraisals (Hoar et al., 2010).

These are two of the areas where an athlete may be taught stress management techniques to increase comfort and enhance performance during athletic competition. Currently, sports psychologists teach techniques and provide counseling; however, sport psychologists are

generally not available to younger elite athletes. In general, however, an athlete’s unique personal attributes such as age, gender, personality, and disposition can affect their experiences in sport as well as influence their ability to cope with and moderate the effects of stress

(Harmison, 2006; Raedeke & Smith, 2004).

There are many things that can be done to improve the sporting environment for children and adolescents. In the United States, there is an obvious lack of female presence at all levels of the sport workplace, including coaching staff. According to Staurowsky (2015), women comprise only 10 % of all high school athletic directors. The sports institution today remains predominantly a male institution. This has resulted in women being left out of key decisions involving young female athletes, which may contribute to the low numbers of girls and adolescents participating in sports. School districts should work fervently toward hiring female coaching staffs and directors as positions become available. Additionally, not all schools have implemented Title IX fully, and that should be addressed sooner rather than later (Staurowsky et al., 2015). The development of a girls’ sport program, whether it be for basketball, soccer, or track, should be undertaken consciously, keeping in mind the need for girls to have accessible, secure, and safe environments to practice and play (Staurowsky et al., 2015). When the coach is male, the use of young women as assistant coaches and volunteers may be helpful and provide valuable role models for young girls in sports. Whether male or female, all coaches need intensive education on problems unique to girls and young women in sport such as eating disorders and the female athlete triad (FAT). Also, coaches should be taught stress management techniques that they could teach and practice with the athletes prior to games and competitions.

This is a particularly important step because it may decrease athlete attrition related to stress.

Statement of the Problem

For health care providers to understand how they can assist in the health and wellbeing of adolescent female athletes involved in competitive sport, they must first understand the experience of that situation as lived by female competitive athletes. Healthcare providers, for the purpose of this dissertation, include not only nurses, but physical and occupational therapists, chiropractors, physicians, and sport psychologists. Minimal research has been found that describes adolescent girls’ lived experiences in competitive sports at the high school level. This research study attempts to begin to fill this gap in the literature.

Statement of the Purpose

The purpose of this study was to understand the lived experiences of high school girls who are participating in competitive sports during one season.

Population of Interest

The population of interest for this study was 10 to 12 freshman through senior females 14 to 18 years of age, participating in a school-offered cross-country running team sport for one season. The cross-country running season started in late August and extended through October.

Participants were selected from a single high school located in an urban locale in Eastern

Washington state. The volunteer subjects were roughly an equal population of varsity and junior varsity runners. Varsity runners were chosen because they are considered the “elite” and most competitive members of a girls’ cross-country running team. Junior Varsity runners are included in this study to offer comparison between varsity and junior varsity skill levels.

Research Question

Heideggerian phenomenology was used to explore the meaning of the lived experiences of high school female competitive athletes. The research question was therefore: What was the meaning of the lived experience of female high school athletes competing on the girls’ high school cross-country running team for one season?

Specific Aim

The specific aim was to describe and interpret the lived experiences of girls who participate in one season of the high school competitive sport of cross-country running.

Summary

Physical activity in childhood and adolescence is necessary in order to ensure the physical and psychological wellbeing of children and adults. Despite the increased access to sports opportunities influenced by the 1972 Title IX law, there remains a considerable gender gap between male and female participation in sports. The gender gap begins in elementary school and gradually becomes larger, extending into adulthood. There has been little to no research that addresses why this gender gap occurs, although suppositions have been made about the effect of masculinization stereotyping, gender identity problems, and the normal developmental maturational processes of girls as contributors. Athletic competitive stress may play a significant role in sport attrition. Programs promoting athletic specialization may be one factor contributing to the gender gap; however, research describing this stress in the voices of the female athletes themselves is very limited. Athletic specialization may not only be discouraging participation of young females in competitive sport, it may be causing physical and psychological problems that endure through adulthood.

This Heideggerian phenomenological study is needed to provide foundational knowledge by which healthcare providers might better understand the effect of the competitive environment in which young female athletes function. Through the voices of the athletes themselves, providers can develop an awareness of the challenges these young athletes face and offer support in sustaining physical activity involvement and preventing burnout and injury.

CHAPTER 2

REVIEW OF THE LITERATURE

Lack of physical activity in children and adults has taken on pandemic proportions worldwide, and in the United States (U.S.), it has become a major focus of public health campaigns (Staurowsky et al., 2015). The U.S. Department of Health and Human Services recently established the 2018 Physical Activity Guidelines (PAG), which recommends that adults and adolescents obtain at least 150 to 300 minutes of moderately intense aerobic physical activity a week or 75 to 150 minutes of vigorous intensity activity (Piercy & Troiano, 2018; Powell,

2019). Evidence continues to pile up demonstrating the role physical activity plays in the prevention of some of the world’s most disabling diseases such as diabetes, cardiovascular disease, cancer, osteoporosis, and mental illness (Piercy & Troiano, 2018; Slater & Tiggemann,

2011; Staurowsky et al., 2015; Wall et al., 2011). The U.S. Report Card on Physical Activity for

Children and Youth found that only 25% participate in at least one hour of moderate to vigorous activity per day (M. Sharma & Nahar, 2018; Staurowsky et al., 2015). Girls continue to lag behind boys in sport participation despite the passage of Title IV, which has done much to equalize female competitive sport opportunities with male opportunities (Kirby et al., 2012;

Slater & Tiggemann, 2011; Staurowsky et al., 2015; Wall et al., 2011). The Health Behavior in

School-Aged Children 2012 study, sponsored by the World Health Organization, found that in boys ages 11 to 15, 30-33% participated in moderate to vigorous physical activity. In girls ages

11 to 15 years old, participation dropped from 24% to 17% (Staurowsky et al., 2015). The transition of children from elementary to middle school appears to have the most deleterious effect on the physical activity levels of both boys and girls (M. Sharma & Nahar, 2018).

Increasing physical activity levels of young females will not occur automatically. It requires research on the specific needs for physical activity in girls and young women and the development of programs tailored specifically to meet these needs. Additionally, there is a need for educational opportunities to encourage girls’ participation in these programs (M. Sharma &

Nahar, 2018).

There is a formidable amount of information about athletes which has come from quantitative and semi-structured qualitative studies on older males and secondarily female athletes at the professional and college levels. While there is an increasing focus of research on youth sport, there is little to no research that asks the adolescents to interpret their own competitive experiences (Harrist & Witt, 2015; Thatcher & Day, 2008). It is for these reasons that this research will investigate the “lived” experiences of high school female competitive athletes. It is hoped that through the development of greater understandings of the young females’ competitive experiences, nurses and health care providers will be better able to care for these young athletes and develop programs that maximize their athletic potential while minimizing physical and psychological injuries.

Literature Search Tactics

The literature review process for this research was complex due to the necessity of understanding the intricate systems of the human stress response and the brain and the uniqueness of the adolescent brain physiology and the stress response. The hypothalamic- pituitary-adrenal (HPA) response needed to be understood as key to the human stress experience.

Key words included “adolescent stress response,” “stress response,” and “Selye.” knowing he was the first to identify the specific neuroendocrine pathway involved in stress. It was felt that a greater understanding was needed of the prefrontal cortex of the brain, the main part of the brain

receiving the stress appraisals. At this point, the key words were “prefrontal cortex and stress.”

These articles came from neuroscience journals and were admittedly, in some areas, beyond this researcher’s comprehension due to their technicality. For the most part, these articles came from

PubMed, and 17 were reviewed and used in this study. Exercise can maintain and improve adolescent brain function, which also occurs through a quite complex mechanism involving neuroanatomy and the endocrine systems. This phenomenon was complicated, but aptly explained in 13 research articles coming from journals such as Exercise Physiology and

Biomechanics and the Journal of Cognitive Neuroscience. Primary search terms were “exercise and brain physiology” and “exercise and brain function,” which also came primarily from Pub

Med.

Once the stress response was understood, another complex topic became resilience, or why does one athlete feel stress in a certain situation and another athlete, all things being equal, does not feel stressed. Research has shown that athlete appraisal of an event or a situation is what leads to stress and coping (Thatcher & Day, 2008). One is then drawn quite naturally into the adult and adolescent athlete stress and coping literature. The key words used were “adolescent athlete stress,” “young athlete stress,” and “athlete stress.” Much of this literature comes from the Web of Science, and 42 articles were found and utilized. Next, there was an attempt to differentiate sport stressors between male and female athletes. The available literature comparing male to female stress and coping in sports was difficult to find; however, 14 articles were found that described these differences, using search terms such as “gender in adolescent sport,” and

“female competitive sport.” Much of this literature came from the Web of Science.

Children and adolescents who are talented in at least one sport are vulnerable to increased injuries and psychological trauma related to excessive participation in the sport year-round. The

term specialization is loosely used to describe these athletes, and 21 sources were found describing this phenomenon. The search terms for this included “specialization in sport,”

“burnout in sport,” and “sport and psychological stress,” most of which were found in Web of

Science. In addition to the above issues, this study also discusses a multitude of issues associated with child and adolescent participation in sports, the delineation of which would be cumbersome.

A total of 301 peer review articles were used to write this literature review. Most of these articles were clinically based; however, there were some articles on the qualitative research methodology, Heideggerian phenomenology and ethical research.

Literature Review

Youth participation in competitive sports has been shown to be beneficial to adolescents both physically and psychologically (Worrell et al., 2016). Participation in competitive sports is, however, intrinsically stressful (Harrist & Witt, 2015; Mellalieu, Neil, Hanton, & Fletcher, 2009;

Tamminen, McEwen, & Crocker, 2016). Despite the well-researched benefits of competitive athletics for children and adolescents, there are those who would eliminate school-sponsored competitive sports because of the “stress” in favor of more “cooperative,” less demanding activities (Worrell et al., 2016). This debate is occurring primarily in the academic field, where resources of time and money are limited (Staurowsky et al., 2015; Worrell et al., 2016). This is a troubling debate for those who advocate for continued competitive sports in childhood and adolescence as they see it as preparing young people to handle stress in the bigger context of the society and the world (Kristiansen & Roberts, 2010; Staurowsky et al., 2015; Tamminen et al.,

2016; Worrell et al., 2016). Understanding adolescent competitive stress is complicated. There is ample opportunity for individual differences in response to stress based on parental and other social support systems. Additionally, sport researchers have elucidated different developmental

levels of coping relative to chronological age and pubertal status of the adolescent athlete (Hoar et al., 2010; Tamminen et al., 2016).

There are significant gender differences in the way adolescents handle stress, and it appears that adolescent females are more sensitive than males to interpersonal stress, in particular teasing (Hoar et al., 2010; Slater & Tiggemann, 2011). Some sport literature has shown that adolescent girls worry most about performing poorly, whereas boys worry most about concentration disruption (Grossbard et al., 2009). Sports psychologists have done most of the research in competitive sports, however, have disproportionately sampled male athletes over female athletes and older athletes over adolescent athletes (Tamminen & Holt, 2010; Troutman

& Dufur, 2007). Historically, this may have been a result of limited participation of women in competitive athletics (Troutman & Dufur, 2007). Female participation in high school athletics was only 7.5% in 1971; however, it comprised 40% of high school athletes in 1996 after the passage of Title IX in 1972 (Troutman & Dufur, 2007).

There is sufficient evidence to demonstrate that adolescent males and females respond to competitive stress differently; however, research is needed on female athletes’ personal lived experiences of stress and coping in competitive athletics in order to fully understand both the positive and the negative consequences of adolescent female participation in competitive sports.

The Stress Response

All living beings experience stress. Stresses vary among living creatures, and so do their responses to it. Hans Selye was the first researcher to identify the intricate steps of the human stress response in 1936 (McEwen, 2004; Szabo, Tache, & Somogyi, 2012). He called it the

General Adaptation Syndrome, which was later renamed the human stress response (McEwen,

2004). Selye’s theoretical framework identifies the physiological response to stress and is

considered to be the cornerstone of modern research involving the study of stress in both humans and animals (McEwen, 2004). Since Selye’s early work, scientists studying the phenomenon of the stress response have extended its parameters significantly, enabling a clear picture both of how humans function under stress as well as the mechanism under which disease develops

(Moal, 2007).

The word stress comes from the French word estresse, meaning to strain or apply a straining force (Moal, 2007). Living beings attempt to establish a dynamic equilibrium, both consciously and unconsciously, to either real or perceived stressful forces (Charmandari,

Achermann, Carel, Soder, & Chrousos, 2012). The process of stabilizing equilibrium is called allostasis, and the term homeostasis is the achievement of equilibrium (Charmandari et al., 2012;

Frodl & O'Keane, 2013). The term allostatic load is used to describe a stress response overload, or a stress reaction that cannot be mediated, or turned off by the brain (Frodl &

O'Keane, 2013). An allostatic load, or the failure of the termination of the stress response beyond its immediate utility for survival, exposes tissues and organ systems to damage as a result of the noxious chemicals released during stress (Charmandari et al., 2012).

Allostasis occurs in two forms, one that is an automatic response, which includes physiological and emotional arousal, involuntary and impulsive responses to stress, and the fight- flight response (Mikoteit et al., 2012). The other form of allostasis involves the main focus of this research, which is a controlled response to stress (Mikoteit et al., 2012). According to

Mikoteit (2012, p. 26), a controlled response to stress involves “conscious volitional efforts to regulate emotion, cognition, behavior, physiology, and the environment in response to stressful events or circumstances,” A stress response begins with an appraisal (Tottenham, Hare, & Casey,

2011), which can be either conscious or unconscious, followed by a physiological response to

the stressor (Hillman, Kamijo, & Scudder, 2011; Kyrou & Tsigos, 2009; Romeo, 2010). The type of response generated by the stimulus depends upon whether the athlete appraises it as a challenge or a threat, which is determined in part by her awareness of feelings of self-efficacy, control over the situation, and her goals (Holt & Dunn, 2004; Williams, Cumming, & Balanos,

2010). Threat appraisals are considered to be the most stress evoking and occur when an individual consciously perceives that she does not have the resources to cope with an event, e.g., a maladaptive event (Williams et al., 2010). Challenge appraisals, by contrast, occur when an individual believes she is capable of dealing effectively with a stressor event and are considered an adaptive response to stress (Williams et al., 2010). Previous experiences with challenge and threat appraisals provide the basis for future coping, complicating appraisal, interacting with emotional processes, and contributing to a cyclical processes of stress response (Grossbard et al.,

2009; Holt & Dunn, 2004).

After the appraisal of a stimulus as a threat, the hypothalamic-pituitary-adrenal (HPA) axis responds with the secretion of the glucocorticoid cortisol from the adrenal gland (Frodl &

O'Keane, 2013; Meggs, Golby, Gucciardi, & Polman, 2016; Romeo, 2010). Stimulants such as epinephrine and norepinephrine are also released into the bloodstream (Charmandari et al., 2012;

McEwen, 2007), which have powerful effects on end organs in the gastrointestinal, endocrine, renal, central nervous system, and cardiovascular systems (Frodl & O'Keane, 2013; Reagan,

Grillo, & Piroli, 2008), all of which have the shared responsibility of insuring an organism’s survival (Kyrou & Tsigos, 2009; Williams et al., 2010). Within a minute after stressor contact and the subsequent release of glucocorticoids, a person will experience increased energy availability through catabolism, an increase in blood flow to the brain and the muscles through vasodilation and decreased peripheral resistance and increased alertness, respirations, and cardiac

output (Kyrou & Tsigos, 2009; Williams et al., 2010). This causes an increase in the athlete’s heart rate and stroke volume, resulting in an increased cardiac output in order to ensure the athlete’s “survival” (Williams et al., 2010). An appraisal of a challenge, however, results in sympathetic-adrenomedullary activity, which also results in an increased heart rate and stroke volume. However, cortisol is not produced through the HP-Axis, so it is significantly less debilitating than a threat appraisal (Williams et al., 2010). The consideration that needs to be given for these physiological stress responses is that the long-term secretion of cortisol and resultant secretion of glucocorticoids has damaging effects on the young, developing brain (Frodl

& O'Keane, 2013). Elevated glucocorticoids inhibits learning and memory as well as increases risk for depression (Frodl & O'Keane, 2013). Additionally, there is increasing evidence showing that adolescents with a significant amount of life stress are at a two to five times higher risk for injury or re-injury (Nipert & Smith, 2008).

In addition to competitive stress such as repeated failures; there can be internal team stressors such as negative peer interactions, ostracism, overambitious internal and external pressures to perform, criticism, and poor role models and coaching (Tofler & Butterbaugh,

2005). This stress is in addition to life event stress, which might include problems at home, poor grades, difficulty getting to practice, etc. (Nipert & Smith, 2008). With but a few exceptions, all athletes will experience stress during sport competitions (Thatcher & Day, 2008).

Additionally, there is increasing evidence showing that adolescents with a significant amount of life stress are at a two to five times higher risk for physical injury or re-injury (Nipert

& Smith, 2008). Coaches and their assistants must be aware of athletes’ stress levels and work with them on coping mechanisms, such as team building and other ways to decrease internal strife. This is because long-term secretion of cortisol and resultant secretion of glucocorticoids

has damaging effects on the young, developing brain (Frodl & O'Keane, 2013). Elevated glucocorticoids inhibits learning and memory as well as increases risk for depression (Frodl &

O'Keane, 2013).

Many athletes will experience stress that at one time or another could be considered extreme (Thatcher & Day, 2008). An extremely stressful event is the result of an athlete’s appraisal of an event as threatening vs. challenging. In response to the threat appraisal, the athlete’s body reacts as if her life is in danger, i.e., sending out strong neurochemicals such as cortisol and glucocorticoids which increase her heart rate and release energy resources to ensure her survival. Experiencing increased levels of cortisol and glucocorticoids on a chronic basis can be very harmful to the developing child and adolescent, causing increased physical injury and psychological problems such as burnout and depression.

The adolescent stress response. Adolescence is a period of time that begins around 10 to 17 years in girls, and around 12 to 18 years in boys (Sturman & Moghaddam, 2011). It is a time of significant growth in all major body systems, including the brain (Sturman2011, p.

1706), which undergoes dramatic changes in “gross morphology.” The adolescent brain is 90% the size of the adult brain; however, it is slow to develop functionally, primarily due to immaturity in the cognitive control systems within the prefrontal cortex (Casey, Getz, & Galvan,

2008). Because of this, it functions differently than the adult brain, particularly when under stress

(Casey et al., 2008; Sturman & Moghaddam, 2011). For example, an adolescent is able to inhibit a competing thought or action in favor of a goal-directed activity in a manner similar to an adult, but it takes much longer and it is less effective due to an immature prefrontal cortex (Casey et al.,

2008; Luna, Padmanabhan, & O'Hearn, 2010). Adolescents also have difficulty maintaining accuracy and precision of their working memory (Luna et al., 2010). This occurs because of the

greater distractibility of the adolescent as compared to adults (Luna et al., 2010). The adolescent also appears to have a heightened sensitivity to stress and an equally heightened response to the

HPA pathway (Romeo, 2010). In the case of the adolescent, once the glucocorticoids are released in the bloodstream, they take twice as long as an adult to dissipate (Romeo, 2010).

Grossbard et al. (2009), report that the levels of anxiety in which adolescents suffer roughly match their level of cognitive development. As a result, older adolescents appear better prepared to handle adversity (Kristiansen & Roberts, 2010). Younger adolescents appear to have a more difficult time handling their negative emotions and developing a problem-solving, or coping strategy (Kristiansen & Roberts, 2010).

The response of the HPA axis to stress appears to be shaped by personal experience, becoming less reactive with age (Romeo, 2010). Evidence suggests that vulnerabilities demonstrated by an immature HPA axis in childhood and adolescence can lead to long-term alterations or greater sensitivities to stress in adulthood (Romeo, 2010). Additionally, prolonged periods of stress in adolescence have been linked to the development of physical and mental disorders in adolescents (Kessler, Avenevoli, Costello, et al., 2012; Kessler, Avenevoli,

McLaughlin, et al., 2012; McGorry, Purcell, Goldstone, & Amminger, 2011; Ormel et al., 2012).

Gender differences in the adolescent stress response. Adolescents are naturally vulnerable to stress resulting from changes in their physical, cognitive, emotional, and psychological domains (Murray et al., 2011). While there are differences in how adolescents respond to stress, for the most part all athletes will experience stress at one time or another during athletic competitions (Thatcher & Day, 2008). Research on gender differences in adolescent response to stress is fairly easy to find in non-sport peer-reviewed literature (Hoar et al., 2010). However, finding research dealing with gender differences in adolescents’ response to

stress in competitive sport is limited (Hoar et al., 2010; Kristiansen & Roberts, 2010). Despite this, it does appear that athletes in their teens appear to fare better with competitive stress than younger children (Kristiansen & Roberts, 2010). The source of the stressor, and how it is appraised by the athlete, is the biggest reason for gender differences in adolescent competitive sport (Hoar et al., 2010). Tamminen and Holt (2010), report that when being exposed to the same stressors as males, adolescent female athletes tend to evaluate the stressors as more severe. For example, adolescent females are highly sensitive to stressors related to interpersonal relationships (Hoar et al., 2010). While both males and females participating in high school competitive sports experience stress in interpersonal relationships, females are more sensitive than males to problems in these relationships (Hoar et al., 2010). There are two hypotheses which attempt to explain the differences between the male and female stress response. The disposition hypothesis states that the differences in abilities to cope with stress reside within the gender of the adolescent, and not her environment (Hoar et al., 2010). Gender may also be a factor in the preferential use of certain types of coping style (Tamminen & Holt, 2010). An opposing hypothesis is the situational hypothesis that states given similar stressors and appraisals, there will be no difference between the coping behavior of male and female athletes

(Hoar et al., 2010). The situational hypothesis was developed as a part of the well- known role constraint theory, which examines in a broad sense how females appraise stressors given their different roles in society (Hoar et al., 2010). The situational hypothesis, as part of the role constraint theory, is well researched and, as such, is the most credible and perhaps most useful hypothesis.

To summarize, adolescence begins in girls between the ages of 10 and 17, and 12 to 18 in boys. In both boys and girls, the brain is not yet fully developed. Casey et al. (2008) reports that

the brain is only 90% developed, and the 10% is related to an immature prefrontal cortex with diminished cognitive control and a heightened sensitivity of the HPA axis system to stress. The younger the athlete, the more difficulty they appear to have with competition stress (Kristiansen

& Roberts, 2010). There is evidence suggesting that girls are more sensitive to stress than boys.

