The survey was distributed in paper format to HS and collegiate athletes. Attached to the survey was a letter explaining to the athlete that the survey was voluntary, anonymous, and would not affect their sport participation in any way. Anumber was assigned to each athlete’s survey for analysis purposes, but no identifying personal information was collected. Athletes took the survey in groups among their peers, but not under the influence or direction of their parents, coaches, or trainers. We distributed the survey to all athletes who were present but did not examine the full roster of each team we were surveying, raising the possibility that we did not survey the entire team. However, all participants present at the preparticipation physical responded to the survey.