Aggression, Violence and Injury in Minor League Ice Hockey: Avenues for Prevention of Injury.
BACKGROUND
In North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice.


METHODS
Semi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13-15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey.


RESULTS
Parents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player's social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players' need to seek revenge and how the social environment reinforces aggressive behaviors.


CONCLUSIONS
This study provides a better understanding of the players' motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules.
Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael's Hospital, Toronto, Ontario, Canada.
Michael D
MD
Cusimano
Dalhousie University Faculty of Medicine, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada.
Gabriela
G
Ilie
Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael's Hospital, Toronto, Ontario, Canada.
Sarah J
SJ
Mullen
Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael's Hospital, Toronto, Ontario, Canada.
Christopher R
CR
Pauley
University of Toronto, Family and Community Medicine, Toronto, Ontario, Canada.
Jennifer R
JR
Stulberg
Faculty of Medicine (Occupational Science and Occupational Therapy), University of Toronto, Toronto, Canada.
Jane
J
Topolovec-Vranic
Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael's Hospital, Toronto, Ontario, Canada.
Stanley
S
Zhang
D000293:Adolescent; D000374:Aggression; D001265:Athletic Injuries / Q000517:prevention & control*; D001924:Brain Concussion / Q000517:prevention & control*; D005260:Female; D006688:Hockey / Q000293:injuries*; D006801:Humans; D007858:Learning; D008297:Male; D012307:Risk Factors; D012919:Social Behavior; D000067570:Social Learning; D014754:Violence