The Disposition Hypothesis states that the differences in girls’ ability to handle stress is a product of their gender, not the environment (Hoar et al., 2010). Gender may also be linked to certain coping mechanisms when under stress (Tamminen & Holt, 2010). This points to the need for stress management interventions to be tailored for girls and competitive venues adjusted to be less stressful for both the male and female adolescent athlete; however, there is a need for much more research in this area. Presently, competitions are organized and structured in the likeness of college and professional competitions, which cause significant stress in young male and female athletes.

The Field of Sports Psychology

Sports psychology is a relatively new discipline, spanning approximately the last 30 years

(Mellalieu et al., 2009). It is the first discipline to begin research on athletes (MacNamara,

Button, & Collins, 2010). Historically, the discipline has studied athletic stress through the use of questionnaires and lists completed either before or after competitions (Mellalieu et al., 2009).

The information that is available now regarding athlete anxiety associated with competitive sports comes from early, or historical, sports psychology’s quantitative research (Mellalieu et al.,

2009). It is noteworthy that sports psychologists have tended to disproportionately sample male over female athletes, and older athletes over younger athletes, i.e., comparing college athletes to adult athletes (Tamminen & Holt, 2010; Troutman & Dufur, 2007).

Sports psychologists, at the present time, use a new paradigm which approximates a qualitative research style called the “transactional approach” to sports research (Mellalieu et al.,

2009; Tamminen et al., 2012). This model was introduced to the sports psychology field in the early 1990s by Lazarus and Folkman, (Holt & Dunn, 2004; Mellalieu et al., 2009; Thatcher &

Day, 2008). Using this approach, sport researchers believe that the only way to understand athlete stress and coping is to study the athlete in the context of his/her environment (Holt &

Dunn, 2004; Mellalieu et al., 2009; Tamminen et al., 2012). This is called the “transactional approach or perspective” because the research involves an athlete’s relationship with her environment that is dynamic, interactional, and complex (Holt & Dunn, 2004; Mellalieu et al.,

2009; Tamminen et al., 2012; Thatcher & Day, 2008). It is within this complex relationship and environment that stimuli are appraised as either a challenge or a threat, and coping is begun (Holt

& Dunn, 2004; Thatcher & Day, 2008). It is also in this context where research is most needed yet is most scarce, according to (Harrist & Witt, 2015; Holt & Dunn, 2004).

The Adult Competitive Athlete

A relatively small number of adult athletes enjoy the thrill of competitive sports

(Mummery, Schofield, & Perry, 2004). There are “Masters” track and field meets, and “Masters” cross-country running meets that feature athletes from ages 30 to 80 and above. The competition is subdivided by age group and is considered to be of professional quality. In general, competition and sporting excellence motivate these athletes (Perez, 2015). In order to excel, these athletes survive harsh workouts under the most grueling conditions (Lemyre, Hall, &

Roberts, 2008). Psychological stress is as inherent in this population as it is in the adolescent athlete population (Mellalieu et al., 2009), and it appears to be intermittent, varied, and

unique to the individual athlete (Meggs et al., 2016). For example, by studying athlete appraisals, it was discovered that the origin of athlete stressors could not be contained simply within the confines of the competitive milieu (Mellalieu et al., 2009). According to Mellalieu (2009), stressors could be divided into two main categories in order to facilitate study.

Mellalieu et al. (2009) studied 12 elite and non-elite male and female competitive athletes ages 19 to 56 (M=23.67). A guided interview was administered from which two major themes evolved, organizational stressors and performance stressors (Mellalieu et al., 2009). A total of

173 organizational and 283 performance stresses were found (Mellalieu et al., 2009). Under the category of performance stressors, there were concerns regarding coach, team, and spectator evaluations, which related to the athlete’s self- presentation, competence, image, and physique

(Mellalieu et al., 2009). Also considered under performance pressure are expectations from recruiters and media, fear of injury, referee decisions, and observing opponents cheating

(Mellalieu et al., 2009; Tamminen et al., 2012). Team rivalry is also a performance stressor, as is the mental preparation for competition (Mellalieu et al., 2009).

Organizational stressors are considered to be stressors intrinsic to competitive sport and include such issues as the competitive environment, competition format and schedule, and nutritional issues (Mellalieu et al., 2009). Other stressors are associated with the roles athletes have on the team; for example, functioning as a team captain, as a mentor to a new team member, or other leadership role (Mellalieu et al., 2009). Interpersonal relationships with team members, and the necessity to sometimes play the role of the coach toward other team players, can also contribute significantly to an athlete’s stress load. Mellalieu’s research in 2009 discovered several important characteristics of athlete stress. Of significant importance is the finding that both performance and organizational stress can be experienced by athletes while

preparing for competition. Six of the participants in this research qualified for elite status as they had competed in major national and international events. The remainder of the 12 participants were competitive athletes; however, of non-elite status. The researchers found no difference in the number of stressors documented by the elite and the non-elite athletes; however, the stressor priorities were different between the two groups. For example, in the non-elite group, organizational issues such as not having the right types of food available and insufficient time available for warm-up were stressful for the athletes. Inability to prepare at the practice facility and insufficient information regarding other competitors were high on the organizational stressor list for elite athletes. In addition to the above-named stressors, both types of athletes had stressors outside of the competitive realm, which included personal stressors such as death in family, family relationships, and financial issues. The athlete therefore had to deal with all of these stressors while still staying focused on the competition at hand. Kristiansen and Roberts

(2010), in their study of 29 adolescents ages 14-17, found similarly that athletes experienced competitive and organizational stressors. The conclusion of this research supports other research findings that indicate that older athletes are better prepared to handle the stress of competitive sports than younger athletes.

Sport psychology has conducted much of the research in sport, and traditionally it has utilized adult males as participants. While females are now being examined more in sport research, it is still the adult that gets most of the attention. Mellalieu (2009) found that there were two types of major stressors of adult male and female athletes, organization stress and performance stress. Examples of organizational stress might include the schedule of competition, environment of competition, and room and board. Examples of performance stressors might include expectations from recruiters, fear of injury or re-injury, media, competitors, etc. One of

the best things about adult research, however, is that it gives us a basis in which we can study elite childhood athletes who always compete in adult venues.

Adolescent Organized Sport and Physical Activity

Historical perspective. Since the time of ancient Greek and Roman cultures, society has recognized the importance of physical activity in both children and adults (Greenleaf et al., 2009;

O'Brien & Robertson, 2010; Tomporowski, Lambourne, & Okumura, 2011). In accordance with ancient medical protocols, it was a person’s responsibility, in collaboration with their physician, to maintain their health (Berryman, 2010). This included not only eating right and getting enough sleep, but getting sufficient exercise (Berryman, 2010). In 1000 BC, women participated in the Heron Games in Greece, which were developed to be for women, and in honor of the goddess Hera, as part of ancient fertility rites (O'Brien & Robertson, 2010).

In the late 1880s, in America the term” physical education” was used by doctors who were promoting the “laws of health,” which included appropriate diet, adequate sleep, avoidance of overindulgence in those things considered noxious to the body such as alcohol, and getting adequate exercise (Berryman, 2010). The physicians who led the movement for physical education were gymnasium directors and physicians who prescribed exercise routinely for their patients (Berryman, 2010). In 1859, the first American female physician, Elizabeth Blackwell, wrote a book entitled The Laws of Life, and the Physical Education of Girls, in which she discusses the need for exercise for girls (Berryman, 2010). Exercise was thought to be so important in the preservation of health that in the early 1900s all states mandated physical education as a part of the curriculum for medical students (Berryman, 2010). In 1866, California was the first state in the union to mandate physical education, or activity, (PE) in schools

(Tomporowski et al., 2011). Other states and school systems followed California’s lead with the

rationale that children and adolescents spend the majority of their time at school, and it seemed appropriate that the legislation of physical activity occur within this environment (Kirby et al.,

2012; Nichol, Pickett, & Janssen, 2009). In the present era, physical activity, including after- school sports programs, are gradually being eliminated (Hillman et al., 2011; Van Dusen, Kelder,

Kohl, Ranjit, & Perry, 2011) because school districts have come upon economic hardships as well as have had to increase class time in core subjects such as math and English in order to ensure that their children pass the nationalized testing mandated by “No Child Left Behind” federal legislation (Hillman et al., 2011; Van Dusen et al., 2011).

Adolescent organized physical activity. Child and adolescent physical activity can be divided into two categories, free-time physical activity (FTPA) and organized physical activity

(OPA) (Wall et al., 2011). Free-time physical activity is defined as encompassing activities which do not occur during school or recess, but which involve activities geared to the idea of

“getting your body moving.” This includes playing actively with friends or family (Wall et al.,

2011). It may also be defined as any physical activity that involves the leadership of a coach, or instructor, and it includes not only traditional sports such as basketball and volleyball, but also physical activities such as dance, gymnastics, and the martial arts (Wall et al., 2011). The 2008

Physical Activity Guidelines for Americans recommends that children and adolescents have at least 60 minutes of exercise every day (Wall et al., 2011). The goal is to maximize the amount of physical activity children and adolescents participate in overall. FTPA by itself does not meet

2008 physical activity guidelines. This means that some OPA must be included in order for the adolescent to meet the guidelines.

Research however indicates that children and adolescents who participate in OPA have higher levels of FTPA (Nichol et al., 2009; Wall et al., 2011; Walters, Barr-Anderson, Wall, &

Neumark-Sztainer, 2009). In a 2005/2006 study of Canadian Health Behavior in School-Aged

Children, 7,638 students participated in a self-report survey regarding their participation in school-sponsored physical activity such as varsity sports and intramural athletics. This study compared availability of sports equipment, playing fields, and opportunities for children and adolescents to play in well-equipped schools compared with schools that had few opportunities for organized or intramural sports, and additionally few fields and minimal equipment. Among high school students in particular, there were higher rates of FTPA in schools where there were more recreational opportunities, i.e., more OPA opportunities (Nichol et al., 2009). High school boys were 1.53 95% CI: [1.12,1.8] times more likely to participate in class-time and FTPA than students with fewest opportunities (Nichol et al., 2009). Girls whose high schools had class-time and organized physical activities were 1.62 95% CI: [0.96-2.21] times more likely to participate in school-sponsored activities as well as FTPA (Nichol et al., 2009). The authors concluded that involvement in organized physical activities, such as the availability of sports at school, appear to have the greatest positive impact on school-age children and adolescent FTPA (Nichol et al.,

2009; Wall et al., 2011).

To the extent that physical activity can be maximized in childhood, the more likely it will be carried over into adulthood (Wall et al., 2011). Unfortunately, statistics in the United States demonstrate a significantly high youth sports attrition rate (Camhi, Phillips, & Young, 2011). In both girls and boys, the greatest drop in physical activity occurs during the transition from youth to adulthood (Makinen et al., 2010; Walters et al., 2009). This decline in FTPA begins in girls between the ages of 10 and 11, and between boys between 14 and 15 years old (Slater &

Tiggemann, 2011; Wall et al., 2011). According to Wall, et al. (2011), within the United States, only 18% of high school students are vigorously active for 60 minutes or greater each day. Girls

are consistently less physically active than boys (Kirby et al., 2012; Slater & Tiggemann, 2011;

Wall et al., 2011). Significantly, women who do not participate in sports as girls are more likely to have a sedentary lifestyle (Greenleaf et al., 2009). Greenleaf et al. (2009), found that only 25% of all adult women are physically active. This places girls and women disproportionately at risk for obesity, Type 2 diabetes, cardiovascular disease, osteoporosis, cancer, mental illnesses such as depression, and slowed academic achievement (Staurowsky et al., 2015; Wall et al.,

2011). This continuing attrition in physical exercise is a significant public health concern because ongoing exercise in adulthood has been shown to prevent chronic diseases such as osteoporosis, cancer, diabetes, and cardiovascular disease later in life (Staurowsky et al., 2015;

Wall et al., 2011).

In general, the health benefits of physical activity that have received the most attention by researchers include a reduction of childhood obesity, decreased risk of cardiovascular disease, and other chronic diseases, as well as improved bone health (Slater & Tiggemann, 2011;

Tomporowski et al., 2011; Wall et al., 2011). Enhanced body image satisfaction and enhanced emotion regulation are also benefits from physical activity (Grossbard et al., 2009). Child and adolescent participation in sport and physical activity has also been credited with providing an opportunity for optimal psychological and social development of children, which include skills of sportsmanship, cooperation, and leadership, coping with success and adversity, and fostering self-discipline and self-confidence (Bergeron, 2010; Slater & Tiggemann, 2011; Tamminen et al., 2012). Improved self-esteem and self-confidence in youth may occur in response to the physical demands of a sport that includes strength, speed, agility, flexibility and coordination

(Greenleaf et al., 2009).

There is also evidence supporting the role of moderately intense aerobic exercise in the enhancement of mood, reduction of psychological stress, depression, and anxiety in young people (Gondoh et al., 2009; Greenleaf et al., 2009; Slater & Tiggemann, 2011; Staurowsky et al., 2015). Aerobic exercise of moderate intensity is defined as “one’s ability to deliver oxygen to the muscles and generate energy during exercise” (Herting & Nagel, 2012, p. 1). Adolescence is a time of vulnerability to depression for both males and females (Staurowsky et al., 2015).

Without physical activity, the risk for the female adolescent to become depressed is twice as high as it is for males (Staurowsky et al., 2015). Between the ages of 15 to 24, the third leading cause of death is suicide (Staurowsky et al., 2015). Multiple studies have found that girls who are involved in sports are less likely to contemplate or attempt suicide as compared to girls who are not involved in sports (Staurowsky et al., 2015). The psychological benefits espoused to exercise appears to be related to retention and increase of insula gray matter volume in the brain, which otherwise naturally decreases as children age (Gondoh et al., 2009).

An additional important benefit derived from childhood exercise is the improved

development of cognitive control (Donnelly & Lambourne, 2011), otherwise known as executive function (Huizinga, Dolan, & van der Molen, 2006). Cognitive control involves the ability of a child or adolescent to influence the interactions of their cognitive thoughts and actions, particularly in adverse situations (Huizinga et al., 2006). It allows for goal-directed behavior, including planning, organizing, self-regulation, and abstract problem solving

(Donnelly & Lambourne, 2011). Cognitive control also involves functions of working memory, motor control, and control of inhibitions (Donnelly & Lambourne, 2011; Herting & Nagel,

2012) and inhibit response to other stimuli in addition to improving the speed of response to the primary stimuli (Hillman et al., 2011). While children generally developed cognitive control

over a protracted period of time, extending even into adulthood (Huizinga et al., 2006;

Tomporowski et al., 2011), it appears that cardiovascular fitness may speed this process

(Donnelly & Lambourne, 2011). The mechanisms behind improved cognition through exercise

in childhood may be related to enhanced neural circuitry in the hippocampus and the prefrontal

cortex of the brain, areas which are responsible for learning and memory encoding (Herting &

Nagel, 2012). In children and adolescents, associations have been made between aerobic fitness

and increased hippocampal volume (Herting & Nagel, 2012).

Overtraining syndromes. Despite all of the benefits of participation in organized, competitive sports, participation is not totally devoid of problems for young athletes (Harrist &

Witt, 2015; Kristiansen & Roberts, 2010). In fact, participation in sports can be extremely stressful for adolescents (Harrist & Witt, 2015; Kristiansen & Roberts, 2010). Overtraining syndrome is defined as “a neuroendocrine disorder characterized by poor performance in competition, inability to maintain training loads, persistent fatigue, reduced catecholamine excretion, frequent illness, disturbed sleep, and alterations in mood state” (Mackinnon, 2000). p. 502. Overtraining symptoms occur when the body is unable to recover from intensive exercise because it is not followed with sufficient recovery time (Mackinnon, 2000). The first, and perhaps the most obvious, symptom of overtraining is poor performance in competition despite continued training. While athletes with overtraining syndrome cannot be considered immunodeficient, according to clinical standards, several immune parameters have been shown to decrease in athletes during prolonged periods of intensive training. According to Mackinnon (2000), recovery from overtraining syndrome requires complete rest, or a greatly reduced exercise schedule for weeks or even months in order to facilitate a full recovery. Overreaching is another training syndrome similar to overtraining, but not as

severe (Mackinnon, 2000). Overreaching has similar symptoms as overtraining; however, recovery

can occur within days to weeks if it is caught early.

Adolescent females may be more sensitive to stress than males (Tamminen & Holt, 2010).

As such, adolescent females participating in competitive sport are more prone to develop

pathological weight control behavior than adolescents who are participating in recreational sports

(Staurowsky et al., 2015). There are sometimes weight limits and body shapes that are needed in

order to compete aggressively (Staurowsky et al., 2015). Controlling food intake and over-

exercising, sometimes up to two hours above and beyond the required workout, are two of the most

common tactics used by athletes to control weight (Staurowsky et al., 2015). In a study of 414

athletes, 31% of athletes competing in “Thin-Build” sports (gymnastics and running) were

diagnosed with eating disorders as compared to 5.5% non-athletes (Staurowsky et al., 2015).

According to an NCAA study of female college athletes, 9% struggled with bulimia and 3% had

anorexia (Staurowsky et al., 2015). Frequently, disordered eating and weight control can also turn

into a more serious condition called the female athlete triad, which involves amenorrhea, loss of

bone density and increased risk for stress fractures, as well as other concomitant hormonal and

nutritional disorders (Staurowsky et al., 2015).

There has not been a significant amount of research on early athlete specialization, physical injury, and burnout. Research done by sports psychologists revealed initially that anxiety was problematic for many athletes (Grossbard et al., 2009), which marked the beginning of further quantitative research studies utilizing an assortment of data collection techniques such as symptom checklists, “snapshot” correlational designs, and retrospective interviews (Harrist & Witt, 2015;

Tamminen & Holt, 2010; Thatcher & Day, 2008). Relationships between the development of life skills and other positive and negative health behaviors in athletes was demonstrated in research;

however, how these skills were learned by athletes was unclear (Holt, Tamminen, Tink, & Black,

2009; Jones & Lavallee, 2009). In an effort to understand how athletes acquired these skills, the use of qualitative methodologies were enlisted by sports psychologists to study the athletes in their competitive sport domain (Jones & Lavallee, 2009). Not just any qualitative research design could be utilized to gain this type of knowledge, however. It needed to be a design in which the data collection instrument, or the researcher, could develop an understanding of the athlete’s experiences through the utilization of the senses, other than just visual, i.e., the sounds of breathing as a measure of successful training, the smells associated with locker rooms, odors and aromas of equipment and seasonal conditions, the taste of the spaghetti dinner the night before every competition, and the haptic experiences with the environment such as shoveling snow off of the track before practice (Sparkes, 2009). The qualitative methodology of phenomenology provides the perfect opportunity to study what Allen-Collinson (2009) calls the sporting embodiment, or the

“flesh of the lived sporting body,” commiserating on how rarely phenomenology is used in sport research (Allen-Collinson, 2009). Research that seeks to understand the “lived “ experience of participating on a competitive sport team as an adolescent, and a female, is even more rare (Harrist

& Witt, 2015).

Stressor appraisal and response are a function of what psychologists and researchers identify as each individual’s executive function (Sperduti et al., 2017). Stressor appraisal and response, or emotion regulation, depends on an intact set of physiological functions and cognitive processes within the prefrontal cortex (Sperduti et al., 2017). Executive function (EF) is an umbrella term used to explain these processes as they relate to adaptive cognitive functioning, or coping with stress (Huizinga et al., 2006). The successful utilization of executive functions is particularly important in demanding or stressful situations when the environment requires rapid,

flexible responses to stress (Huizinga et al., 2006; Montgomery, Stoesz, & McCrimmon, 2012).

The ability to use the tools of response inhibition and shifting is very important to athletes because they are exposed to a multitude of stimuli, frequently all at once, which requires instant prioritization and inhibition of other responses continuously (Holt & Dunn, 2004). EF further facilitates goal-directed behavior with the use of problem solving and appraisals, thereby enhancing the ability to cope with aversive stimuli (Hostinar, Stellern, Schaefer, Carlson, &

Gunnar, 2012). Having the ability to focus on running a race, for example, means that the runner has to shift their attention from other competing stimuli, such as people cheering around the track, while at the same time inhibiting responses to stimuli such as fatigue and pain.

The process of coping describes all efforts aimed at reducing the impact of a stressor,

even if the coping effort is inefficient, or ineffective (Beasley, Thompson, & Davidson, 2003).

Attempts to exert cognitive control in the face of perceived emotionally damaging information is

called emotional regulation, or coping (Mikoteit et al., 2012; Tamminen et al., 2012; Tottenham et

al., 2011). In sports psychology, coping is viewed as a dynamic, transactional process that is

antecedent to an appraisal in which the athlete perceives a threatening situation (Kristiansen &

Roberts, 2010). According to Nicolas and Jebrane (2009) and Smith (2006), the process of coping

is constantly changing, and is highly dependent on the context and the environment. Coping

occurs in stages across different events and times and in different situations (Nicolas & Jebrane,

2009). How an athlete responds to either an internal or external stimulus is dependent upon the

acquired meaning a stimulus has (Smith, 2006). The ability to mitigate or decrease the effects of a

stressor is especially important in adolescence due to the detrimental effects long-term,

accumulated stress has on adulthood (Hostinar et al., 2012; Kubala, Christianson, Kaufman,

Watkins, & Maier, 2012). The ability of a young person to demonstrate confidence and self-

control in the face of environmental or personal stress is called potency, and it is an important quality for stress management (Beeri & Lev-Wiesel, 2012). The processes involved in EF are particularly important in adolescence because they assist in stabilizing emotional arousal, which is needed because of the heightened emotional sensitivity and reactivity of adolescence (Flouri &

Panourgia, 2012; Hostinar et al., 2012).

Research has shown that some athletes appear to be less vulnerable to competitive stress than others (Meggs et al., 2016). Resilience describes an individual’s patterns of dealing with stress successfully (or coping) over long periods of time (Ng, Ang, & Ho, 2012). Resilience may be defined as “the role of mental processes and behavior in promoting personal assets and protecting an individual from the potential negative effect of stressors”. Resilience is necessary for athletes wanting to continue, or even excel, in sport (Gerber et al., 2012). Resilience and coping are related to each other in a cyclical process, where coping is antecedent to resilience, with resilience also helping to shape the coping response (Ng et al., 2012). Sports psychologists and nurses have begun to address the possibility of learned resilience in athletes, as it is a concept that promotes the development over time of optimal physical and mental health (Ahern, 2006;

Meggs et al., 2016).

