Changes in U.S. girls' participation in high school sports: implications for injury awareness.

Context: The number of female athletes has grown exponentially since Title IX. However, little data exists on the proportion of women and girls who play each sport.

Objective: To quantify changes in female sports participation in high school sports from 1973 to 2018.

Design: Retrospective analysis of data from the National Federation of State High School Associations Participation Survey.

Setting: US high schools.

Participants: US high school athletes from 1973 to 2018.

Main Outcome Measures: Percentage of female participation for each high school sport in 5-year intervals; and changes in rates of participation by player gender and sport at designated intervals.

Results: From 1973 to 2018, the percentage of high school sports played by girls increased from 24.2% to 42.9% ([95%CI, 18.6,18.8], p < 0.0001). In the 14 sports included in our study, all had an increase in the percentage of female participation between 1973 and 2018. >80% of the increases occurred between 1973 and 1998 for all sports except lacrosse, ice hockey, football, and wrestling. Between 1998 and 2018, the percentage of girls playing each sport increased by less than 5% in all sports, except for ice hockey (11.5%, 95% CI 11.0, 12.0, p < 0.001) and wrestling (7.1%, 95% CI 6.9, 7.1, p < 0.001).

Conclusions: Girls' participation in high school sports continues to grow not only in numbers but in the types of sports played. Between 1998 and 2018, the greatest increases were noted in ice hockey and wrestling, which had fewer than 1% female participation before 1998. Physicians providing care for female athletes should be aware of these changes and understand the potential injuries associated with these sports.