The labeling of coping styles across theoretical frameworks differs; however, researchers generally agree that there are three main types of coping used by athletes; task-oriented coping, disengagement coping, and distraction coping (Gaudreau, Nicholls, & Levy, 2010; Holen, Lervag,

Waaktaar, & Ystgaard, 2012). The task-oriented coping style involves engagement with the stressor (Mikoteit et al., 2012). Some of the activities associated with task-oriented coping include information gathering, goal setting, time management, cognitive reappraisal, and emotional regulation (Gaudreau et al., 2010; Holen et al., 2012; Holt & Dunn, 2004). Disengagement coping

involves an emotional withdrawal from striving for an important goal and/or venting of negative thoughts (Gaudreau et al., 2010). Distraction-oriented coping is a short-term, momentary action in which the athlete refocuses her attention on something other than the goal at hand (Gaudreau et al., 2010). Instead, she focuses her attention on activities such as watching MTV, which is unrelated to the race she has to run in several hours. (Gaudreau et al., 2010).

Researchers have documented a wide variety of coping strategies used by adolescents, which include problem focused-seeking support, venting emotions, aggression, acceptance, withdrawal, or behavioral disengagement (Tamminen et al., 2016). Tamminen and Holt (2010) studied thirteen members of a girls’ high school basketball team. The mean age of the girls was

16. They found that the coping styles varied somewhat from early season to late season; however, the predominant style was problem solving and accommodation, with some escape and submission early in the basketball season (Tamminen & Holt, 2010). Overall, researchers believe that the task-oriented style of coping is the most effective style of coping because it relates more strongly with goal attainment and decreased incidence of mental illness (Gaudreau et al., 2010;

Holen et al., 2012; Mikoteit et al., 2012; Ng et al., 2012). While task-oriented coping is viewed as the most adaptive of all of the coping strategies, there is evidence that disengagement coping may also be valuable in certain situations (Holt & Dunn, 2004). The disengagement style of coping may be best for short-term stress because it results in the use of fewer cognitive resources, thereby lessening the impact of cumulative stress on the athlete (Holt & Dunn, 2004; Mikoteit et al.,

2012). Disengagement coping may therefore be helpful in preventing long-term memory of experiences, which might otherwise be harmful to a child or adolescent (Mikoteit et al., 2012).

Disengagement coping has also been found to be most helpful in situations where an athlete has less control (Holen et al., 2012; Holt & Dunn, 2004; Nicolas & Jebrane, 2009). In their study,

Gaudreau et al. (2010) found that while not associated with sport achievement, distraction may be a valuable coping strategy when used in combination with task, or problem-focused coping.

Distraction-oriented coping may provide an individual with a brief respite from a stressful situation, thereby preserving badly needed coping resources (Gaudreau, et al., 2010).

While research on gender variation in competitive sport is limited (Hoar et al., 2010;

Kristiansen & Roberts, 2010), the research that has been done indicates there are differences between male and female athletes in regards to attitudes and experiences in sport, in particular with respect to activity levels, developmental outcomes, and negative experiences (Harrist &

Witt, 2015). Some research indicates that female adolescent athletes experience more stress at a higher intensity than males, both in their interpersonal relationships as well as in their experience of anxiety (Grossbard et al., 2009; Hoar et al., 2010)

The Social Cognitive Theory

Social Cognitive Theory provides a framework for the study of an athlete’s cognitive appraisals, her social interactions, and her behavior in the competitive environment (Bandura,

2004). Social Cognitive Theory (SCT), developed by Alfred Bandura in the mid 1950s helps to understand the complexity of youth participation in competitive sport (Miller, 1988).

Bandura’s early model of the SCT involved two main concepts, triadic reciprocal determinism and behavioral modeling. Over the years Bandura refined his model, and in 2001 he introduced expansions to his model that he called human agency and fortuity (Bandura,

2001). Human agency and fortuity are not divergent from his original thesis on triadic reciprocal determinism; instead, they offer greater depth and enhanced application of the social cognitive theory to research. The SCT model is presented in the shape of a triangle, with the elements of E,

B, and P located on each tip. The concept of triadic reciprocal determinism can be applied readily

to adolescent sport. For example, environment (E), has been shown to have a significant impact not only on an athlete’s success, but on their perceptions of stress during competition

(Kristiansen & Roberts, 2010). Competitive venues provide multiple opportunities for social comparison (Hoar et al., 2010). Also, within the sporting environment, organizational factors that allow insufficient recovery time between events increase stress for young athletes (Capranica &

Millard-Stafford, 2011). The climate where the competition takes place, i.e., extremes of heat and cold, in addition to issues of housing and bus schedules during competitions, impose additional stressors (Kristiansen & Roberts, 2010). Also important in the environment is the availability of social support from both teammates and coaches, which appears to be more essential the younger the athlete (Kristiansen & Roberts, 2010). An athlete’s unique personal attributes (P), which include age (Kristiansen & Roberts, 2010), gender, (Grossbard et al., 2009), personality, and disposition can affect a child’s or an adolescent’s experience in sport (Harmison, 2006).

An athlete’s behavior (B) is influenced by her appraisal of experiences that occur

within the competition setting (Harmison, 2006; MacNamara et al., 2010). The ability to

cope with adversity is paramount, and psychological skills such as positive thinking, imagery,

goal setting, planning, and pre-performance routines can have a positive effect on athlete

performance (Harmison, 2006; MacNamara, et al., 2010). In the framework of SCT, there

is an ongoing synergistic relationship between an athlete’s environment, personal factors, and

behavior (Denham, 2009). Within this framework people have the ability to influence, or

exert control over their lives, which Bandura calls human agency (Bandura, 2001; Denham,

2009). For example, psychological skills can be taught to young athletes through

cognitive- b ehavioral interventions (Harmison, 2006). Human agency is a function of

reciprocal triadic determinism (Harmison, 2006). It should be noted also that the very

process of triadic determinism instills a sense of movement, interaction, and overlapping of functions. Within SCT, the concept of human agency is of paramount importance, and is described by Bandura as “the essence of humanness” (Bandura, 2001). Human agency explains in greater detail the personal, behavioral, and environmental factors associated with triadic reciprocal determinism. According to Bandura (2001), agency is the willful action of an individual to influence or exert control over their life.

The Cognitive Affective Processing System. The cognitive-affective processing system (CAPS), is a modern theoretical framework in psychology that combines SCT with elements of Freud’s understanding of neural connectivity and behaviorism (Bargh & Ferguson,

2000; Tryon, 2009). The CAPS theory embodies Bandura’s view of personality as product of triadic reciprocal determinism (Shoda & Smith, 2004) where an individual’s personal characteristics, their environment, and their behavior influence one another (Shoda & Smith,

2004); however, it also integrates and expands on Bandura’s concept of human agency

(Bandura, 2001). The model demonstrates the interaction of a person within their environment and illustrates how behavior is not only an outcome of an interaction between a person and their environment, but also is integrated into their personality. The CAPS theory takes into consideration human differences based on genetics and physiology (Smith,

2008). It also focuses on the interaction between a person and their environment, and how resultant behavior is integrated into behavior signatures (Smith, 2008).

Key Elements of CAPS. The primary elements of the CAPS system are cognitive- affective units, which are essentially personal attributes that an individual brings to a situation or an environment (Shoda & Smith, 2004). These cognitive- affective units include personality traits and sensitivities, and unlike other personality theories, also include an

individual’s interpretation of themselves, their situation, their goals, values, expectations, competencies, feeling states, experiences, and memories (Eaton, South, & Krueger, 2009;

Shoda & Smith, 2004; Shoda, Tiernan, & Mischel, 2002). Cognitive-affective units can become activated by internal or external stimuli, and are particularly important for self- regulation (Shoda et al., 2002). The sensitivity of behavioral units to stimuli are unique to an individual, depend on the psychological issue being processed, and are inhibited or stimulated by other units (Shoda et al., 2002; Smith, 2006). Within an individual’s social world, repeated unit activation creates a unique, stable pattern of behavior called an “attractor state” (Shoda et al., 2002). Shoda et al. (2002) believe that a person’s responses to external and internal stimuli may be stable across situations, however the behavioral output from one situation to another will vary in ways that are frequently predictable, which Smith (2008) calls a “behavior signature”. Personal attributes, or cognitive-affective units, are divided into six categories labeled encodings (Enc), expectancies (Exp), values (V), goals (G), affects (Aff), and behavior (B) (Smith, 2006). The Encoding unit (Enc), is perhaps the most important of the cognitive-affective units because it is responsible for the process of identification that triggers the response of other cognitive-affective units (Shoda et al., 2002). Encoding sets in motion multiple feedback loops releasing a stream of multiple responses to stimuli in the form of thoughts, feelings, and behaviors (Shoda et al., 2002). The stimuli that individuals respond to, and the extent to which they focus on it, is based on the psychological meanings of situations that they have acquired through their lifetimes, in what Smith (2006) calls a learning history.

According to Shoda, Tiernan, and Mischel (2004), a person’s network of cognitive-affective units, and the way they influence emotions and behavior, is a reflection of their culture, or subculture (Shoda et al., 2002). One of the most powerful encodings consists of how

people view themselves, including their views of self-efficacy (Smith, 2006). It is by this mechanism that an adolescent may identify herself as an athlete, and then, consequently, have great difficulty seeing herself in any other roles if she can no longer compete (Smith,

2006). An athlete’s identity is linked to future goals, and is a strong predictor of how she handles athletic successes and failures (Smith, 2006). Failure to achieve this identification can add to stress, leading to injury, illness, and reduction or complete cessation of involvement in sport (Bergeron, 2010; Capranica & Millard-Stafford, 2011; Grossbard et al., 2009; Kutz &

Secrest, 2009). According to the CAPS theory, therefore it is reasonable to say that the way an athlete responds to stress is strongly related to the interactions of her cognitive-affective network, which includes elements of their learned history, values, and goals, etc. (Smith,

2006). Encodings naturally lead to athlete expectations (Smith, 2006).

Gaps in Knowledge

It is well accepted by researchers and theorists that there may be an inordinate amount of stress placed on adolescents who participate in competitive sports (Holt et al., 2009; Malina,

2010; Staurowsky et al., 2015). There are many researchers who believe that the process in which talented adolescent athletes are trained for a future in sports is frankly hazardous to their physical and mental health (Bergeron, 2010; Malina, 2010). The majority of research concerning this issue is quantitative (Tamminen & Holt, 2010). This kind of research, while valuable, does not allow a complete picture of this phenomenon.

Children’s participation in structured sports occupies the highest percentage of their out- of-school time, and yet is one of the least understood childhood activities (Harrist & Witt, 2015).

Boys’ and girls’ teams are highly competitive, and the goal is winning (Harrist & Witt, 2015).

Research has shown that not all adolescents have a positive experience in sports, however

(Harrist & Witt, 2015). In order to fully understand adolescent competitive female athletes, their

voices need to be heard through their lived experiential stories.

The purpose of this research, therefore, is to better understand the lived experience of high school girls who are participating in competitive sports. Obtaining a more comprehensive meaning of the lived experiences of high school competitive female athletes allows healthcare providers, including nurses, a more balanced approach when dealing with this meaning of the lived experiences of high school competitive female athletes. It might be that for one athlete distress and pressure to compete on a varsity cross-country running team is problematic; however, the attention and the accolades she gets from friends and family, having her name in the newspaper, and being scouted by prestigious universities makes up for all of the painful stress she experiences before each race. By interviewing individual athletes about their lived experiences in competitive sports, nurses and other providers will be able to find out more about their experiences and discern more accurately what may be problematic for them as individuals.

CHAPTER THREE

RESEARCH DESIGN AND METHODOLOGY

Introduction

Adolescence is a formative period of time for both males and females. Research suggests that many of the habits and lifestyles developed during adolescence tend to remain into adulthood (Wall et al., 2011). This makes it important for parents, teachers, coaches, and healthcare providers to understand the environment that is influencing and shaping children. As they become adolescents, children spend more time at school, many times because they are participating in extracurricular sports. People want to believe that childhood participation in sport is a healthy activity; however, as Harrist (2015) reports, there can be problems associated with competitive sport such as hazing activities, violence, and “contextual pressures.” These occur in relation to the highly competitive nature of sports, and the fact that sports are frequently used as a vehicle for social mobility by children (Bergeron, 2010; Harrist & Witt,

2015). Schubring and Thiel (2014) describe situations where sport socialization and excessive physical training collide with normal adolescent maturational processes, such as hormonal and musculoskeletal changes, to create conditions that are unsustainable for the young athlete, both physically and psychologically.

Female athlete participation in competitive sports differs from male participation in areas such as physicality, developmental outcomes, and negative experiences (Harrist & Witt, 2015;

Schubring & Thiel, 2014). Research indicates that the short- and the long-term consequences of

these experiences for female athletes can cause negative peer interactions (Tofler & Butterbaugh,

2005), decreased memory and learning, increased athlete stress, increased risk for anxiety and depression (Frodl & O'Keane, 2013), and a two to five times higher risk for physical injury

(Nipert & Smith, 2008). Competitive stress, anxiety, and injury have been shown to be linked to a reduction of enjoyment in sport by children, as well as reduced athlete performance, both which are key predictors of athlete attrition (Bergeron, 2010; Grossbard et al., 2009).

Statistics show that the numbers of both boys and girls participating in sports is declining; however, this decline occurs earlier in girls, starting at ages 10 to 11, and ages 14 to 15 in boys

(Camhi et al., 2011; Makinen et al., 2010; M. Sharma & Nahar, 2018; Slater & Tiggemann,

2011; Wall et al., 2011). Girls are consistently less physically active than boys through grade school and adolescence (Kirby et al., 2012; Slater & Tiggemann, 2011; Wall et al., 2011). There is evidence that girls who quit sports in childhood and adolescence continue to be physically inactive as adults (Greenleaf et al., 2009), thereby placing girls and women disproportionately at risk for obesity, Type 2 diabetes, cardiovascular disease, osteoporosis, cancer, mental illnesses such as depression and anxiety, and slowed academic achievement (Slater & Tiggemann, 2011;

Staurowsky et al., 2015; Wall et al., 2011).

Research has thus far provided valuable information to coaches and healthcare providers about child and adolescent participation in sport; however, we have limited information about how young athletes interpret their own competitive experiences (Harrist & Witt, 2015; Thatcher

& Day, 2008). Such information could be very helpful for parents, coaches, and healthcare professionals providing care for the young athlete. To uncover the meaning of the stories young athletes might impart about their athletic experiences, nurse researchers could consider using the

“aesthetic ways of knowing,” which encourages the nurse to view situations in a holistic and

unifying manner and invokes imagination and creativity into the search for new information

(Johns, 1995; Sorrell, 1994). Aesthetic nursing research involves discovery through engaging with research participants, interpreting their experiences, and envisioning future possibilities and interventions (Sorrell, 1994). In 1978, Barbara Carper identified four distinct “ways of knowing” in nursing: empirical, ethical, personal, and aesthetic ways of knowing (Johns, 1995).These ways are based on Florence Nightingale’s extensive writings about nursing as an art and a science

(Clements & J, 2006; Johns, 1995; MacMillan, 1994; Selanders & Crane, 2012).

There is a natural fit between the nursing aesthetic way of knowing, and qualitative research design (Mackey, 2005), which provided the incentive for its use in this research study.

The investigator seeks to understand adolescent girls’ lived experiences competing in high school competitive sports. Qualitative research designs are particularly helpful in understanding the experiences of populations and small groups of people (Sorrell, 1994).

Heideggerian Phenomenology

Heideggerian phenomenology is the methodology of choice for this research. This methodology was chosen for several reasons. Heideggerian hermeneutic phenomenology views the human being as a changing, ever-evolving individual (Guignon, 2012). The process of living, according to Heidegger, is like the opening of a storybook, starting at birth and constantly evolving until death (Guignon, 2012). Characteristically, Heideggerian methodology insists that the research include pre-existing bias and assumptions of both the researchers and the participants (Guignon, 2012). The methodology is inherently descriptive, considering every human action meaningful and value laden. As such, it provides science with a “fresh”, or new, perspective on the phenomenon of study (Guignon, 2012). Heidegger based his phenomenological approach on several concepts: that of epistemology and Dasein, translated

literally as “being there.” In this study, female athletes respond to what they perceive happening in their lives and what takes prominence. This is what Heidegger referred to as Dasein in the lives of these athletes. It is this lived experience, which informs this research.

Edmund Husserl initially informed phenomenology in 1916 (Bakewell, 2016). Husserl’s philosophy was fundamentally epistemological, meaning that as a phenomenologist, he was interested in the development of knowledge about what he referred to as “things” (Bakewell,

2016). Husserl and researchers were encouraged to clear their minds of pre-existing assumptions, or knowledge about the things in question and put them aside in their brain, or ” bracket them,” so as not to interfere with the efforts of the research at hand (Mackey, 2005). It is important to note that Husserl’s phenomenology served only a descriptive function, without interpretation

(Mackey, 2005). Herein lies the difference between Husserl’s early phenomenology and

Heideggerian hermeneutic phenomenology, which began developing in the early 1920s and 30s.

Heidegger’s philosophy is ontological, meaning he sought to understand the meaning of

“Being in the World” (Mackey, 2005), or, as applied to this research, the meaning of being a female member of a high school cross-country running team for at least one season. Heidegger believed that research participants cannot be separated from the world around them, so their current interactions with the researcher’s previous experiences and her assumptions must be taken into consideration during the research process (Mackey, 2005). Mackey (2005) describes

four concepts related to Heidegger’s philosophical phenomenology, which include being in the world, fore-structures, time, and space. For Heidegger, a key component of understanding Being in the World is the concept of Dasein, which is difficult to interpret from German, but is loosely translated to mean “being there,” or the idea of the self in everyday life (Bakewell, 2016;

Mackey, 2005). Dasein includes authentic everyday activities and provides explanatory access to

Heidegger’s primary philosophical work (Mackey, 2005). Heidegger believed that people and the world are inseparable; consequently, neither entity can be considered as an isolate (Mackey,

2005). Significant to being and time is the ability of the participant to have introspection, a human activity which is also part of the concept of Dasein (Mackey, 2005). Dasein also involves diverse moods experienced by people, including boredom, anxiety, and even oppression. Dasein therefore includes literally all day-to-day interactions between a person and the world they inhabit.

Fore-structure for Heidegger includes all the awareness that researchers and their participants bring to the hermeneutic research process. For example, a participant may have a good understanding about why an event occurred because she has had similar events occur in the past. The researcher listens to the participant’s narrative and utilizes this information in her holistic presentation of the data (Mackey, 2005). This new understanding can be communicated among committee members and evaluated for accuracy (Mackey, 2005).

Time is a major integral component of Heideggerian phenomenology (Mackey, 2005).

Everyday living in this world is temporally based (Mackey, 2005). Dasein, and our belonging in the world requires grounding in time (Mackey, 2005). Time provides the structure in which people can reflect on their being. Heidegger believed that the things that we study stand out on a linear timeline, and how things are situated on that timeline can enhance the description of their experience.

The final component of Heideggerian phenomenology is spatiality (Mackey, 2005).

Spatiality reflects the Heideggerian researcher’s obligation to discuss with the participant information which is “close” in their foreground, or most important to them. The researcher will also listen to the participant’s narrative about experiences which seem less pressing and are more

remote, but which still hold a place in the background of a participant’s consciousness (Mackey,

2005).

Application of Heidegger’s Philosophy to Research

Heidegger did not develop a specific methodology which can be used with his philosophy

(Mackey, 2005); however, he did give some hints as to how he believes the research process should flow (Mackey, 2005). The objective of Heideggerian research is to understand Dasein

(Being), or the lived experiences of the participants being studied. This occurs through hearing and interpreting relevant, uncritical accounts of Dasein in everyday lives (Mackey, 2005).

Typically fore-structures are uncovered and included when describing Dasein (Mackey, 2005).

This process produces an intense, rich, unbiased description of the participant’s reality as it is communicated to the researcher and followed by interpretation (Mackey, 2005).

The use of phenomenology, including Heideggerian hermeneutics, has become more popular among nurse researchers; primarily because of its ability to reflect the lived experiences of patients receiving medical care (Mackey, 2005). For example, Janice B. Clarke (1999) studied six adults with motor neuron disease (MND), six lay caregivers, and nine professional caregivers. This research explored the question, “What are lay and professional values of care in the context of motor neuron disease. and are there any differences between lay and professional care?” Ultimately, this research revealed two major categories, personal struggles and personal control, which were achieved through a process of clustering individual categories. These categories were obtained through the use of Heideggerian hermeneutic analysis, which started with the principle investigator (PI) reading and re-reading the written transcripts of the participant interviews in order to fully understand the participant’s world (Clarke, 1999).

Each team member also reads transcripts of the interview prior to the committee meeting with the goal being to search for patterns and themes (Vandermause & Fleming, 2011). The interpretive team also discusses each member’s interpretations of the interview texts. In the

MND research above, common themes included protecting self and others, forced life changes, importance of personal control, need for a sense of control/changes in relationships, strength from purpose, and personal struggles, (Clarke, 1999). It is the iterative flow of partial to more full information that creates what Heidegger calls the hermeneutic circle (Mackey, 2005). The PI is responsible for maintaining a list of all developing patterns, themes, and other issues associated with data collection for this research. This study reveals important information for nurses caring for patients with MND. For example, in developing a nursing care plan for the patient with MND, it is important to allow them as much control as possible over their environment and self-care, particularly early in the disease process.

Another example of how the Heideggerian research methodology benefits nursing is a study done by Ghada Abu Shosha with 22 Jordanian adolescents undergoing chemotherapy for cancer. This research explores the meanings of physical changes and body image resulting from chemotherapy for cancer. The use of Heideggerian hermeneutics allowed the nurses to understand the meaning of the “lived experience” of an adolescent undergoing chemotherapy

(Ghada, 2010). Each research participant was interviewed in an unstructured, conversational manner for 45 minutes to one hour. The interviews were transcribed, and each member of the research team read and interpreted the interviews. During research team meetings, discussions centered on respective team members’ interpretations of the interviews, and common ideas, clusters, and themes were sought through the Hermeneutic approach to data analysis

(Vandermause & Fleming, 2011). Four final emergent themes developed as a result of several

first and secondary thematic clusters. These included awareness of deteriorating physical changes, psychosocial impact and effects, coping strategies, developing and supportive structures (Ghada,

2010). This information is very helpful to nurses caring for young patients in chemotherapy because they can prepare the adolescent for the possibilities of problems and be proactive in terms of comforting the young patient, recognizing that this treatment is not only uncomfortable physically, but psychologically as well.

Sample

Purposive sampling was used in this study because it allowed the researcher to choose participants that would best fulfill the needs of the research (Patton, 2002). According to Glaze

(2001), by maximizing the ability to select research participants, the researcher has the potential to gather rich and insightful information about the research phenomenon being studied. The inclusion criteria for this research was that each participant be a full-time member of a high school cross-country running team and be enrolled in grades 9-12 in the school, or ages 14 to 18 years old. A sample of 10 female students was recruited with one-third consisting of varsity level runners. The involvement of varsity athletes ensures that the highest level of competition is represented in the sample.

The setting for this research was an urban high school in the state of Washington. This school was chosen because of the researcher’s familiarity with the coach and the school.

According to Creswell (2007), when children are the participants of research, it is particularly helpful to have an adult who works for the school or agency function as a go-between of the researcher and school or agency administration. In this study, that key individual was the girls’ cross-country running coach.

After the WSU IRB approved this research, recruitment began at the first

girls’ cross-country meeting, where girls interested in participation met with the coach and discussed plans and issues associated with the upcoming season. The researcher introduced herself at this meeting and informed the girls about the study and the need for participants. Those interested in participating in the research were given both child assent and parent consent forms and were asked to return these signed to the coach, who will then pass them on to the researcher

(Appendices A & B). The researcher attended a second, routinely scheduled meeting by the coach with the parents of the athletes. This was a parent information meeting where the researcher introduced the research and its aims. The researcher made herself available to the parents after that meeting as well. The parents and athletes were assured that participation in the study was not required in order to join the cross-country running team, and there would be no preferential treatment to those who do participate, nor discrimination to those who choose not to participate. Additionally, if they decided to participate, they could withdraw at any time without penalty. The researcher distributed assent and parent consent forms during this meeting

(Appendices A & B). To be available to potential research as well as answer questions, the researcher attended the first three weeks of team practice and competitions. Initially, a period of two weeks was the goal for the collection of consent and assent forms from the athletes.

Ultimately, however, more time was needed in order to collect all of the needed paperwork.

Data Collection

Data collection began mid-cross-country season, which is in early September. Data was collected through the use of the Hermeneutic interview. This interview style had its beginnings in Greece and Biblical times, where it was used to interpret the Bible and other sacred texts

(Vandermause & Fleming, 2011). The Hermeneutic interview is unique to other forms of qualitative interviews in that it is grounded in Heideggerian phenomenology (Vandermause &

Fleming, 2011). According to Vandermause and Fleming (2011), there are four characteristics of a philosophical hermeneutic interview: 1) Setting the tone of the research; 2) Using incomplete sentences; 3) Looking for assent, and; 4) Returning participant to the story. The goal of the

Hermeneutic interview is to elicit a story of the participant’s lived experiences regarding a certain phenomenon. The exchange between the researcher and the subject is relaxed and conversational where, during the conversation, researchers will attempt to understand not only the events, but the feelings and deep emotions associated with these events (Vandermause &

Fleming, 2011). According to Vandermause and Fleming (2011), how the interview question is phrased has a major impact on how much information is obtained from the interview. Using an interview approach that asks the participants to tell a story about their experiences works particularly well in Hermeneutic interviews. Vandermause and Fleming (2011) call this “setting the tone of the research.”

In preparation for their interview, athletes selected a pseudonym to represent themselves for the purposes of maintaining confidentiality. This pseudonym was used in all of the documents associated with the research. The only document that contains the athlete’s real name is the child assent form, which was kept in a secure file cabinet in the principle investigator’s locked office. Guided by a simple research question, the researcher recorded the athlete’s average “everydayness,” or Dasein, which led to an understanding of their being-in-the-world relevant to the research question (Mackey, 2005; Vandermause & Fleming, 2011).

The interview question for this research began with the introduction, “I am a nurse interested in the experiences of high school athletes engaged in competitive sports.” This was followed by, “I am interested in your personal experience. Is there a memory or an experience you can share?” In addition to appropriately framing the interview question, the researcher was

an active listener, paraphrasing statements when understanding is unclear, and remaining open to the athlete’s story (Vandermause & Fleming, 2011). During the interview, the researcher utilized incomplete sentences to encourage continued discussion and to redirect the interview when the subject’s disclosure became distracted (Vandermause & Fleming, 2011). The investigator was seen as a facilitator and co-creator of the narrative text by posing questions to the participant that kept the interview moving along, yet deeply reflective of the participant’s involvement in the phenomenon (Vandermause & Fleming, 2011).

The interviews were tape-recorded and then professionally transcribed for analysis. Voice recordings and transcripts were kept on a secure WSU, HIPAA-compliant SharePoint website.

The only individuals who have access to these de-identified computer files will be members of the research team and select graduate students involved in qualitative research at Washington

State University Graduate Programs. The interviews lasted 30 to 45 minutes and were held in the coach’s classroom after school. Audio-recorded interviews will be destroyed after the completion of the investigator’s final dissertation examination. While the results of this research may be published or presented in professional meetings, the identities of the participants will remain anonymous. All data will be destroyed after completion of the research. As a thank you for participating in this study, each participant received a $5 Amazon gift card and a certificate stating that they participated in this research study.

Competitive sports can at times be stressful, particularly when there are losses in competitions and problems with relationships among team members and/or with the coach.

There are also joyful, fun times. All of these experiences generate emotions, which may at times be difficult to discuss. There are some things that may surface during the interview for which the researcher is obligated to report by law. The coach will also necessarily be involved in all

decisions regarding the wellbeing of the athlete, as she is legally responsible for them while they are in a school-sanctioned activity. This would include the athlete threatening suicide or threatening to harm somebody. Counselors are generally available to students during school hours, so the student will be referred to the school counselor immediately. If the school counselor is not available, a discussion will ensue regarding the involvement of the athlete’s parents. Ideally, the student’s parents will come to the school and take her to the ER for a suicide evaluation and the establishment of intensive outpatient mental health services. If parents or guardian are not available, and after consultation with the coach, the PI will contact EMS to transport the student to the ER. The PI will stay with the student throughout the EMS waiting and transport process and will help get the student safely established in the ER before the PI departs.

Additionally, if the adolescent reports that she is being physically or sexually abused at home, appropriate authorities will be contacted to ensure her safety, which is paramount.

Regardless of the level of abuse, it cannot be assumed that the student will be safe upon returning home, even for the time it would take to make a referral for support. Police and Child Protective

Services must, by law, be contacted. The police and Child Protective Services will be contacted, and the PI will stay with the student at the school until they arrive. Fortunately, during this research, there was no reason to require activation of the emergency mental health system, or referral to Child Protective Services.

Data Analysis

After several interviews were obtained, they were sent to the transcriber for dictation.

After the dictation, the transcriber put the interviews in a restricted, safe file on the College of

Nursing’s SharePoint computer network. Data analysis began after the principle investigator

received the transcribed interviews. Members of the data analysis team are asked to access these files and analyze the interview texts. An interpretive committee composed of three members, two who have had experience in Heideggerian phenomenology, one of whom is an expert, and one who is interested in learning Heideggerian phenomenology, performed the analysis. According to Vandermause (2011), data analysis occurs in the following steps:

1. Reading the entire transcript carefully start to finish.

2. Re-reading the text line by line.

3. Making notes about ideas and concepts that stand out.

4. Reviewing notes and observing the general categories while noting frequency of

related ideas, position in the text, response to interview questions, and style of

response

5. Devising a rudimentary list of emerging patterns of ideas.

6. Reviewing transcripts with these general patterns in mind.

7. Naming patterns of ideas.

8. Writing a summary of the transcript with enough detail or support to convey a

plausible and coherent expression of findings. Included in this summary is a

retelling of the account and/or interpretive commentary.

Each member of the interpretive team began with one transcript, reading and re-reading the text, and then wrote out their interpretations in order to obtain a deep, sometimes emotion- laden understanding of the participant’s lived experiences (Clarke, 1999). It was important that the researcher and all members of the interpretive team reflect on their own personal experiences and their understandings about the phenomenon being studied, which Heidegger called the forestructure (Greatrex-White, 2008). According to Heidegger, the past experiences and beliefs of

the interpretive team naturally had the potential to become part of the meaning of the phenomenon and could become visible during the interview. Heidegger embraces fore-structure as a part of his methodology, which contrasts with the legacy of Edmund Husserl, and the bracketing of personal experiences (Greatrex-White, 2008).

The interpretive team met as a group and we discussed our interpretations of the interviews, looked at their context, intention, and possible meanings embedded in the text as per the procedure identified by Allen-Collinson (2009). We identified, insofar as possible, our own thoughts, feelings, and biases about the interview content. The interview, reading transcripts, identifying patterns, and interpretive commentary are an iterative process and represent what

Heidegger calls a “Hermeneutic circle.” According to Guignon (2009), in order to understand humans through the use of Hermeneutic inquiry, people inevitably become “trapped in a circularity,” which enables continued knowledge and inquiry (Guignon, 2012). The Interpretive team together engages in a dialogic process about the individually transcribed interviews and is thus able to certify the iterative process as reliable and free from personal bias. The analysis in this research proceeded in this manner until all of the interviews had been processed. Finally, the committee looked for shared meanings, themes, exemplars, and developed an interpretive summary (Crist & Tanner, 2003).

Evaluation of Rigor and Trustworthiness

Evaluating the quality of phenomenological research is very different than evaluating the quality of quantitative research. For example, reliability cannot be assumed because phenomenological research involves studying the personal journeys of people in their daily lives, the content of which is neither reliable, stable, nor consistent. Patton (2002), however, believes that a close parallel to reliability in phenomenology is “dependability.”

Validity is a term that can be used to describe both types of research; however, it describes different things for each design. Validity in quantitative research means that the data collection instrument is precise and that it measures accurately what it is intended to measure

(Annells, 1999). Additionally, valid quantitative research must be generalizable, which is in sharp contrast to phenomenology, which is neither concise nor generalizable. (Annells, 1999).

For phenomenological research, Creswell (2007) describes validity as “trustworthiness”, as evidenced by spending large amounts of time with the participants, producing detailed descriptions of experiences and events (Creswell, 2007). Trustworthiness is considered a parallel to rigor (Patton, 2002).

Rigor appears to be the one research criteria that could be used to evaluate all phenomenological nursing research (deWitt & Ploeg, 2006). This is very controversial, however. deWitt and Ploeg (2006) believe that the utilization of their framework, “expressions of rigor,” could facilitate knowledge transfer, assist funding agencies and publishers, and help bring together a body of knowledge which previously was inaccessible due to lack of database and keywords.

Nurse researchers utilize different types of phenomenology to study the nature and the meaning of patients’ experiences (Annells, 1999). They have not, however, had a consistent framework for evaluating the quality of phenomenological research (deWitt & Ploeg, 2006).

Utilizing evaluation criteria developed for generic qualitative studies restricts the amount, and type of information obtained from phenomenological studies (deWitt & Ploeg, 2006). However, developing evaluative criteria specific to phenomenological research is controversial, with some researchers believing that the creation of any type of system creates obstacles to freedom and restricts the expression of phenomenological research (deWitt & Ploeg, 2006).

After a lengthy review of published nursing research where interpretive phenomenology was used as the methodology, deWitt & Ploeg (2006) found that the expression of rigor was a satisfactory measurement of quality in phenomenological research. The evaluation of rigor presented by deWitt and Ploeg (2006) consists of five parts: balanced integration, openness, concreteness, resonance and actualization. Balanced integration occurs when the philosophical basis of the study can be seen through the study of participants’ voices. The participant voices and the research methodology become intertwined with each other (deWitt & Ploeg, 2006).

Heideggerian phenomenology allows for the use of subject quotes as data, which in turn fosters deep understanding of the subject and the phenomenon under study. The quality of openness in phenomenological studies reflects the degree to which research procedures and decisions can be seen and understood by the reader (deWitt & Ploeg, 2006). Concreteness reflects the ability of the research to be communicated clearly to readers in a manner that they can understand the lived experiences of the research participants (deWitt & Ploeg, 2006). Resonance describes the ability of the research to create an emotional response in the reader (deWitt & Ploeg, 2006). The property of actualization may occur if the reader sees implications for the future in the research

(deWitt & Ploeg, 2006). This property is difficult to evaluate in phenomenological studies because it can occur in the future; theoretically, any time the research is read by an interested individual.

Human Subjects Review

The Human Subjects Review Board, or IRB, must approve all research involving human subjects at Washington State University (WSU). The purpose of this policy is to protect subjects from both physical and psychological harm during the research process. Because this research involves working with adolescent children, their protection is of utmost importance. The WSU

IRB approved this research. The purpose of this research is not interventional; however, the adolescents in this study may benefit from this research indirectly because of the nature of the research. The interviews are not meant to implement a therapeutic modality. However, by talking and sharing their experiences, both positive and negative, they may be perceived as therapeutic by some participants. In so doing, these activities may help the adolescent learn effective ways of coping with stress.

CHAPTER FOUR

RESULTS

Background and Demographics

This study took place at a large public high school which enrolls approximately 1600 students. In athletics it qualifies as a 4A school, competing with some of the larger, more competitive schools in the state. During the cross-country running season, it also competes with local schools, some of which are smaller in size. This schools’ girls’ cross-country running team was selected because of the principle investigator’s familiarity with the coach, and the school.

The head coach is an experienced runner, having been a cross-country runner in high school and a competitive runner as an adult. Female runners were selected because girls typically drop out of races sooner than girls.

Historically, this girls’ cross-country running team has a reputation of being fierce competitors not only locally, but in the region and state. Between the years of 1983 and 2000 the team placed consistently in the state competitions in the top ten places. More recently, in 2010 the team placed eighth in state, and in 2015 they placed ninth. Every year there are individual runners from the girls’ cross-country team who qualify to run at the state meet. Having the opportunity to compete at the state level is considered a great accomplishment by all of the high school runners. As mentioned in the literature review, there are a multitude of reasons why girls initiation and continuation in sports is occurring, and these findings may contribute to the changing competitiveness of the girls in this school.

Ten female competitive athletes from a local high school girls’ cross-country running team were selected for interviews utilizing a purposive sampling method. Grades of the participants ranged from freshman to seniors in high school, ages 16-18 respectively. There was

some limitation on the selection of the girls for the interviews based on time and their availability. For example, it was difficult to get interviews with the varsity runners due to their training schedules. This interview sample therefore includes four varsity runners, and six junior varsity cross-country runners. Two of the varsity runners interviewed are twins. One girl was injured, which allowed interview time during practice. The other two varsity runners made time after practice for the interviews. An important goal of data collection was that the research activities not interfere with the girl’s education and training schedule.

Table 1. Summary of Demographic Information of Runners

N=10 Age in years Grade Competition Level 2 16 Freshmen Varsity

1 17 Junior Varsity

1 18 Senior Varsity

6 15-18 Freshmen-Junior Junior Varsity

Contextual Information

A factor important to the culture of running is the recruitment of girls for the cross- country running team, which begins in the spring. The coach and the senior runners visit the middle school that feeds into the high school, to talk to girls who have expressed an interest in running in high school. Additionally, the coach attends the freshman open house in the spring and attempts to pick up a few more interested participants. All of the new girls, including transfer students, are invited to the summer cross-country camp which is an opportunity to meet and bond with fellow teammates, and begin the training process. This is a particularly important time for

freshmen and transfer students because they have an opportunity to develop a support system, and a group of friends by the time school starts in the fall. Approximately 40-50 girls comprise the cross-country team after the first couple weeks of practice. There is one head coach, and two assistant coaches.

Determining racing levels for competition is also an important aspect of team culture.

This involves the selection of girls to run on the varsity, junior varsity, and freshman squads for the first race in the fall. This selection is based on a cross-country race called the Blue and Gold

(team colors). Half of the team is randomly chosen to be on the blue team, and the other half is on the gold team. The girls paint t-shirts, wear hair ribbons, and cheer for their teams. The fastest girls through the course from either team are the varsity runners, and the rest are junior varsity, or freshman runners, based on their age. It is understood by everybody however that membership on the varsity team is fluid and can be joined by any runner with the fastest time in any of the races. If a new member (including a freshman) has a faster time than the slowest varsity runner, that runner gets bumped down to JV status, and is replaced by the faster runner. This can be stressful for the runners, particularly if they are used to running on the varsity squad. There are generally seven members on a varsity team, and one or two alternates that practice with the varsity squad in case there is an injury or an illness.

Common Structures and Themes

Interpretive phenomenology was chosen for this methodology because after exhaustive research, nowhere could we find the “voices” of the female high school athletes. We wanted to access the lived experiences of these girls through interviews, thereby attempting to understand their experiences as cross-country runners. Additionally, it was hoped that through interpretive

phenomenology, we could learn how to support these athletes both physically, and psychologically. Data analysis began with the interpretation of the interviews by the four interpretive team members. Each committee member read and re-read the interviews and wrote an interpretation for each athlete. Included within each member’s interpretation was what

Heidegger called the forestructure, or their own understanding of “being-in-the-world”

(Greatrex-White, 2008). The forestructure is impacted by an individual’s unique personal and social relationships, as well as their culture. Heidegger emphasized the importance of including forestructure in the interpretive process, as this was the only way to insure openness, and dialogue among researchers (Greatrex-White, 2008).

Through an intense discussion, and iterative process, committee members identified two overarching structures that ran through all of the athlete interviews. According to Greatrex-White

(2008), structures are entities that help shape our lives (Greatrex-White, 2008). Structures can include social organizations, social classes, or discourses, that help shape and define our lives.

Within the girls’ cross-country running team two overarching structures, or patterns were identified; The Culture of Running, and Approval and Attention from Others. These patterns, while they were identified as common among all athletes involved in the study, contained some elements that were different for each athlete because they represented different social contexts, personal history, and ways of “being -in-the world”. Nevertheless, the research team concluded that these patterns were sufficiently similar, to describe what it is like to be a member of a female cross-country running team in a highly competitive public high school in Washington State.

These patterns remained consistent between both varsity and junior varsity athletes, despite age and small sample size.

The first overall pattern was the culture of running. This pattern was easily identified by the way the athletes talked about bonding with their peers, even those they have never met, just because they are runners, and “people think we are crazy”. They are united by the pride in the difficulty of their sport and are quick to recognize each other when others don’t. It is easy to see why the second overall pattern is so important.

The second overall pattern was approval and attention from others. This pattern was exemplified by how much the young athletes enjoyed being recognized by their coaches, their teachers, their parents, teammates, and friends. It could be seen by the way they encouraged each other during the races, and the caring attitude they had when a teammate was sick crossing the finishing line. At home it was exemplified by their parents when, for example, they got out of doing chores because they ran a large number of miles that week.

Within the overarching pattern of the culture of running, the interpretive team was able to clearly identify three common themes. These included: being part of a team, the physiological effects of running, and the psychological effects of running. Through further iterative discussion, additional themes were identified under the pattern of approval and attention from others. These common themes include approval from friends/teammates, from family/parents, from coaches/teachers, and from culture and community. The following section will describe these themes in detail.

Pattern 1: The Culture of Running

Common theme 1: Being part of a team.

For girls participating in cross-country running, being part of a team means that they share the ability to do something very difficult together. They describe their relationships with each other as a “sisterhood”, regardless of whether they are running in varsity, junior varsity, or

freshmen squads. Running 30-50 miles a week for training, and racing approximately 3.5 miles a week, in sometimes rough terrain, is hard on their body, and often painful. The girls develop respect for each other because it is a difficult sport.

Megan: “And it’s just like-so I have so much respect for other runners because I’m just like you put yourself through that whole entirely and you learn to enjoy it. And like half of my friends are like, I hate running. I would never run. And-there is like- there is like a quote somewhere that it’s like our sport is your sport’s punishment”.

The girls’ cross-country running team, as described by the athletes, is a “positive sport”.

This is because all of the participants and the coaches are always encouraging everybody on.

Penelope: “Because (the coach) kind of molds the freshmen. And then everyone above them gives them a good example of what-this is what being a team member is like. You should treat your fellow teammates like this. And-so she sets the standard”.

The participants on this team make comparisons between their experiences, or their siblings’ experiences playing on the basketball, the volleyball, or the tennis teams at school.

They are impressed by how negative the relationships are among the athletes on these teams, primarily because they are competing for playing time, and trying to stay off the bench, etc.

Penelope: “But everyone-it’s like the school tennis team is so negative. And like some of the girls are nice, but it’s so like cliquey-that it’s-it’s hard cause it’s like in pairs of two and things like that and you’re just like-and everyone’s trying to like get the number one spot or whatever. Like on varsity, it’s-it’s really awful. Yeah. So, like it’s not like –why would you be nice to your competition? That’s your enemy?”

It’s not to say that there is no stress, or competition between the runners when vying for spots on the varsity running squad. Frequently the seventh and eighth, or alternate varsity positions jostle back and forth, depending on the runners’ race times in the previous race.

Paris: “I felt threatened a little bit for most of the season just because I’m a little bit nervous about some of the freshmen. And just like-not in like a, oh, I don’t like them. Just like, oh hey, they’re getting pretty good”.

Not getting onto the varsity team is made a little easier however by the fact that nobody sits on the bench in cross-country running. All of the team participates in the races, with the exception of those who are injured or ill. The participants, whether they are varsity, or otherwise, spend most of their time together, with the exception of when they are racing. The participants cheer for one another during their races, which is described by all as very helpful.

Lilly:” Yeah, it’s fun. Um, like in the races when I’m running-cause like all the girls will be like cheering for me, and I feel like it makes me go faster sometimes”.

Jasmine: “And everybody loves the other people and we’re always rooting for each other. So like if you don’t-I don’t know-you don’t do your best, like they are like, oh I did better than you, or whatever. You know, people are just like oh, I’m so proud of you, you, you did so good.”

AG:” That’s the other great thing about this team, though, is if someone exceeds, everyone’s happy. Like no one is jealous. Like I’m not jealous”

There are plenty of opportunities for recognition, even if you are not running on the varsity team. These include team dinners which are hosted by one of the team members parents in their home, and sometimes team games.

Banana Ramma: “You don’t have to be good. You don’t get cut from this sport. You’re not going to sit on the bench. The only time that we’re not together is when we’re actually running. But we do everything else together. Our meetings are together. Anytime we do team dinners it’s always together.”

Lilly: “Yeah. And it’s cool cause we have a team dinner sometimes, and like those are fun to just go over to someone’s house and eat dinner.”

“Yeah, it’s fun. And then like, you know sometimes we will like play games and stuff. I think it is just to, um, -just do something fun after like a hard workout. And then it’s also like, um, still a little bit of a workout because we were like moving and stuff. And then just to get you closer with our team.”

Banana Ramma:” Even though I’m not the fastest runner, I love being a part of the team. And that’s-again, the most important.” Another aspect of being part of a team for these participants is the acceptance of each

other when one of them is having a bad race, which could be due to, for example, an

illness or an injury. The important thing for these young athletes is that the runner has

tried her hardest.

Penelope: “There’s always a race where for some reason you’ve got a side cramp, or (name) had a stomach ache and she had a bad race, and it was really hard to watch. But everyone just ran with her at the end. We’ve all-had something like what they’re going through.”

The athletes know that functioning as a team does not come naturally, and they respect their coach for her ability to foster this in her team. The expectation for incoming freshmen is that team members “will be nice to each other, and that we all make sure we get through it”.

Senior members of the team, and team captains role model these expectations. The current cross- country running team members believe, however that it is this current mix of girls that make it truly a “sisterhood.” The team dinners, and other fun activities planned by the coach, help to reinforce the team concept.

Penelope: “She (coach) makes it-she forces us to be nice to each other and to support each other and to be a team. But like it’s kind of like a sisterhood-not much of a team. Everyone knows each other. We’re all nice to each other. We all make sure we get through it.

“But I really do think that it’s (sisterhood) is only specific to this team. If there were different girls on it, it wouldn’t be this way.”

“But doing cross-country is-you’ve got to love running and you’ve got to love the team.”

Common theme 2: Psychological effects of running

These participants experience some of the traditional competitive stress athletes experience in any sport, which is frequently anxiety. Some of this is related to fears of injury, or

re-injury, a fear of letting teammates and coaches down, family pressures, and a desire to be considered for college scholarships. The reasons, and the severity of the anxiety appeared to have some variance based on whether the athlete was on the varsity or the junior varsity team.

Becoming injured, either as a result of running, or otherwise, was reported as stressful for the participants. The girls want very much to continue to compete with their teammates, and anything that keeps them from running is stressful. The desire to continue to compete is so strong that sometimes injuries sustained by the participants are hidden from their coach until they are unable to run, this despite the coach’s admonishments. Injured athletes are required to spend lots of time on the elliptical, watching and cheering their teammates on.

Thor: “There’s so many of us, and we call it-hiding injuries from coach. And when it gets to a certain point where it would be like I physically can’t run anymore, then we’ll go and tell her. And she’ll get mad at us.”

Once recovered from the injury and back to practice and competition the fear of re-injury often lingers in the athlete’s mind. Cross-country runners are trained to “push-through” their pain, so there is a natural confusion in their mind about what type of pain is okay to “push- through”, and what kind needs the attention of the coach.

Emily: “Like I hate not running right now because of my shins-like I hate it. It’s just-I feel like it even-like I asked my dad, I was like I feel so useless. Like I feel like this is just a stupid little thing that’s hurting me, but I should be running.”

Since the passage of Title IX in 1972 female athletes have had more opportunities to obtain college scholarships in sports. Paris was the only varsity runner who is college recruitment age and is hoping to obtain a college scholarship for cross-country running. She reported that this was very stressful for her as she has had, in addition to normal recruitment issues, family pressures due to her parents’ divorce.

Paris: “My parents are getting a divorce, and so things are just affecting me a lot differently. And I kind of thought like around the summertime that like maybe this isn’t

what I want to do. But like just because maybe not being near my dad as much has made me feel like-I don’t know. Like, yeah, I’m-yeah, I may be a good runner. Like I might be- like it makes me happy. But like do I want to do this all the time? And I definitely don’t want running to be my life. It’s definitely a part of my life-. And I know that I have always had different aspects of my life like friends and family and running. Those have always been the main three.”

“But I never-like especially now, I’m just seeing like running is only a part of my life. It doesn’t like describe me who I am completely.”

Varsity runners understand that there is a commitment to advance the team into regional, and hopefully state competition. Participants reported that they love competition, however at times it can be tiring. Paris is a junior this year and is reaching what could be the end of her running career, as she thinks about going into college. She is evaluating the place running has in her life.

Paris: “I’m also trying to be-have a little bit more fun with it for myself because it hasn’t been fun for the last few years. It’s just been super competitive. And I get that because this is a very competitive sport. It’s individual, but it’s also team. But like I also want to have fun with it and have a reason to be here. And I know like coach has this serious side, and like that’s fine. But like I’m also trying to be-have a little bit more fun with it for myself because it hasn’t been fun for the last few years it’s just been super competitive.”

Family pressure was also a source of anxiety for some of the athletes. Several of them had two and three siblings who ran cross-country, either during the same years, or during previous years. Many of the older siblings ran at the varsity level, which at times was frustrating for the younger participants who could not reach the varsity level. At least one athlete in the sample experienced parental pressure related to the type of sport she chose to participate in.

Emily’s father coached she and her sister in basketball since they were in grade school. They have their own court at home, so they could practice anytime. Emily decided to run cross- country however, which left her with less time to practice basketball. Emily tries to get out on the court to practice, however it is hard to find the time with school and cross-country practice in the off-season.

Emily: “So, I don’t usually play outside of the basketball season. I mean, we have a sports court, and my dad encourages us to get out there as much as possible. Yeah, kind of nagging sometimes. But, you know? Just a little. But, I mean, he’s always like, go out there. Get on the court. But I don’t know. It’s hard to do this sport and homework and that. So, he understands. He definitely gets it. But I don’t know. I feel like cross-country will help me with basketball, though, because-yeah. Last year it was good.”

Emily is currently a sophomore and played on the JV basketball team last year and hopes to play on the varsity team this year. Her older sister, with whom she has practiced since first grade, has been on the varsity basketball team for the past two years. Emily states that she does experience pressure to be playing basketball with her sister on the varsity team.

There are positive psychological effects of running as well as negative. The participants on the cross-country team enjoy running for many reasons, and surprisingly, one of the most important benefits comes from the fact that it is such a difficult sport. The pride of being able to complete the runs, and compete against other girls increases self-confidence, and is transformative in nature for many of the young athletes.

Thor: “Yeah. Like before cross-country, I wasn’t the most confident and I was kind of negative towards like myself body image and stuff. But I don’t know. After- when I started running, it just was like really cool to see that effect. And my parents saw it and everyone else saw it, too. And everyone was like, wow you are so much happier.”

Many of the girls discovered that participating in cross-country running helps them deal with stress and anxiety, and this is consistent with the literature. After a difficult day at school, a two-hour break running, and visiting with friends provides relaxation before going home to study. Running does not cure their anxiety, but it gives them a break from the anxiety, and helps them learn how to deal with it in a healthy way. Some girls notice other significant changes in their mood as a result of running cross-country. One of the girls in our sample stated that running helped her handle frustration and anger because after she runs, she “doesn’t feel anything” anymore. This same athlete believes that she might be “addicted to cardio”. Cardio generally

refers to intense, aerobic exercise that increases the heart rate, an example of which is running, but could also be any exercise such as kick-boxing or jazzercize.

Penelope: “Yeah, I didn’t really realize how much I relied on running. When I-I don’t know. My mom said I got addicted to cardio. Because as soon as I had to abruptly stop cardio, my moods changed drastically. I just got angry and frustrated at things. It used to be that when I got super angry at something, I’d go on a run. Because after a run, you didn’t feel anything. But I didn’t have that. I couldn’t balance out my hormones. It was just – I was angry all of the time. And I just couldn’t run.”

Perhaps the greatest benefit participation on the girls’ cross-country running team are the attitudes and skills learned that can be used in adulthood. Part of the motto of the girl’s cross- country running team is the importance of positive thoughts. Team members know that “it’s so easy to slip into negative thoughts”. Thinking negatively frequently leads to a bad race, particularly if the athlete is injured, and hurting. Conversely, positive thoughts give them confidence in their ability to finish the race, and accept the results, i.e., their time, or place.

Megan: “Something I’ve learned about running just over high school is like it’s a very mental sport.”

“It’s so easy to slip into negative thoughts. Like start talking yourself down. Because as soon as you start doing that, it’s a bad race. Especially when you are hurting.”

One runner went so far as to say a runner’s mental state is more important than their physical shape because they have to be able to “push through” the inevitable pain of running the course. the following runner believes that a successful athlete is able to understand what she needs to run a good a race. This could mean walking the course the night before the run, to eating a bagel with peanut butter three hours before a race. She has to be alert, and observant in order to find out what works for her.

Megan: “But I don’t Know. When I look at it, like you don’t even have to be in that good of shape to be like a strong runner because it’s all about like being mentally there and like mentally like push through the pain and like get through whatever you have to deal with just on that course. And like I notice even on the bad days like at school,

when I go running, it’s like I’m not as like-I’m not as fast or like I notice pain and more because I’m not in the mental-like the right mental state for running.”

“And so like I’ve actually-I’ve gotten really good at like preparing like right before a race. Like I have my own little saying I say right before-like at the start line. It’s- I go, Strong, confident, calm, and content, is like what I do so it’s strong in your body, strong in your mind, strong- like having strong thoughts. Confident in yourself, confident in your training, and confident in your ability to finish. Um, calm-so like keep a relaxed body. Keep calm thoughts. Because you have to have positive thoughts. And then just content with whatever time I get. Because I know like at the end of the race, I’ve given it all, and that’s where it’s at.”

Common theme 3: The physiological effects of running The participants in this research are quick to say that physiologically they benefit from cross-country running. While they are aware of the long-term health benefits of exercise, their attention tends to be focused on the short-term effects of exercise. Battling injuries is a common problem in cross-country running, as it is in other sports. Torn or sprained quadriceps, plantar fasciitis, shin splits, and stress fractures are a few of the injuries mentioned by the participants in this research. “Pushing through pain” is a term frequently used by the participants, which in fact is understandable, because in order to run 3.5 miles for competitions, they have to learn to ignore their body’s messages telling them to stop, by way of their body sending signals causing pain. As AG puts it, “I can’t breathe, my lungs hurt, my legs and arms hurt, and I feel like I’m going to die” So, drawing a line between what is considered “normal pain” for a cross-country runner, and pain that needs to be examined, becomes complicated for the participants. The following sentiment was echoed by at least two of the athletes.

Thor: “Yeah. Well, I guess it’s kind of ironic because I’m really bad at telling the coach when I’m injured or like hurting. Because like I don’t want to stop running. That’s one of them. The second thing is I don’t want her to think I’m a wimp. And I-also, I’m really bad at like pain tolerance. Like I don’t know when something is really awful, and I don’t know when something is like not really hurting that much.”

Talk to any of the participants in this sample and they will freely admit to how brutal cross-country running can be on their body.

Eden: “And it’s weird when you’re running-like when I’m running-I like don’t really feel pain. Like I rarely have like a side ache during a race. It’s just like you just-I don’t- know. Like your whole body is just exhausted. And- and you always tell yourself like, oh I can’t go faster. And then you finish, and you’re like I could’ve gone faster. But like in the moment, you can’t. Like it’s-like you’re so tired.”

Thor:” I feel like I can do anything. Because it’s a really hard sport. I’ve played a lot of sports in my lifetime so far, and so this has probably been one of the hardest like physically taxing. And so being able to do it even makes me feel like I can accomplish anything-not just sports related, but also like other areas of my life. Yeah, it’s fun. It’s also a good way to like relieve stress I found. This is-because all the other sports I played I feel like a lot of stress, and this is one where I don’t really have to-cause I’m not like a varsity runner or anything.”

Frequently, the physical feelings after the race trump the physical pain experienced during the race. Participants report feeling more relaxed and less anxious than before the run, as well as a release of pent-up energy. A few girls, after experiencing the initial physical pain of the first mile, transcend into a racing mode where they are not aware of anything but the race. Some have called this the “runners high”.

AG: “-but once it started, you like get into the racing mode. And you don’t know anything else in the world except for the girl in front of you or the girl behind you. And I just feel like when I run, I have so many more senses in my head.”

Thor: “This has by far been one of the most athletic sports I have done. So, it-it was just like I wasn’t in shape for it, so when I’d get done with a workout or something, I was just like I can’t believe I could do that actually. And when I completed it, I just-like people call it a runner’s high. So, it makes you feel like you can do-you can do anything.”

Another major physiological issue which complicates adolescent female runners is their own growth and development. Many girls when they begin their high school running career as a freshman are quite small, appearing sometimes as young as ten years-old. Hormonally they are

under-developed, frequently not having started their menses. They break into the freshmen cross- country season running well ahead of the majority of the girls, and there is much optimism about their future performance on the team. Slowly however, as their body develops, their race times become slower, this despite a rigorous training schedule. This is understandably very difficult for the athlete, as they are trying to exceed their previous performance records, or at the very least, maintain their times.

Finally, these athletes are very busy with school, in addition to being fully committed to the sport and their peers. For many of them the day starts at six a.m. with a run, or weight-lifting before school. After school there is practice until five o’clock, dinner, homework, and then bedtime. Some try to squeeze in church, or another academic activity around the dinner hour a couple times per week.

Penelope: “Well, cross-country does take up a lot of time, and my schedule recently has been wake-up, go to weights, do the day, go to cross-country, go home, eat, homework, sleep. No time for anything else. Real busy with life, but not a lot of socialization. Um, I’m doing what I want. It’s fine.”

Summary of Pattern 1

After hermeneutic analysis by the team the Culture of Running became the first visible pattern. The culture of running may be considered a pattern of behavior, fostered by an attitude that develops when the athletes interact with one another, and as a team. For the new girls, this is their introduction to the philosophy of their high school cross-country team. It is a pattern of behavior and comradery that is set forth by the coach, and subsequently reinforced by the team captains, and followed by all the runners. It may be considered a team norm, or an expectation that is passed on year after year, as long as the same coach is in charge. Within this overarching pattern there were three common ideas which included being part of a team, the psychological effects of running, and the physiological effects of running. These three common ideas can be

visualized as each athlete competes and interacts with their teammates, their coach, and their opponents. The season starts with becoming a team, as the athletes meet each other, and plan their “blue and gold” meet. This is the meet that sets the stage for the first competition of the year.

Within the psychological effects of running, feelings of anxiety are not uncommon.

Indeed, it may occur in any situation that involves performance, whether it is in the arts, or in sport. Even the youngest athletes are not immune to anxiety, although the reasons for it may differ slightly among the ages. In high school athletes, the main concerns include fear of reinjury, fear of letting teammates and coaches down, and parental pressures. These feelings can, to some extent, be buttressed or neutralized by being part of a team.

Many girls have found that cross-country running decreases their anxiety significantly.

They find that taking a running break after school helps them to relax, and study better in the evening after a difficult day at school. Some girls find that running cross-country has helped them develop coping skills for every day anxiety, as well as assist them in learning how to develop relationships with other girls and young women. Another important psychological benefit that was verbalized by many of the girls, was the pride they felt as a result of participating in such a rigorous sport. Many of their friends not on the team would never consider running, which further reinforced the girls’ sense of pride in their sport.

If you listen to the participants talk about the physiological effects of running, it’s hard to believe that there is anything more important. These cross-country runners have become experts at ignoring their body’s signals of fatigue and pain. As a result, they sometimes have difficulty ascertaining when their pain is something they should worry about, i.e. continue to run and “push through the pain” or talk to the coach about it. The cross-country season is short, and it takes

very little, injury wise, to side-line these young athletes. Torn or sprained quadriceps, plantar fasciitis, shin splits, and sprained ankles are but a few of the injuries. Physical effects of running interact with the psychological effects of running as fear of re-injury impacts an athlete’s performance. Being part of a team, or a “sisterhood”, helps to buffer some of these painful physiological and psychological experiences.

There are however some very positive, short-term benefits that some girls achieve from running cross-country. These would include becoming physically fit or “in shape”, feeling relaxed after the run, or experiencing an elevated mood during and after a run, which some have called a “runners high”. The long-term benefit of developing a habit of physical activity is very important, and while the participants are aware of this, it is not one of their immediate goals.

Pattern 2: Approval and Attention from Others

Cross-country running is not a sport that gets a significant amount of attention from students, school administrators, or even the media. This is in particular, when contrasted to basketball, football, and even track and field. Admittedly, the media has slowly been giving more attention to prep cross-country running, but this is primarily at the regional, and state levels. The runners in this study frequently revel in the uniqueness of their sport, and how much more difficult they believe their sport is compared to other sports, i.e. “our sport is your sport’s punishment”, etc. The fact that their sport is more strenuous and does not command a lot of attention from others, seems to bolster their team spirit, and make these athletes rely even more on each other and their coaches for support. Understandably however, when they do get attention from outside their team, they fully enjoy it.

Common theme 1: From friends/teammates.

For the athletes in this study, the experience of being on a team appears to be a significant part of their high school competitive experience. However, in addition to being on the team, many of the girls are also friends, and they enjoy being recognized by each other.

Paris: “But I definitely have gotten a big group of friends from running, which has been nice because it like coming in I transferred in middle school to-from like my elementary school, I was like separated from the group of kids I was supposed to go out with.”

AG: “Um, also, it was funny because my friends-um, one time after one of our races- probably our first or second race-they go wow, you look so good when you run. You’re so like-you’re not even ugly looking. Like with the red and splotchy. They’re like you look fine. You look good. I’m like I die. I die from it. Like it hurts. It sucks when-while I’m running.”

The athletes spend a lot of time together during the cross-country season. The practices are long, and there are “away” meets in which they travel and spend nights together in a hotel.

Meets are held not only during the week, but also on the week-end with travel on a bus.

Sometimes they are together in pre and post-season competitions. The participants, even at their young age, demonstrate an enhanced awareness of the value of their participation in this sport, above and beyond the thrill of the competition, and the other physical aspects cross-country running imparts.

AG: “Um, I think probably the most part that cross-country does for you is preparing you for relationships pretty much. Like not like a male and female-but like female and female, male and male.”

Thor: “And we have such high respect for each other that we’re able to, um-like just even with working out or seeing each other in the hallways. Like people think that runners are kind of dorky cause like we run for fun”. “Like even if we don’t have classes together, if we just see each other in the hallways or things like that, we act like we’re the jocks in school.”

Megan: “Definitely. When-especially just running in general. If you go for a run with anybody, I feel like you just bond because you have nothing to do but talk to each other. So, it’s just-and even if you don’t talk, like I feel like if you go through a hard work out with somebody, you’re automatically just more bonded because you’re like, we went through this together.”

One of the best things about participating in cross-country running in high school is that everybody is able to compete at their own skill level. This makes it an appealing sport for those girls who may not be particularly athletic, and who would normally be cut, or sit on the bench, in another sport. The girl’s cross-country running team also has a place for those girls who want to compete at a higher level, these girls may be looking at receiving college scholarships for running, and possibly running professionally as young adults. So, while there is a place for everyone, there are some expectations that come along with participation, no matter what level.

Banana Ramma: “You have to do the work. And you’re not going to go in and everything’s going to be wonderful and people actually love you. Like you have to go- you have to put yourself in there. You have to socialize. You have to make friends and show like-that you want to be there.”

Anita: “But like this season, especially like with the varsity runners, like you definitely like try your hardest to do a really good job to like maybe make it to state and other stuff.”

AG: “It takes a lot of work-to get where you are. So, a lot of people that are-at the end of the season-are very strong people and mentally like advanced than others.”

For the hard-working athlete, there are many opportunities for recognition and support from their peers. For example, team captains select one athlete in every meet to be the “Athlete of the Meet”. This award is given to one of the girls (varsity or JV) who has made significant progress in her PR, has demonstrated especially good sportsmanship, or other notable contributions to the team. This is not a reward based solely on race times or given just to varsity runners, as one might expect.

AG: “We celebrate athlete of the meet, not just varsity, or the fastest runner, or the fastest of JV. It’s like everyone. Yeah they celebrate everyone basically.”

Jasmine: “And everybody loves the other people and we’re always rooting for each other. So, like if you don’t-I don’t know-you don’t do your best, like they are like, oh I did better than you, or whatever. You know, people are just like oh, I’m so proud of you, you did so good.”

AG: “And everyone worries about you, too, like when you are sick and stuff. So, like when I was-after my meet which I almost tied my PR-I got 25:18 instead of 25:17. And, um, I was super sick that day, so I just wasn’t feeling very well. And, um, everyone was worried about me because I couldn’t breathe very well, and I was coughing. So, everyone was really kind and trying to help me in any way they could. But there’s nothing you could really do. But it’s really nice to have all that support and love from them.”

This quote illustrates that sometimes the athletes put unrealistic expectations or pressures on themselves to achieve certain race times or advance their level on the team.

Common theme 2: From family and parents.

Not all of the participants talked about their parents, however those that did, discussed a variety of topics related to parental involvement. Some parents were more involved with the athletes than others. Some demonstrated a more protective role with their athletes, giving them breaks from household chores due to hard workouts. Many parents brought special snacks after meets and had team dinners at their home.

AG: “And what’s so great is how supportive people’s parents can be. Especially on the team. And how like everyone brings snacks and stuff. Like their parents are really nice.”

Lilly: “Yeah. And it is cool cause we have a team dinner sometimes, and like those are fun to just go over to someone’s house and eat dinner”.

“And my parents are always like okay take it easy. You don’t have to overdo yourself. And like, you know, the great thing is like it being extracurricular activity-having siblings is they can do all of the chores. Because you’re like oh I’m tired, I’ve been working really hard. I run like 50 miles a week dad remember? What so, it’s-that also a good thing

about extracurricular activities.” Many of the participants interviewed came from athletic families. The parents are currently athletic, and the athlete and her siblings are multi-sport athletes. This has caused pressure for some of the athletes due to parental expectations, although these were not noted to be severe.

Thor: “Yeah. Well, I have five siblings and all of them play sports-multiple sports. I know. And my dad is a coach (at the same high school). And my mom is a multi-sport athlete, too, so she-. “

“Yeah, it is helpful. Except for when they force me to play all the sports they want.” “Yeah, it’s funny. And I felt like I was always the odd one out because like I wasn’t the athletic athlete.” So, they-um, they were all super athletic. And I was like the person not good in sports to play all these sports. And I’m the oldest. So, they were like, “you have to lead the way”. And I was like, I want to stay home and read a book. And they were like “that’s weird.” So, yeah. So, they were like just get out and do something.”

Some parents have desires for their athlete to excel in a sport other than cross-country running.

There is also pressure on some athletes to obtain running scholarships for college, although it is not clear to what extent this pressure comes from the parents.

Emily: “So I don’t know. My parents are-they definitely will let me choose, but I feel like since I was little, I’ve gotten pushed toward certain sports or certain things. But I don’t know. If I went back, I probably would focus more on basketball.”

“So, I don’t play (basketball) usually outside the season. I mean, we have a sports court and my dad encourages us to get out there as much as possible. Yeah, kind of nagging sometimes. But you know? Just a little. But, I mean, he’s always like “go out there. Get on the court. But I don’t know. It’s hard doing this sport and homework and that.”

Paris: “And so, like if I don’t-I mean, I feel like I need to get a scholarship to run because that’s how I need to pay for college. So, then I just feel more pressure. And then it stresses me out, and then it’s not fun.”

AG: “And, um, so I thought I could get a scholarship possibly from cross-country. But now it’s kind of changed more to track because I am way better at track than cross- country.”

Athletic siblings frequently work-out, and support each other, as well as compete against each other. There is a set of twins on the varsity team. The two girls are used to running with each

other, and when one of them is not able to run (as in the case of an injury), it is very difficult for the other twin to run on her own.

Anita: “We’ve done this thing at our house since I was probably like three where we go- we’re like-I do like 25 laps in the morning around this like circle in our house. And I guess it just gets bigger as I grow up and stuff. We go outside now in our back yard. We live on an acre. So, I think we do like 15 laps around it. It’s like two miles or something.”

“We all run. I have a little sister that’s pretty-a really good runner. Yeah, -I have an older-I have a twin and a younger sister. She’s really fast.”

“Um, I guess I’m pretty competitive against people. I’m probably most competitive against my twin.”

Jasmine: “I know that like one time during the season, it got like kind of stressful. But then like that was only like because we had-we had like a really solid like varsity set- and it was always going to be that varsity set. Yeah, and so then it kinda-so that-there was like eight, and then it got a little more stressful-because then my girl (twin) was injured. And I don’t know. It was just kind of hard for me because I always run with her, so I didn’t have anyone to run with.”

Common theme 3: From coaches and teachers Almost unanimously, the girls on the cross-country team are very fond of their coach and respect her knowledge of the sport. One of the main things the girls appreciate is the fact that she allows them to be individuals. They are able to run and develop their skills to their own abilities, and desires. If a runner wants to work toward being on the varsity team, she will help that individual develop as much as possible. She will not however put pressure on the girls to run at a higher level, particularly if it is beyond their ability, or if they don’t want to put the effort into it.

AG: “Yeah it’s really nice here. And I love the coach. She’s a great coach and everything. And like it’s really nice to have like her say like you don’t need to like do your best exactly.”

“She doesn’t-she doesn’t say, oh, well this person can run a seven-minute mile or like a six-minute mile, and so you have to run that much. She says, ok, you’re going to

try your hardest and you’re going to do great. And just do yourself and tested out. It’ll take a while. You know, it takes training.”

So, she just lets you like do your thing. And like she’ll help you in any way that you want, but she won’t force anything. And she can tell if you’re really bad or if you’re like iffy or- she can tell if you don’t want to run it just because you’re lazy or something.”

Both the high school teachers and the coach function as advocates for the young athletes

in many ways. According to one participant, there is an understanding among the teachers that cross- country runners have some of the best grades in school because they are tough, and “never quit” anything. The cross-country coach also teaches advanced English and occasionally she will identify a student whom she feels would benefit from joining the cross-country running team.

Banana Ramma was one such student, who suffered from severe anxiety.

Banana Ramma: “And it’s like the change that I have seen in myself since freshman year when I could barely like make it into school without having a full-on panic attack to now me being here as captain for cross-country, in ASB class, Breakthrough-I was a leader in Breakthrough. So, just like seeing the difference in myself has been like one of the coolest things. Cause like I-I literally-I owe it all to the coach. Because I would be a completely different person if I never came out and ran.”

Additionally, until the summer after the girls’ junior year in high school, the coach functions as a conduit of communication between an athlete, and colleges interested in recruiting her. This is because NCAA guidelines prohibit a college from contacting an athlete directly, prior to the summer. It is sometimes difficult for an athlete when she wants a scholarship, but the coach has not been contacted by any colleges. The letters are basically communications from a college or university (i.e. cross-country running program), telling the student that they are interested in recruiting her into their cross-country running program. The interested coach will generally introduce him/herself in person at a larger meet during the athlete’s senior year, in accordance with NCAA recruiting guidelines.

Paris: “But I’m not really like full-swing recruiting or I’m not talking to any schools, A

lot of that needs to be initiated by the coach, which is kind of hard right now because I don’t know if I should ask her for things. Or she gets like letters for other girls, and I’m like I don’t know why I haven’t gotten myself any letters. Because girls younger than me at this point were getting letters. So, I’m like-you know? So, I just am kind of figuring out if that’s the road I want to take, what do I need to get from her?”

The high school teachers also provide valuable support to the participants, as they are generally aware of the athletes’ schedules and frequently, they have to be excused from class early to go to meets. Additionally, there are strict academic standards which must be met in order for the student to participate in sports. So, in this way, an athlete’s teachers become a vital part of the students support network.

Megan: “Like you talk to any of the teachers at the school and they say cross-country runners are some of the ones with the best grades. They never really quit anything cause it’s just like we practice that every single day in our work-outs. It’s just like you don’t quit when it comes to running cause that’s just not what you do.”

Common theme 4: From culture and community

Many of the participants, particularly those girls who run in the varsity squad, started running at an early age, through participation in community running clubs. There are a couple of clubs locally who specialize in both cross-country running and track and field. This enables the athlete to run all season. Many of them also compete in postseason track and field, going to

USATF (United States of America Track and Field) meets, which are regional and national competitions. The Spokane community, as well as the larger Inland Empire area, have many races sponsored by various businesses and organizations. This is another opportunity for the participants to maintain their conditioning during the off-season. The hope is that maintaining, and even increasing their fitness, will enhance their competitive edge.

Paris: “Um, I do things for school. I do things outside of school. I run club, um, cross- country and track during the postseasons. Um, so I would say that this for me is pretty competitive. Um, and I feel like I am very-I don’t know. I feel like I’m very into it what I

do here (at school), but I feel I also get a different level of competitiveness from this club that I am in.”

“Um, I have made it to Nationals twice for the club, and it’s taking me to, um (geographical location), and to (geographical location). And so last December, I actually, went there, and that was just a whole level of different crazy. I mean, it was so fun, though. So worth it. But overall, my experience of just like running and stuff is like-I don’t know-just like I-I feel more competitive when I feel more into it.”

AG: “And I think the best place that I have gotten is like 12th place in regionals (USATF) or like the middle schools and elementary schools all running combined.”

Anita: “Well I started running with a club team when I was like eight, but I didn’t actually, compete with them until I was nine or ten. Somewhere in there. I was in the nine, ten age group.”

Figure I. Illustration of the athletes and their interactions with the school and the community.

Summary of Pattern 2

Most of the cross-country runners in this study began their running careers in the community, long before they were in high school. Some athletes who were born into athletic families started early, running around their home. Once in elementary school, some of the

participants ran in community clubs sponsored by the USATF (United States of America Track and Field association). Some went to national championships all over the country, which are quite an honor to be able to participate in. Additionally, within the local community, there are many “fun runs”, which are usually about 3.5-mile cross-country runs open to the public, which provide good training for the young cross-country athlete. Girls who have had this early preparation present to the high school cross-country team usually as varsity runners.

For all of the athletes in this study, obtaining approval from, and interacting with their peers was of the utmost importance. All of the twelve athletes interviewed, considered their teammates as “friends”. It did not seem important which competitive level they were on, e.g., varsity or junior varsity, they cheered for each other, and were there for each other after the race.

This is not always the case, and the girls were quick to compare this cross-country running team to other sports teams they have been on, i.e. basketball, volleyball, and tennis. They give credit to their coach for setting the standards of good sportsmanship and team spirit.

In this study family determinants were quite visible in the girls’ participation in cross- country running. Nothing related to family dynamics showed up as being significantly negative or positive among these participants, however these are issues that have been cited in the literature as problematic in the greater population of young female athletes. Some parents had high expectations for their child to excel in a sport other than cross-country. This puts pressure on the child to train, for example for basketball, while she is still competing in cross-country running. This can lead to injury due to fatigue. Many of the cross-country runners in this study

compete with their siblings on the cross-country team, as well as in spring sports such as tennis or basketball.

Emily: “And my other sport-tennis-I haven’t really played much like outside of school. I played-like seventh and eighth grade, had like a little tennis club for middle school. I played those. And then my sister, since I can remember, she played in high school.”

“So she was really good. And so it’s kind of -I feel the pressure of getting up there. But I don’t know. I feel like that’s a sport-I focused so much on my other things. And also staying in shape-is such a big thing for me. I work out a lot. And so it’s hard to do like-I think about doing tennis outside of school because it’s just like- I don’t know it’s just another thing to add to my schedule.”

Anita: “We all run. I have a little sister that’s pretty-a really good runner. Yeah, -I have an older-I have a twin and a younger sister. She’s really fast.”

“Um, I guess I’m pretty competitive against people. I’m probably most competitive against my twin.”

Families can provide a significant amount of support to the young athlete. In this study some parents gave their daughter a break from household chores because she had run a lot of mileage one week. The parents who attend the meets regularly learned the names of the girls and cheer all of the girls on. Some parents have all of the girls over for spaghetti dinners, and some parents bring snacks after the meets, etc. There are a lot of opportunities for parental support of the girls and the team.

AG: “And what’s also great is how supportive people’s parents can be. Especially on the team. And how like everyone bring snacks and stuff. Like their parents are really nice.”

Banana Ramma:” Yeah. And it is cool cause we have a team dinner sometimes, and like those are fun to just go over to someone’s house and eat dinner.”

The coach provides the structure in which she expects the young athletes to participate and behave. These athletes appreciate her standards of behavior, and the clarity in which she

communicates them because it encourages them to take care of and support each other. The girls believe they are special, because they all agree with the coach’s efforts to unite the team. The cross-country team appears to have the support of their teachers as one of the faculty members commented on how the girls had the best grades. This is important because the girls frequently miss classes during the cross-country season.

Summary of Results

The two overarching patterns discovered through interpretive analysis of the transcripts were The Culture of Running, and Approval and Attention from Others. These two patterns describe what it’s like to be a young female competitive athlete and describes what is valued most by this highly specialized group of young women. It is interesting to note that these patterns were consistent throughout cross-country team, regardless of the age, or whether the runner was on the varsity or the junior varsity squads.

Within The Culture of Running three common ideas emerged which included being part of a team, the physiological effects of running, and the psychological effects of running. Being part of a team appeared to be the most highly sought-after quality of the cross-country running team. All of the team enjoyed this quality and recognized that this was something that had to be initiated and supported by their coach. The girls also recognized that they have developed friendships within the team, which helped maintain the team spirit.

The psychological effects of running are considerable and can be both positive and negative. The negative psychological consequences may be mediated by the support the athlete receives from her team and her coach. Anxiety is a very common emotion seen in athletic competitions, and to some extent can be seen as normal. However, it can also interfere with optimal athlete performance. There are many reasons for this, which a competent coach can

recognize and address. There are also a lot of positive psychological effects of running cross- country, one of the most important of which is an increase in self-esteem. Some athletes develop more confidence in themselves, and what their bodies could do after training and running sometimes up to fifty miles per week. Some girls described these changes in self-confidence as being almost transformational in nature.

The physiological effects of running are perhaps the most obvious effects of cross- country running. Distance running is very hard on the body, although the girls are young, and the season is short. Their coach is mindful of the potential for injury and wants the girls to report any pain they may have. They are however hesitant to report their injuries because they do not want to be held out of any races. A well-known practice among the girls is to “hide” their injuries from the coach until they absolutely can’t run. The girls are aware of lots of physiological effects of cross-country running. They report feeling more relaxed and able to do their homework after they have gone for a run after school. Some of them experience the “runners high” towards the end of a long run. The girls also enjoy feeling physically fit.

The second pattern which emerged from the interpretive analysis was Approval and

Attention from Others. Within this pattern there were four themes which were from friends and teammates, from family and parents, from coaches and teachers, and from community and culture. One of the most important aspects of cross-country running is the fact that anyone can be on the team and participate in the competitions. Nobody sits on the bench in cross-country running. Additionally, athletes are rewarded for a variety of achievements in the “Athlete of the

Meet” award. It is not an award based on times or given just to varsity athletes as one might expect. It is given for the most improved athlete, or a PR (personal record), or even the best sportsmanship, etc. This is an award which is voted on by the team captains.

Family was shown to be a significant factor in the girls’ participation in cross-country running. It was not significantly positive or negative, however there were elements of both in the interviews. Many of the girls came from athletic families. Some had siblings who are, or were on the cross-country running team, and there was some pressure to follow in their success. Some girls experienced pressure to excel in a sport other than cross-country running, such as basketball, or tennis. Many of the parents were very supportive of the girls by having team dinners at their homes and providing snacks after the competitions.

All of the girls interviewed were highly appreciative of their coach. The biggest reason that was cited was that she allowed them to be individuals. The standard was that they try their hardest in practice and in the competitions. If they are in junior varsity and want to work toward varsity the coach will work with them toward this goal, she does not however put pressure on the girls to achieve this goal.

For many of the participants the local community has had, and will continue to have, a significant influence. Their running careers began before high school in running clubs and community supported local runs, which served as training opportunities. Participation in clubs allow the girls to compete in USATF national competitions, which served to give them even more of a competitive edge.

Megan: “Because I remember talking to people after they graduated and being like, “you need to appreciate this right now”. Because you’re never going to be able to come back and have this many people like holding you accountable to go for a run every day, and you won’t ever have-like you won’t ever have the privilege of like everyone’s footsteps together while you’re running.”

CHAPTER FIVE

DISCUSSION AND IMPLICATIONS

Meaning of Results

Through the use of Heideggerian Hermeneutic analysis, this research sought to capture the lived experiences of high school female runners during a single competitive cross-country season. Through interpretive analysis, two overarching structures, or patterns were revealed.

These structures were The Culture of Running, and Approval and Attention from Others. Within the pattern of the culture of running, three major themes developed, which provided further insight into the lived experience of the athletes. These themes consist of 1) being part of a team,

2) the psychological effects of running, and 3) the physiological effects of running. The second major pattern, Approval and Attention from Others revealed four major themes which consisted of 1) attention from friends and teammates, 2) attention from family and parents, 3) attention from coaches and teachers, and 4) attention from one’s own culture and community.

This cross-country running team allows an examination of the culture of running, which is a pattern of interaction and function that can be seen at all levels of running, including varsity and freshmen runners. Within the culture of running, the theme being part of a team, describes in further detail the relationship the athletes have with one another. The theme being part of a team describes the participants unity toward established team goals, such as getting first or second place in the all city league or making it to state competition.

Cross-country running is a difficult sport, and as with any sport, there are injuries. The season is short, so becoming injured means the participants could miss half or all of their practice and competition time. Under the culture of running there is, therefore, the theme of the physiological effects of running. In order to be a successful cross-country runner, one has to be

able to ignore what would normally be the body’s signals of pain, i.e. breathlessness, side cramps, and muscle aches and pains, especially if there was a previous injury. Additionally, the athletes reported that they try not to tell their coach about an injury, because they know she will probably take them out of practice and competition for an unknown period of time. The motto that the researcher heard over and over among the athletes was “You’ve just gotta push through the pain”. “There’s so many of us, and we call it – hiding injuries from the coach. And when it gets to a certain point where it would be like I physically can’t run anymore, then we’ll go and tell her. And she’ll get mad at us (Thor, 507).” This kind of coping with sport injury clearly has both physical and psychological ramifications for the athlete.

The next theme under the culture of running is the psychological effects of running. The psychological and the physiological effects of running can sometimes overlap. More specifically however, the participants in this study acknowledged that they experienced an increase in self- esteem and confidence as a result of their participation in cross-country running. Additionally, some of the athletes have noticed a decrease in their anxiety and depression as a result of their participation in cross-country running. This decrease in adolescent stress, anxiety, and depression as a result of physical exercise has been well-documented in the literature (Gondoh et al., 2009;

Greenleaf et al., 2009; Slater & Tiggemann, 2011; Staurowsky et al., 2015).

There are additional psychological benefits to girls participating in a female competitive sports program that is not focused solely on competition. The team studied in this research is an example of how the athletes were able to compete, as well as support each other as teammates.

The athletes on this team described their experience running cross-country on this team as

“positive” and gave their coach the credit for creating this atmosphere. If they are in high school next year, these athletes will continue running on the team. Additionally, according to statistics,

there is a high probability that they will continue to be active into adulthood. Similar to the study team, it might be suggested that by providing a less competitive, more supportive team atmosphere, girls will stay in physical activity longer in high school, and then hopefully, will continue to stay active in adulthood. Certainly, goals for educators responsible for teaching physical education and coaching students in the future, must have as a priority the goal of continued physical activity in adulthood. This may require significant curriculum changes in the universities, however, it is essential given our current epidemic of obesity in both children and adults. This would also be a great area for research either by nursing or education.

The second overarching pattern is approval and attention from others. This pattern was identified by athlete stories, which demonstrated how each of the athletes were committed to supporting each other, and their team. The first theme within this pattern was approval from friends and teammates. Cross-country running is a difficult sport, and because of this, runners indicated that it is easy to bond with teammates when running together. The athletes on the team spent a lot of time running together, traveling, and when necessary, rooming together. The team does not expect accolades from their student body or the community (as would be the case with basketball, or volleyball), so they have developed their own support network within their own team. It didn’t seem to matter whether the runner was varsity, junior varsity, or freshmen.

Everybody cheers for each other, even if they have not had a good race. Their coach has taught and reinforced this behavior in the team, for which they are very grateful and proud. According to Penelope (201), “The coach kind of molds the freshmen. And then everyone above them gives them a good example of what-this is what being a team member is like. You should treat your other fellow teammates like this. And-so she sets the standard.”

The second theme within this overarching structure of approval and attention from others is from family and parents. Many parents demonstrated their support of the participants in ways such as sponsoring a team dinner at their home, bringing snacks after a meet, or working in the school snack bar to earn money for uniforms and track and field equipment. The athletes themselves experienced support from their parents on a more personal level such as when they did not have to do their chores at home after a particularly difficult week of running, or having their favorite meals served, etc.

Many of the participants in this study had siblings who also ran cross-country. Most of them were older, although one had a younger sibling. Additionally, there was one set of twins who ran. The participants that had the older siblings reported stress in trying to obtain the level of athleticism as their sisters, who were multi-sport athletes, and ran at the varsity level. This was not an issue however, when the sibling was younger or was a twin. In one instance, for example, the participant felt very strongly that she did better when she ran with her sister, as this was what she was used to doing at home.

Jasmine“I know that like one time during the season, it got like kind of stressful. But then like that was only like because we had-we had like a really solid like varsity set-and it was always going to be that varsity set. Yeah, and so then it kinda - so that-there was like eight, and then it got a little more stressful-because then my girl (twin sister) was injured. And I don’t know. It was just kind of hard for me because I always run with her, so I didn’t have anyone to run with”

Approval from coaches and teachers is the next theme under the major category of approval and attention from others. The participants in this research recognized that not only the coach, but the teachers are their advocates. This is important because during the cross-country running season, there are times when the participants need to receive adjustments to the classroom calendar or schedule due to their cross-country meet schedules. This was not a problem for these runners as all of them have good grades. Their good academic standing is due,

in part at least, to their teacher’s willingness to accommodate the erratic schedule of the participants. Additionally, all of the participants interviewed spoke very fondly of their coach.

They appreciated her ability to respect them based on their skills, and abilities, and cited how she did not force or pressure them to run harder or longer than they can or wanted to. In accordance with NCAA regulations, the coach also provided the connection to an under-age (junior or under in HS) athletes when colleges became interested in recruiting the athlete.

Approval from their own culture and community is the final theme under the category of approval and attention from others. Several of the participants in the varsity group started running before high school. The local community has a lot of informal, seasonal cross-country runs providing opportunities that can be fun if the participants have a relative, or a friend to go with them. Additionally, there are two running clubs in the local community to which many of the serious runners belong and compete in postseason USATAF (USA Track and Field) meets.

In this way some athletes are involved continuously in running, either in the community or at school.

Implications for Provisions of Clinical Care

This study sheds light on the experiences of high school female competitive athletes.

While there would certainly be variations in these experiences depending on the characteristics of the team, the school, and the coach, the research team was convinced that that this research could be applicable in many ways to other girls’ high school competitive sports. Admittedly cross-country running is different than many other female high school sports such as basketball, soccer, and volleyball, primarily because not everybody can play at once. However, there are significant similarities among the sports which include the fact that they are all a group of young female athletes, they compete within a team structure, they love their sport, and they are very

100

competitive. The utilization of certain aspects of this study, therefore, have the potential to inform any girls’ high school coach or parent who would like to contribute to building emotionally well-adapted, and physically healthy adults (Bronikowski, 2016). Goals within this would specifically include prevention of psychological problems such as anxiety and depression, and low self-esteem, as well as physical problems such as metabolic syndrome, diabetes type 2, and cardiovascular disease (Greenleaf et al., 2009; Staurowsky et al., 2015).

A significant finding in the study was the importance of the team culture. The identification of and reflection upon the culture of the team by the coach allows him/her to evaluate in some ways, the health of her team. It helps the coach to monitor the steps relative to the culture of the team. In this research, the athletes identified the importance of being “part of a team”. The theme of “being part of a team”, covers many smaller steps or parts such as the athletes being socialized to cheer for each other during their races, having team dinners at someone’s house, and playing games at a work-out. A lot of this was done for the athletes as recognition for their efforts regardless of the speed of their run. A coach could choose other ways to recognize her athletes, such as ice cream socials, or a day at a nearby theme park for instance. It should however be a step toward athletes “feeling part of a team”. During the interviews with the participants several described their team as a “positive team”. This was because of the above activities, and the support each of them got from their teammates and their coach. It is important to note that the “positive team”, and the feelings of all the girls as part of a team, did not occur all on its own. The foundation was laid by the coach. She taught new girls what she expected in terms of good sportsmanship and supporting each other as a team. Her team captains and senior team members modeled this behavior. It is therefore a dynamic process in that every year seniors leave the team, and freshmen join the team, so the teaching process is

101

recycled year after year. It is a repetitive process, year after year. It’s necessary however, if you believe that it’s important for athletes to “feel part of a team”, and if you believe we may be able to protect girls from early sport drop-out. The coach’s philosophy is reflected by Penelope who states that “everybody gets to play, it’s individual scores. There’s nobody getting mad at you for not getting a certain place (i.e. first, second, or third place). As long as you did your best. Even if it wasn’t a PR (personal record) but you did your best (143).”

In sport, an athlete’s mental state, and her physical state can affect her performance on the field. Sometimes psychological symptoms such as mild to moderate anxiety, can improve an athlete’s performance, whereas when severe, it can significantly impair performance. The participants in this research experienced anxieties shared by many young athletes regarding their performance, and associated concerns about letting their coach and their teammates’ down. “I mean I feel like sometimes there’s pressure because like you feel like you have to be the best.

But I think at some point you just have to realize like, oh, it’s just for fun. Like you are not going to play like this sport forever probably (Emily, 40).” This experience of competition stress was not strongly represented in this sample in part, because only four varsity runners were interviewed, two of whom were injured at the time of the interviews. Additionally, however, it is possible that in a positive team culture, some of these fears were minimized because the athletes and the coach were in agreement about their expectations, and there was considerable emotional support from the teammates and the coach even if expectations were not met.

The physicality of running cross-country competition is hard on the body, and it is here where the psychological and the physiological effects of running merge. Athletes who have been injured in the past while running, even if it was in the relative distant past, worry significantly about re-injury. At the same time the running season is very short, and the young athlete knows

102

that any physical complaints to the coach will generally result in time away from practice and competition. This Is a highly undesired outcome for most athletes, and the participants in this study shared with the researcher their practice of hiding their injuries from the coach, at least until they felt they were no longer able to run at all. This behavior was evident despite admonitions from the coach to let her know when they are hurting. A coach who is highly engaged with her athletes is generally able to catch her athletes when they are injured or having difficulty in their runs. However, it is something the parents could also be educated about and requested to monitor.

Part of the running culture and the positive team requires the support of the parents and the family of the athlete. However sometimes the family support is not optimum. For example, in this study one girl’s parents wanted her to excel in basketball, and anything that took time away from practicing basketball (e.g. cross-country running) was a problem. Additionally, several girls came from families where the siblings and the parents compete in multiple sports. The cross- country athletes felt like they were not participating in a sufficient number of sports, focusing instead on running. Finally, sometimes there is competition between the athlete and an older sister who has graduated, or a twin sister who is a running partner. These are all normal stresses that can arise at any time, and an attentive coach is usually able to help her athletes through these types of stressful situations. For the varsity runners, the coach is also able to function as a protective barrier between gifted athletes, college recruiters, and the community, which is very important because college recruiters start looking at talented athletes as early as their freshmen year in high school. NCAA regulations prohibit colleges from contacting athletes until the summer of their junior year in high school. This is because if allowed, college recruiters would call the athlete frequently, and otherwise attempt to engage the athlete too soon, which is

103

disruptive to the athlete’s family and school life. The coach also regulates time and place in which local media may have access to interview athletes.

In this research, the coach allowed her athletes to run at their own speed yet encouraged them if they wanted to run faster. She also finds ways to encourage all of the athletes, such as awarding the “athlete of the meet”, which is given not just to the fastest runner, but to runner who has improved the most during a meet, or a runner who has overcome significant challenges in order to run in a meet. This is also an opportunity for the coach and the nurse educator to emphasize to both the parents and the athlete’s that competition is only one component of participation in the cross-country team, and other components are a sense of belonging and comradery, physical fitness, and the development of healthy habits in preparation for adulthood.

In this study, it was apparent that the girls on the cross-country team were very fond of their coach. This fondness came out clearly in the interviews. There were also many things that they experienced and enjoyed while on this team. These included improved relationships with other girls, enhanced mood, or the “runners high”, and an overall decrease in anxiety, and depression, to name just a few. The athletes called this team “a positive team” for good reason.

According to Burner et al. (2019), these girls will likely continue to have an active life style well into adulthood because of their competitive cross-country running experiences in high school.

This coach does not necessarily represent the majority of female high school coaches working today. She might be considered “ideal” in that all of her athletes felt valuable, despite their rank (varsity vs jv) on the team, and they enjoyed participation on the cross-country running team. Using this coach as an example, i.e. identifying the characteristics of a good coach in this

“new age” of obesity prevention, might be another area for nursing research. Educating new

104

coaches to look at high school competitive sports as more than competition, should be the focus of their education, and their classroom experience.

Implications for Future Research

Historically, nursing has had no presence in high school sports, unless the nurse is working in a primary care setting, where generally the practitioner has no experience in sports medicine, or adolescent psychology. Nursing however, with its holistic, psycho-social approach to patient care has a lot to offer to adolescent competitive sports, particularly in high school where there are limited resources for young athletes.

The overall goal of any high school athletic program should be to provide and maintain a robust physical activities program that is safe, fun, and educational. In this way the program is preparing adolescents for a future of continued physical activity as adults. The education component of physical activity is very important, according to Burner (2019). Physical education

(PE) programs in high school have the opportunity to educate adolescents about the importance of continued physical activity (PA) into adulthood. Additionally, this is an area where a consulting nurse could be particularly helpful by providing athletes with information on nutrition, stress management, and healthy lifestyle management. Research indicates that if an adolescent athlete enjoys PE and/or PA, they are more likely to continue PA into adulthood

(Burner, 2019). This is important because by contrast 32% of US adolescents continue to have sedentary life styles, and are obese (Burner, 2019). This is often accompanied by overweight or obese adolescents.

The Institute of Medicine, in accordance with the Center for Disease Control, has requested that educators supplement their regular PE classes with more opportunities for PA during school hours, after and before school, and for all grade levels (Egan, 2019; Goh, 2019).

105

The Society of Health and Physical Educators and the CDC, recognized that attempting to provide physical activity (PA) before, during, and after school using the traditional school physical education format was daunting, and often not effective in dealing with the childhood obesity epidemic (Goh, 2019). PE teachers need assistance, education, and new curriculum models to prepare for their expanded role in addressing this epidemic.

In response to the increased demand for more PA in schools, The Society of Health and

Physical Educators, and the Centers for Disease Control and Prevention developed a

Comprehensive School Physical Activity Program (CSPAP). Within this framework, the new role of PE teachers is to develop and carry-out programs of physical activity. Physical activity leaders (PAL) carry out the plans given them by the PE teachers (Goh, 2019). According to Egan et al. (2019) there are five components to CSPAP. These include PA during school, which could include education with teaching staff involvement, and more traditional PA before and after school, which could be competitive sports, as well as family and community involvement. The goal is to keep PE, and PA, including competitive experiences, positive, and hopefully retain more athletes.

The CSPAP model however is not the only model that is being used in attempt to curb obesity in school children and adolescents. The CDC, the National Institutes of Health, the

Robert Wood Johnson Foundation, the Institute of Medicine, and the White House Task Force on

Childhood Obesity have suggested that in order to dramatically reduce childhood obesity, a multisector, social-ecological approach might be more effective (Adams, 2016; Bronikowski,

2016; Mehtala, 2014). The socio-ecological model would focus on the social and physical aspects of PA for children, as well as the policy and environmental aspects needed to provide PA

(Mehtala, 2014). Within the socioecological model, assessing individual PA needs is done

106

through an assessment of their individual attitudes, beliefs and gender, behavior, sedentary or active, social support from family and friends, and physical environment, availability of a basketball court, or a gym, etc. (Bronikowski, 2016). The psychosocial model of nursing care incorporates some, if not all, of the areas in the socioecological model. Nurses trained in community health nursing might be the most likely to intervene in this population.

Either way, no matter which model a community may, or may not be using, there are plenty of opportunities for nursing presence and involvement in school physical activity and competitive sports programs. For example, within the CSAP model, nursing could be a valuable university faculty/external institutional support mechanism. (Goh, 2019; Mehtala, 2014).

It provides a perfect opportunity for the nurse to consult with the coaches of the cross-country running and track and field teams, as well as other high school competitive sports teams (Goh,

2019). With any of these teams, the nurse could work with the coach on communication issues and team development. This could be helpful, particularly with teams where there is more of a competitive spirit among team members. Despite the seriousness of the competitive teams, it’s important for the games to be fun for all of the adolescents. The nurse can help the coach with stress management strategies.

The nurse could be “another set of eyes” on the field if there is an injury while he or she is in attendance. If for instance, an injury is evident, the nurse may be able to alert the coach. On the course, or in the gym, the nurse can help identify and track injuries. Nurses specialize in holistic person care, which allows them to get to know the athletes, and potentially recognize psychosocial problems they may be experiencing. The adolescent is particularly vulnerable to hormonal changes and rapid mood swings related to their stage of development. Referral to a counselor or a doctor could occur quickly, with a nurse’s assessment, instead of waiting to be

107

seen by a primary care provider, and then be given a referral. The nurse could be an invaluable resource to parents regarding concerns about their athletes. Perhaps one of the most important features of the CSPAP model, and the instillation of the nurse as a community consultant, is that the nurse is available to help the PE teacher in other areas of PA such as teaching nutrition, and injury prevention. There is a great amount of flexibility in the use of the nurse, however, the greatest role would lie with the competitive sports teams.

Two structures for possible nursing intervention for the purpose of decreasing childhood and adolescent obesity epidemic have been introduced in this section. One was the

Comprehensive School Physical Activities Program (CSPAP), which centered around the schools’ ability to provide the required physical activity level of 60 minutes per day (Egan,

2019). This requires an infusion of services into schools called PAL’s to provide mid-day physical activity, as well as before school and after school activities. The PE teachers would become coordinators of daily physical activity. There has been some sentiment that the CSPAP as a focal point for the reduction of childhood obesity is insufficient in meeting this need

(Adams, 2016). The second was the socio-ecological model which focuses on the physical and social environment of the child, as well as his individual characteristics, such as gender, and his lifestyle, sedentary or active. In this model the nurse could identify potential targets, or areas which could be impacted, that would influence the child or adolescence obesity problem.

This author was unable to find a specific model which would utilize the nurse as a consultant in the area of sports athletics, and PA. It would be appropriate to conduct research to see if there are any models available that puts the nurse in this role. The socio-ecological model perhaps holds the most promise because it involves several aspects of a child’s life, and it is familiar ground for nursing theory. It would be interesting to see if the use of a nurse in this

108

setting would be helpful for even a small group of children. This is also an area which would benefit from further research.

109

REFERENCES

Adams, A. C., B; Meinen,A; Korth,A; Remington, P; Lindberg, S; Schoeller, D. (2016, Nov.

2016). The obesity prevention initiative: a statewide effort to improve child health in

wisconsin. WMJ Author manuscript.

Ahern, N. (2006). Adolescent Resilience:An Evolutionary Concept Analysis. Journal of

Pediatric Nursing, 21(3), 175-185. Retrieved from doi:10.1016/j.pedn.2005.07.009

Allen-Collinson, J. (2009). Sporting embodiment: sports studies and the continuing promise of

phenomenology. Qualitative Research in Sport and Exercise, 1(3), 279-296.

Annells, M. (1999). Evaluating phenomenology: usefulness, quality and philosophical

foundations. Nurse Researcher, 6(3), 5-18.

Bakewell, S. (2016). At the Existentialist Cafe': Freedom, Being, and Apricot Cocktails (Y. E.

Ca'rdenas Ed. First Edition ed.). Great Britain: Chatto & Windus.

Bandura, A. (2001). Social Cognitive Theory: An Agentic Perspective. Annual Review of

Psychology, 52, 1-26.

Bandura, A. (2004). Swimming against the mainstream: the early years from chilly tributary to

transformative mainstream. Behavior,Research and Therapy, 42, 613-630.

Bargh, J., & Ferguson, M. (2000). Beyond behaviorism: on the automaticity of higher mental

processes. Psychological Bulletin, 126(6), 925-945.

110

Beasley, M., Thompson, T., & Davidson, J. (2003). Resilience in response to life stress: the

effects of coping style and cognitive hardiness. Personality and Individual Differences,

34, 77-95.

Beeri, A., & Lev-Wiesel. (2012). Social rejection by peers: a risk factor for psychological

distress. Child and Adolescent Mental Health, 17(4), 216-221.

Bergeron, M. (2010). The young athlete: Challenges of growth,development, and society.

Current Sports Medicine Reports, 9(6), 356-358.

Berryman, J. (2010). Exercise is medicine: A historical perspective. Current Sports Medicine

Reports, 9(4), 195-201.

Berz, K., & McCambridge, T. (2016). Amenorrhea in the female athlete: What to do and when to

worry. Pediatric Annals, 45(3), e97-102.

Bronikowski, M. B., M; Pluta, B; Maciaszek, J; Tomczak,M; Glapa, A. (2016). Positive impact

on physical activity and health behavior changes of a 15-week family focused

intervention program: junior for seniors. BioMed Research International, 2016, 1-7.

Brown, K., & Connolly, C. (2010). The role of law in promoting women in elite athletics: an

examination of four nations. International Review for the Sociology of Sport, 45(1), 3-21.

Burner, A. B., Melissa; Papalia,Zack; Weimer, Alison; Bopp,Christopher. (2019). Examining the

relationship between high school physical education and fitness outcomes in college

students. The Physical Educator, 76, 285-300.

111

Camhi, S., Phillips, J., & Young, D. (2011). The influence of body mass index on long-term

fitness from physical education in adolescent girls.

. Journal of School Health, 81, 409-416.

Capranica, L., & Millard-Stafford, M. (2011). Youth sport specialization: How to manage

competition and training ? International Journal of Sports Psychology and Performance,

6, 572-579.

Casey, B., Getz, S., & Galvan, A. (2008). The adolescent brain. Developmental Review, 28, 62-

77.

Charmandari, E., Achermann, J., Carel, J., Soder, O., & Chrousos, G. (2012). Stress response

and child health. Sciencesignaling, 5(248), 1-5.

Clarke, J. (1999). Hermeneutic analysis: A decision trail. International Journal of Nursing

Studies, 36, 363-369.

Clements, P., & J, A. (2006). Finding patterns of knowing in the work of Florence Nightingale.

Nursing Inquiry, 54, 268-274.

Cosh, S., & Tully, P. (2014). "All I have to do is pass": A discursive analysis of student athletes'

talk about prioritising sport to the detriment of education to overcome stressors

encountered in combining elite sport and tertiary education. Psychology of Sport and

Exercise, 15, 180-189.

112

Creswell, J. (2007). Qualitative Inquiry and Research Design. (Second Edition ed.). Thousand

Oaks: Sage Publications.

Crist, J., & Tanner, C. (2003). Interpretation/analysis methods in Hermeneutic interpretive

phenomenology. Nursing Research, 52(3), 202-205.

Denham, B. (2009). Youth sports participation and attitudes toward societal competition,concern

for material items, and the consequences of manipulative advertising. Youth and Society,

41, 124-147. deWitt, L., & Ploeg, J. (2006). Critical appraisal of rigour in interpretive phenomenological

nursing research. Methodological Issues in Nursing Research, 1-15.

Donnelly, J., & Lambourne, K. (2011). Classroom-based physical activity,cognition,and

academic achievement. Preventive Medicine, 52, 536-542.

Eaton, N., South, S., & Krueger, R. (2009). The Cognitive–Affective Processing System (CAPS)

approach to personality and the concept of personality disorder: Integrating clinical and

social-cognitive research. Journal of Research in Personality, 43(2), 208-217.

doi:10.1016/j.jrp.2009.01.016

Edwards, J., Mauch, L., & Winkelman, M. (2011). Relationship of nutrition and physical activity

behaviors and fitness measures to academic performance for sixth graders in a midwest

city school district. Journal of School Health, 81(2), 65-73.

113

Egan, C. W., C; Stewart, G; Weaver, G; Russ, L; Brian,A; Stodden, D. (2019). Case study of a

health optimizing physical education-based comprehensive school physical activity

program. Evaluation and Program Planning, 72, 106-117.

Flouri, E., & Panourgia, C. (2012). Role of nonverbal cognitive ability in the association of

adverse life events with dysfunctional attitudes and hopelessness in adolescence.

Archives of Psychiatric Nursing, 26(5), 411-419.

Frodl, T., & O'Keane, V. (2013). How does the brain deal with cumulative stress? A review with

focus on developmental stress, HPA axis function and hippocampal structure in humans.

Neurobiology of Disease, 52, 24-37.

Gaudreau, P., Nicholls, A., & Levy, A. (2010). The ups and downs of coping and sport

achievement: an episodic process analysis of within-person associations. Journal of

Sports and Exercise Psychology, 32, 298-311.

Gerber, M., Kalak, N., Lemola, S., Clough, P., Perry, J., Puhse, U., . . . Brand, S. (2012). Are

adolescents with high mental toughness levels more resilient against stress ? Stress and

Health, 29, 164-171.

Ghada, A. (2010). Employment of Colaizzi's strategy in descriptive phenomenology: A

reflection of a researcher. European Scientific Journal, 8(27), 31-43.

Giel, K., Hermann-Werner, A., Mayer, J., Diehl, K., Schneider, S., Thiel, A., & Zipfel, S. (2016).

Eating disorder pathology in elite adolescent athletes. International Journal of Eating

Disorders, 49, 553-562.

114

Goh, T. W., C; Brusseau, T; Hannon, J. (2019). Infusing physical activity leadership training in

PETE programs through university-school partnerships: principals’ and graduate

students’ experiences The Physical Educator, 76, 238-257.

Gondoh, Y., Sensui, H., Kinomura, S., Fukuda, H., Fujimoto, T., Masud, M., . . . Takekura, H.

(2009). Exercise physiology and biomechanics; Original articles. Effects of aerobic

exercise training on brain structure and psychological well-being in young adults. Journal

of Sports Medicine and Physical Fitness, 49, 129-135.

Greatrex-White, S. (2008). Thinking about the nature of research findings:A Hermeneutic

phenomenological perspective. International Journal of Nursing Studies, 45, 1842-1849.

Greenleaf, C., Boyer, E., & Petrie, T. (2009). High School Sport Participation and Subsequent

Psychological Well-Being and Physical Activity: The Mediating Influences of Body

Image, Physical Competence, and Instrumentality. Sex Roles, 61(9-10), 714-726.

doi:10.1007/s11199-009-9671-z

Grossbard, J., Smith, R., Smoll, F., & Cumming, S. (2009). Competitive anxiety in young

athletes: differentiating somatic anxiety, worry, and concentration disruption.

Anxiety,Stress, and Coping, 22(2), 153-166. doi:10.1080/10615800802020643

Guignon, C. (2012). Becoming a person: Hermeneutic phenomenology's contribution. New

Ideas in Psychology, 30, 97-106.

115

Harmison, R. (2006). Peak performance in sport: Identifying ideal performance states and

developing athlete's psychological skills. Professional Psychology:Research and

Practice, 37(3), 233-243.

Harrist, C., & Witt, P. (2015). Calling the screens: self-reported developmental outcomes in

competitive basketball. Journal of Adolescent Research, 30(6), 751-774.

Harwood, C., & Knight, C. (2009). Stress in youth sport: a developmental investigation of tennis

parents. Psychology of Sport and Exercise, 10, 447-456.

Herting, M., & Nagel, B. (2012). Differences in brain activity during a verbal associative

memory encoding task in high-and low-fit adolescents. Journal of Cognitive

Neuroscience, X(Y), 1-18.

Hillman, C., Kamijo, K., & Scudder, M. (2011). A review of chronic and acute physical activity

participation on neuroelectric measures of brain health and cognition during childhood.

Preventive Medicine, 52, S21-S28.

Hoar, S., Crocker, P., Holt, N., & Tamminen, K. (2010). Gender differences in adolescent

athletes' coping with interpersonal stressors in sport: more similarities than differences?

Journal of Applied Sport Psychology, 22, 134-149. doi:10.1080/1041.3201003664640

Holen, S., Lervag, A., Waaktaar, T., & Ystgaard, M. (2012). Exploring the associations between

coping patterns for everday stressors and mental health in young school children. Journal

of School Psychology, 50, 167-193.

116

Holt, N., & Dunn, J. (2004). Longitudinal idiographic analyses of appraisal and coping responses

in sport. Psychology of Sport and Exercise, 5, 213-222.

Holt, N., Tamminen, K., Black, D., Sehn, Z., & Wall, M. (2008). Parental involvement in

competitive youth sport settings. Psychology of Sport and Exercise9, 663-685.

Holt, N., Tamminen, K., Tink, L., & Black, D. (2009). An interpretive analysis of life skills

associated with sport participation. Qualitative Research in Sport and Exercise, 1(2),

160-175.

Hostinar, C., Stellern, S., Schaefer, C., Carlson, S., & Gunnar, M. (2012). Associations between

early life adversity and executive function in children adopted internationally from

orphanages. PNAS, 109(suppl. 2), 17208-17212.

Huizinga, M., Dolan, C., & van der Molen, M. (2006). Age-related change in executive function:

developmental trends and a latent variable analysis. Neuropsychologia, 44, 2017-2036.

Johns, C. (1995). Framing learning through reflection within carpers fundamental ways of

knowing in nursing. Journal of Advanced Nursing, 22, 226-234.

Jones, M., & Lavallee, D. (2009). Exploring perceived life skills development and participation.

Qualitative Research in Sport and Exercise, 1(1), 36-50.

Kessler, R., Avenevoli, S., Costello, J., Green, J., Gruber, M., McLaughlin, K., . . . Merikangas,

K. (2012). Severity of 12-month DSM-IV disorders in national cormorbidity survey

replication adolescent supplement. Archives of General Psychiatry, 69(4), 381-389.

117

Kessler, R., Avenevoli, S., McLaughlin, K., Green, J., Petukhova, L., Pine, D., . . . Merikangas,

K. (2012). Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity

Survey Replication Adolescent Supplement (NCS-A). Psychological Medicine, 42(9),

1997-2010.

Kirby, J., Levin, K., & Inchley, J. (2012). Associations between the school environment and

adolescent girls' physical activity. Health Education Research, 27(1), 101-114.

Kristiansen, E., & Roberts, G. (2010). Young elite athletes and social support:coping with

competitive and organizational stress in "Olympic" competition. Scandinavian Journal of

Medicine and Science in Sports, 20, 686-695

Kubala, K., Christianson, J., Kaufman, R., Watkins, L., & Maier, S. (2012). Short and long-term

consequences of stressor controllability in adolescent rats. Behavioural Brain Research,

234, 278-284.

Kutz, M., & Secrest, M. (2009). Contributing factors to overtraining in adolescent mult-

season/sport athlete. Strength and Conditioning Journal, 31(3), 37-42.

Kyrou, L., & Tsigos, C. (2009). Stress hormones: physiological stress and regulation of

metabolism. Current Opinion in Pharmacology, 9, 787-793.

LaPrade, R., Agel, J., Baker, J., Brenner, J., Cordasco, F., Cote, J., . . . Gould, D. (2016).

AOSSM Early sport specialization consensus statement. The Orthopaedic Journal of

Sports Medicine, 4(4), 1-8.

118

Lemyre, P., Hall, H., & Roberts, G. (2008). A social cognitive approach to burnout in elite

athletes. Scandinavian Journal of Medicine and Science in Sports, 18, 221-234.

Luna, B., Padmanabhan, & O'Hearn. (2010). What has the fMRI told us about the development

of cognitive control through adolescence. Brain and Cognition, 72, 101-113.

Mackey, S. (2005). Phenomenological nursing research: methodological insights derived from

Heidegger's interpretive phenomenology. International Journal of Nursing Studies, 42,

179-186.

Mackinnon, L. (2000). Overtraining effects on immunity and performance in athletes

. Immunology and Cell Biology, 78, 502-509.

MacMillan, K. (1994). Brilliant mind gave Florence her edge. Registered Nurse, 6(2), 29-31.

MacNamara, A., Button, A., & Collins, D. (2010). The role of psychological characteristics in

facilitating the pathway to elite performance. Part 1:Identifying mental skills and

behaviors. The Sport Psychologist, 24, 52-73.

Makinen, T., Borodulin, K., Tammelin, T., Rahkonen, O., Laatikainen, T., & Prattala, R. (2010).

The effects of adolescence sports and exercise on adulthood leisure-time physical activity

in educational groups. The international journal of behavioral nutrition and physical

activity, 7, 27. Retrieved from. doi:10.1186/1479-5868-7-27

119

Malina, R. (2010). Early sport specialization: Roots,effectiveness, and risks. Current Sports

Medicine Reports, 9(6), 364-371.

McEwen, B. (2004). Protection and damage from acute and chronic stress. Annals New York

Academy of Sciences, 1032, 1-7.

McEwen, B. (2007). Physiology and neurobiology of stress and adaptation:Central role of the

brain. Physiological Review, 87, 873-904.

McGorry, P., Purcell, R., Goldstone, S., & Amminger, P. (2011). Age onset and timing of

treatment for mental and substance use disorders: implications for preventive intervention

strategies and models of care. Current Opinion in Psychiatry, 24, 301-306.

Meggs, J., Golby, C., Gucciardi, D., & Polman, R. (2016). The cortisol awakening response.

International Journal of Sports Medicine, 37, 169-174.

Mehtala, M. S., A; Inkinen,M; Poskiparta,E. (2014). A socio-ecological approach to physical

activity interventions in child care: a systemic review. International Journal of

Behavioral Nutrition and Physical Activity, 11(22), 2-12.

Mellalieu, S., Neil, R., Hanton, S., & Fletcher, D. (2009). Competitive stress in sport

performers:stressors experienced in the competition environment. Journal of Sports

Sciences, 27(7), 729-744.

Mikoteit, T., Brand, S., Beck, J., Perren, S., Von Wyl, A., Von Klitzing, K., . . . Hatzinger, M.

(2012). Visually detected NREM Stage 2 sleep spindles in kindergarten children are

120

associated with stress challenge and coping strategies. The World Journal of Biological

Psychiatry, 13, 259-268.

Miller, L. (1988). Behaviorism and the new science of cognition. The Psychological Record, 38,

3-18.

Moal, M. (2007). Historical approach and evolution of the stress concept:a personal account.

Psychoneuroendocrinology, 32, 53-59.

Montgomery, J., Stoesz, B., & McCrimmon, A. (2012). Emotional intelligence, theory of mind

and executive functions as predictors of social outcomes in young adults with Asperger

Syndrome. Focus on Autism and Other Developmental Disabilities, 28(1), 4-13.

Mountjoy, M., Armstrong, N., Bizzini, L., Blimkie, C., Evans, J., Gerrard, D., . . . Van

Mechelen, W. (2008). IOC Consensus Statement on Training the Elite Child Athlete.

Clinical Journal of Sports Medicine, 18(2), 122-123.

Mummery, W., Schofield, G., & Perry, C. (2004). Bouncing Back: The role of coping

style,social support and self-concept in resilience of sport performance. Athletic Insight,

6(3), 1-18.

Murray, K., Byrne, D., & Rieger, E. (2011). Investigating adolescent stress and body image.

Journal of Adolescence, 34, 269-278.

121

Myer, G., Neeru, J., DiFiori, J., Faigenbaum, A., Kiefer, A., Logerstedt, D., & Micheli, L.

(2015a). Sport Specialization, Part 1: Does early sport specialization increase negative

outcomes and reduce the opportunity for success in young athletes ? Sports Health, 7

(5), 437-442.

Myer, G., Neeru, J., DiFiori, J., Faigenbaum, A., Kiefer, A., Logerstedt, D., & Micheli, L.

(2015b). Sports Specialization, Part II: Alternative solutions to early sport specialization

in youth athletes. Sports Health, 8(1), 65-73.

Ng, R., Ang, P., & Ho, M. (2012). Coping with anxiety,depression,anger,and aggression:The

mediational role of resilience in adolescents. Child Youth Care Forum, 41, 529-546.

Nichol, M., Pickett, W., & Janssen, I. (2009). Associations between school recreational

environments and physical activity. Journal of School Health, 79(6), 247-254.

Nicolas, M., & Jebrane, A. (2009). Consistency of coping strategies and defense mechanisms

during training sessions and sport competitions. International Journal of Sport

Psychology, 40, 229-248.

Nipert, A., & Smith, A. (2008). Psychologic stress related to injury and impact on sport

performance. Physical Medicine Rehabilitation Clinics North America, 19, 399-418.

Retrieved from. doi:10.1016/j.pmr.2007.12.003

O'Brien, M., & Robertson, A. (2010). Women and Sport. Scottish Medical Journal, 55(2), 25-28

122

Ormel, J., Oldehinkel, A., Sijtsema, J., Oort, F., Raven, D., Veenstra, R., . . . Verhulst, F. (2012).

The TRacking Adolescents' Individual Lives Survey (TRAILS): Design,Current Status,

and Selected Findings. Journal of the American Academy of Child and Adolescent

Psychiatry, 51(10).

Patton, M. (2002). Qualitative Reaearch and Evaluation Methods. Thousand Oaks: Sage

Publications.

Perez, A. (2015). The characterization of the athlete athletic high profile. Revista de

Investigacion en Educacion, 13(2), 219-242.

Piercy, K., & Troiano, R. (2018). Physical Activity Guidelines for Americans from the US

Department of Health and Human Services [Doc. Diss.]. Circulation:Cardiovascular

Quality and Outcomes, (1-3). doi:10.1161/CIRCOUTCOMES.118.005263

Powell, K., King, A, Buchner, D., Campbell, W., DiPietro, L, Erickson, K., Hillman, C.,Jakicic,

F, Janz, P., Katzmarzyk, W., Kraus, R., Macko, D.,Marquez, A., Russell, R., Pescatello,

L., Whitt-Glover, M. (2019). The Scientific Foundation for the Physical Activity

Guidelines for Americans, 2nd Edition. Journal of Physical Activity and Health(16), 1-

11.

Raedeke, T., & Smith, A. (2004). Coping resources and athlete burnout:An examination of stress

mediated and moderation hypothesis. Journal of Sport and Exercise Psychology, 26, 525-

541.

123

Rasberry, C., Lee, S., Leah, R., Laris, B., Russell, L., Coyle, K., & Nihiser, A. (2011). The

association between school-based physical activity,including physical education, and

academic performance: A systematic review of the literature. Preventive Medicine, 52,

510-520.

Reagan, L., Grillo, C., & Piroli, G. (2008). The As and Ds of stress: Metabolic, morphological

and behavioral consequences. European Journal of Pharmacology, 585, 64-75.

Romeo, R. (2010). Pubertal maturation and programming of hypothalamic-pituitary-adrenal

reactivity. Frontiers in Neuroendocrinology, 31, 232-240.

Schubring, A., & Thiel, A. (2014). Growth problems in youth elite sports. Social conditions,

athletes' experiences and sustainability consequences. Reflective Practice, 15(1), 78-91.

Selanders, L., & Crane, P. (2012). The voice of Florence Nightingale on advocacy. Online

Journal of Issues in Nursing, 17(1), 1-12.

Sharma, M., & Nahar, V. (2018). Promoting physical activity in upper elementary children using

multi-theory model (MTM) of health behavior change. Journal of Preventive Medicine

and Hygiene, 59, E267-E276.

Sharma, M., Nahar, V. (2018). Promoting physical activity in upper elementary children using

multi-theory model (MTM) of health behavior change. Jounal of Preventive Medicine

and Hygiene, 59, E267-E276.

124

Shoda, Y., & Smith, R. (2004). Conceptualizing personality as a cognitive-affective processing

system: a framework for models of maladaptive behavior patterns and change. Behavior

Therapy, 35, 147-165.

Shoda, Y., Tiernan, S., & Mischel, W. (2002). Personality as a dynamical system: Emergence of

stability and distinctiveness from intra and interpersonal interactions. Personality and

Social Psychology Review, 6(4), 316-325.

Slater, A., & Tiggemann, M. (2011). Gender differences in adolescent sport participation,

teasing, self-objectification and body image concerns. Journal of Adolescence, 34, 455-

463.

Smith, R. (2006). U nderstanding Sport Behavior: A Cognitive-Affective Processing Systems

Approach. Journal of Applied Sport Psychology, 18(1), 1-27.

doi:10.1080/10413200500471293

Smith, R. (2008). Advances in cognitive-social-personality theory: applications to sport

psychology. Revista de Psicologia del Deporte, 17(2), 253-276.

Sorrell, J. (1994). Remembrance of things past through writing: Esthetic patterns of knowing in

nursing. Advanced Nursing Science, 17(1), 60-70.

Sparkes, A. (2009). Ethnography and the senses: challenges and possibilities. Qualitative

Research in Sport and Exercise, 1(1), 21-35.

125

Sperduti, M., Makowski, D., Arcangeli, M., Wantzen, P., Tiziana, Z., Lemaire, S., . . . Piolino, P.

(2017). The distinctive role of executive functions in implicit emotion regulation. Acta

Psychologica, 173, 13-20.

Staurowsky, E., DeSousa, M., Ducher, J., Gentner, N., Miller, K., Shakib, S., . . . Williams, N.

(2009). Her Life Depends on it II: Sport, Physical Activity, and the Health and Well-

Being of American Girls and Women. New York: Women's Sports Foundation.

Staurowsky, E., DeSousa, M., Miller, K., Sabo, D., Shakib, S., Theberge, N., . . . Williams, N.

(2015). Her Life Depends On It III: Sport, Physical Activity,, and the Health and Well-

Being of American Girls and Women. Retrieved from Eisenhower Park, East Meadow,

New York.

Stearns, E., & Glennie, E. (2010). Opportunities to participate: Extracurricular activities'

distribution across and academic correlates in high schools. Social Science Research, 39,

296-309.

Sturman, D., & Moghaddam, B. (2011). The neurobiology of adolescence: Changes in brain

architecture,functional dynamics, and behavioral tendencies. Neuroscience and

Biobehavioral Reviews, 35, 1704-1712.

Suitor, C., & Kraak, V. (2007). Adequacy of evidence for physical activity guidelines

development:Workshop summary. Retrieved from Washington DC:

126

Szabo, S., Tache, Y., & Somogyi, A. (2012). The legacy of Hans Selye and the origins of stress

research: a retrospective 75 years after his landmark brief "letter" to the editor of Nature.

Stress, 15(5), 472-478.

Tamminen, K., & Holt, N. (2010). Female adolescent athletes' coping: A season-long

investigation. Journal of Sports Sciences, 28(1), 101-114.

doi:10.1080/02640410903406182

Tamminen, K., Holt, N., & Crocker, P. (2012). Adolescent athletes: psychosocial challenges and

clinical concerns. Current Opinion in Psychiatry, 25(4), 293-300.

Tamminen, K., McEwen, C., & Crocker, P. (2016). Perceived parental support , pressure, and the

socialization of adolescent athletes' coping. International Journal of Sport Psychology,

47(335-354).

Thatcher, J., & Day, M. (2008). Re-appraising stress appraisals:The underlying properties of

stress in sport. Psychology of Sport and Exercise, 9, 318-335.

Thomas-Fraser, J., Cote', J., & Deakin, J. (2007). Understanding dropout and prolonged

engagement in adolescent competitive sport. Psychology of Sport and Exercise, 9, 645-

662.

Tofler, A., & Butterbaugh, G. (2005). Development overview of child and youth sports for the

twenty-first century. Clinical Sports Medicine, 24, 783-804.

127

Tomporowski, P., Lambourne, K., & Okumura, M. (2011). Physical activity interventions and

children's mental function: An introduction and overview. Preventive Medicine, 52, S3-9.

Tottenham, N., Hare, T., & Casey, B. (2011). Behavior assessment of emotion

discrimination,emotion regulation, and cognitive control in childhood,adolescence, and

adulthood. Frontiers in Psychology, 2, 1-9.

Troutman, K., & Dufur, M. (2007). From high school jocks to college grads: Assessing the long-

term effects of high school sport participation on female's educational attainment. Youth

and Society, 38(4), 443--462.

Tryon, W. (2009). Missing mechanism information. American Psychologist, 64(4), 273-287.

Ullrich-French, S., & Smith, A. (2009). Social and motivational predictors of continued youth

sport participation. Psychology of Sport and Exercise, 10, 87-95.

Van Dusen, D., Kelder, S., Kohl, H., Ranjit, N., & Perry, C. (2011). Associations of physical

fitness and academic performance among school children. Journal of School Health,

81(12), 733-740.

Vandermause, R., & Fleming, S. (2011). Philosophical Hermeneutic Interviewing. International

Journal of Qualitative Methods, 10(4), 367-377.

Wall, M., Carlson, S., Stein, A., Lee, S., & Fulton, J. (2011). Trends by age in physical activity:

Youth media campaign longitudinal survey. Medicine & Science in Sports & Exercise,

43(11), 2140-2147. doi:10.1249/MSS.0b013e31821f561a

128

Walters, S., Barr-Anderson, D., Wall, M., & Neumark-Sztainer, D. (2009). Does participation in

organized sports predict future physical activity for adolescents from diverse economic

backgrounds ? Journal of Adolescent Health, 44, 268-274.

Williams, S., Cumming, J., & Balanos, G. (2010). The use of imagery to manipulate challenge

and threat appraisal states in athletes. Journal of Sports and Exercise Psychology, 32,

339-358.

Worrell, F., Plucker, J., Simonton, D., Schultz, S., Knotek, S., Portenga, S., . . . Subotnik, R.

(2016). Competition's role in developing psychological strength and outstanding

performance. Review of General Psychology, 20(3), 259-271.

129

Appendix A Recruitment Flyer Request for Volunteers

Dear parents,

My name is Patrice Codd, and many years ago I had 2 daughters who ran for Mead high school girls’ cross country, and track and field teams under Dori Whitford. The experiences of both girls were very different, although were very important to their development as healthy adults today. Neither of the girls run competitively any more, however both consider exercise a key component of everyday living. For those of us in health care (myself), and education (Dori), this is one of our main goals; to encourage continued physical activity through adulthood. Without research, for which we have very little, we do not know how to develop programs that will encourage continued physical activity through the lifespan.

My research, entitled “The Lived Experiences of Female Athletes Engaged in High School Competitive Sport” is a one-of-a-kind qualitative study which encourages young female athletes to describe their competitive experiences during their running season, thereby allowing for a more complete understanding of what the young female experiences in competition. If there is a greater understanding of the experiences of adolescent girls in competitive sport, we might be able to design programs that would include participation of a greater number of girls in athletic activities, as well as provide opportunities for more research.

I am asking that you and your daughter consider participating in my research which I am doing for completion of my doctorate in nursing at Washington State University. Participation would consist only of a single interview about 30 minutes long where she can talk about anything related to her running experiences this year. Participation, or lack of participation, will not influence her competitive status on the team. She may refuse to participate at any time. I will be standing by the exit door of the library if you have any questions and will have consent forms which detail the research in more detail. The parent and athlete assent forms must be signed in order for the athlete to participate in the study.

Patrice Griffin-Codd ARNP, MSN, CS

130

APPENDIX B

Parental Consent Form WASHINGTON STATE UNIVERSITY College of Nursing Research Study Consent Form

Study Title: The Lived Experiences of Female Athletes Engaged in High School Competitive Sport.

Researchers: 1. Patrice Griffin-Codd ARNP, MS, PhD candidate, College of

Nursing, Washington State University. Phone 509-999-2301

2. Dr. Billie Severtsen, Associate Professor, College of Nursing

Washington State University. Phone 509-999-2301.

This research is seeking young female athlete volunteers who are participating in the current cross-country running season. We are especially interested in girls who are participating in practice and competition on a regular basis, as this study is longitudinal, and will continue throughout the season until it ends in October. There is no obligation for your daughter to participate in this study, and if she agrees to participate now, she can change her mind at any time. There will be no penalty or consequences if she decides to withdraw from the study at a later date, or not participate at all. Please read the following material. Patrice Griffin-Codd, a member of the research team, will stay after the meeting today to answer any questions.

Alternatively, she can also be contacted at any time on her cell phone number, which is 509-999-

131

2301, to answer questions. You will be able to retain a copy of this consent form for future consultation if necessary. You will be able to retain a copy of this consent form for future consultation if necessary.

What is the Purpose of this Study?

This is research that is being done to help nurses, and other health care professionals understand both the psychological and the physical experiences of being a competitive high school female athlete. A better understanding of the “lived experiences” of these high functioning athletes may provide knowledge to improve physical and psychological support and services offered to high school athletes when needed.

This research has been approved for human subject participation by the Washington State

University Institutional Review Board.

What Will My Daughter Be Asked to Do?

If your daughter participates in this study she will choose a pseudonym, or a “fake” name, to insure her privacy. She will participate in a 1:1 interview with the research team member, Patrice Griffin-Codd. The interview will be similar to a conversation, focusing on her experiences this year in cross-country running, and should take no more than 30-45 minutes. Your daughter may refuse to participate at any time, or refuse to discuss a certain topic. There are no penalties or negative consequences if she refuses to participate or answer questions.

Are There Any Risks to My Daughter’s Participation in The Study?

Competitive sports can sometimes be stressful, particularly when there are losses in competitions, problems with relationships among members of the team, or the coach. There are also joyful, fun times. All of these experiences generate emotions, which may at times be difficult to discuss. It is generally considered healthy to talk about these highly charged, emotional situations. The intent of the study is to explore these experiences and how they affect

132

the athlete. The conversations between your daughter and the researcher are private and cannot shared unless the content meets any of the conditions stated below.

There are some things for which the researcher is obligated to report by law, and this would include if your daughter reports she has been experiencing physical or sexual assaults, or has been thinking about, or threatening suicide or self-harm. In this case the researcher would notify the coach. The coach and the researcher will follow school protocol which will includes referral to the school counselor, and an emergency call for evaluation by a mental health professional if appropriate, and notification of the parents.

Will My daughters Privacy be protected?

The researchers will use your daughter’s pseudonym when referring to her during participation in the study. The only link to her real name will be on the child’s assent form and demographic form. The assent forms will be kept in a locked office, in a locked file cabinet to insure participant’s privacy. The interview with your daughter will be audio -taped for analysis at a later date. Voice recordings and transcripts will be kept on a secure WSU, HIPPA compliant website. The only individuals who will have access to these transcripts and recordings will be members of the research team, and select graduate students involved in qualitative research at the

Washington State University graduate nursing program. While the results of this research may be published or presented in professional meetings, the identities of all of the participants will remain anonymous. There is a form accompanying this consent requesting demographic data.

Please complete this form as well. All of this information will be confidential to the extent allowed by federal and state law.

Will My Daughter Get Paid?

133

Your daughter’s participation is voluntary, and deeply appreciated. As a thank you for participating in the research she will receive a 5.00 $ Amazon gift card, and a certificate documenting her participation in the research.

What If I Have Questions?

Please feel free to call Patrice Griffin-Codd at 509-999-2301, or e-mail her If you have questions about your rights as a research participant, or would like to report a concern or complaint about the study, please contact the Washington State University Institutional Review Board at (509)

335- 3668, or email irb @ WSU .EDU, or regular mail P.O. Box 643143 Neill Hall 427 Pullman,

WA. 99164-3143

What Does My Signature on This Consent Form Mean?

It means that you have been given this form and have read it, and have had the opportunity to ask questions, or voice concerns to the investigator. It means that you understand and are comfortable with your daughter’s involvement in this research study, and know that she can refuse to participate, or dropout at any time without consequences.

134

APPENDIX C Athlete Assent Form WASHINGTON STATE UNIVERSITY

College of Nursing

Study Title: The Lived Experiences of Female Athletes Engaged in High School in Competitive Sport Researchers: 1. Dr. Billie Severtsen, Associate Professor, College of Nursing,

Washington State University. Phone: 509-324-7286.

2. Patrice Griffin-Codd ARNP, M.S.N., PhD candidate, College

of Nursing, Washington State University. Phone: 509-999-2301

You are being asked to participate in research that seeks to understand the experiences of high school female competitive athletes during the course of a single track and field season. This information will be used by nurses, and other healthcare personnel to improve their ability to help athletes cope with stress, and physical issues associated with the competitive environment.

There is no obligation to participate in this study, and if you agree to participate now, you can change your mind at any time. There will be no penalty or consequences if you decide to withdraw from the study, or not participate at all.

Please read the following material, and if you have any questions please let Patrice

Griffin-Codd know. Patrice Griffin-Codd, a member of the research team, will stay after the parent meeting today to answer any questions. She will come to the remainder of the team practices this week, and to some of the team practices next week, to be available for questio

135

1. Signature of Parent ______Date ______

Printed Name of

Parent______

I understand that the interview with the co-pi Patrice Griffin-Codd will be audio-taped, and will be stored on a highly confidential WSU website and server, using only your daughter’s pseudonym to label the interview______(initials).

Statement of Person Obtaining Informed Consent

I have carefully explained to the parents of the child in this study what they can expect.

______

I certify that when this person signs this form, to the best of my knowledge, he or she

understands the purpose, procedures, potential benefits, and potential risks of participation.

______

I also certify that he or she;

 Speaks the language used to explain this research

 Reads well enough to understand this form or, If not, this person is able to hear and

understand when the form is read to him or her.

136