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Perspectives and Practices of Athletic Trainers and Team Physicians Implementing the 2010 NCAA Sickle Cell Trait Screening Policy

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Journal of Genetic Counseling


Sickle cell trait (SCT) is usually benign. However, there are some conditions that may lead to SCT-related problems and put athletes with the trait at particular risk. In 2010 the National Collegiate Athletic Association (NCAA) issued a policy that required all Division I (DI) student-athletes to confirm their SCT status or sign a liability waiver to opt out of testing. Athletic trainers and team physicians play key roles in the policy implementation and we examined their perceptions and practices. Between December 2013 and March 2014 we interviewed 13 head athletic trainers and team physicians at NCAA Division I colleges and universities in North Carolina. We used an interview guide with open-ended questions covering knowledge of SCT, historical screening and education practices, current implementation, and policy benefits and challenges. Participants were knowledgeable about SCT and thought the policy was beneficial in providing SCT health information to and for student-athletes. Schools varied in provision of genetic counseling, offering the waiver, SCT tests administered, and other aspects. Challenges included: insufficient guidance from the NCAA; financial considerations; and misunderstanding of the relationships of race and ancestry to SCT risk. Athletic staff found the policy valuable, but felt it needs clarity and standardization.

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  • Acharya, K., Benjamin, H. J., Clayton, E. W., & Ross, L. F. (2011). Attitudes and beliefs of sports medicine providers to sickle cell trait screening of student athletes. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 21(6), 480–485. doi:10.1097/JSM.0b013e31822e8634.

    Article  Google Scholar 

  • Aloe, A., Krishnamurti, L., & Kladny, B. (2011). Testing of collegiate athletes for sickle cell trait: What we, as genetic counselors should know. Journal of Genetic Counseling, 20(4), 337–340. doi:10.1007/s10897-011-9366-9.

    Article  PubMed  Google Scholar 

  • American Society of Hematology. (2012). Statement on Screening for Sickle Cell Trait and Athletic Participation. Retrieved July 29, 2015, from

  • Baskurt, O. K., & Meiselman, H. J. (2007). Sickle cell trait should be considered asymptomatic and as a benign condition during physical activity. Journal of Applied Physiology, 103(6), 2142–2142. doi:10.1152/japplphysiol.00886.2007.

    Article  PubMed  Google Scholar 

  • Bediako, S. M., Lanzkron, S., Diener-West, M., Onojobi, G., Beach, M. C., & Haywood, C. (2016). The measure of sickle cell stigma: Initial findings from the improving patient outcomes through respect and trust study. Journal of Health Psychology, 21(5), 808–820. doi:10.1177/1359105314539530.

    Article  PubMed  Google Scholar 

  • Bernard, H. R., & Ryan, G. (2010). Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Blinder, M., & Russel, S. (2014). Exertional sickling: Questions and controversy. Hematology Reports, 6(5502), 66–70. doi:10.4081/hr.2014.5502.

  • Bonham, V. L., Dover, G. J., & Brody, L. C. (2010). Screening student athletes for sickle cell trait--a social and clinical experiment. The New England Journal of Medicine, 363(11), 997–999. doi:10.1056/NEJMp1007639.

    Article  CAS  PubMed  Google Scholar 

  • Brown, G. (2013, January 19). DIII approves sickle cell measure. Retrieved from

  • Caughey, M. C., Loehr, L. R., Key, N. S., Derebail, V. K., Gottesman, R. F., Kshirsagar, A. V., & Heiss, G. (2014). Sickle cell trait and incident ischemic stroke in the atherosclerosis risk in communities study. Stroke, 45(10), 2863–2867. doi:10.1161/STROKEAHA.114.006110.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Drehner, D., Neuhauser, K. M., Neuhauser, T. S., & Blackwood, G. V. (1999). Death among U.S. air Force basic trainees, 1956 to 1996. Military Medicine, 164(12), 841–847.

    CAS  PubMed  Google Scholar 

  • Eichner, R. (2010). Sickle cell trait in sports. Current Sports Medicine Reports, 9(6), 347–351.

    Article  PubMed  Google Scholar 

  • Eichner, R. (2011). Sickle cell considerations in athletes. Clinics in Sports Medicine, 30(3), 537–549. doi:10.1016/j.csm.2011.03.004.

    Article  PubMed  Google Scholar 

  • Ferrari, R., Parker, L. S., Grubs, R. E., & Krishnamurti, L. (2015). Sickle cell trait screening of collegiate athletes: Ethical reasons for program reform. Journal of Genetic Counseling, 24(6), 873–877. doi:10.1007/s10897-015-9849-1.

  • Ferster, K., & Eichner, R. (2012). Exertional sickling deaths in Army recruits with sickle cell trait. Military Medicine, 177(1), 56–59.

  • Folsom, A. R., Tang, W., Roetker, N. S., Kshirsagar, A. V., Derebail, V. K., Lutsey, P. L., et al. (2015). Prospective study of sickle cell trait and venous thromboembolism incidence. Journal of Thrombosis and Haemostasis, 13(1), 2–9. doi:10.1111/jth.12787.

    Article  CAS  PubMed  Google Scholar 

  • Gardner, J. W., & Kark, J. A. (1994). Fatal rhabdomyolysis presenting as mild heat illness in military training. Military Medicine, 159(2), 160–163.

    CAS  PubMed  Google Scholar 

  • Grant, A. M., Parker, C. S., Jordan, L. B., Hulihan, M. M., Creary, M. S., Lloyd-Puryear, M. A., & Atrash, H. K. (2011). Public health implications of sickle cell trait: a report of the CDC meeting. American Journal of Preventive Medicine, 41(6 Suppl 4), S435–S439. doi:10.1016/j.amepre.2011.09.012.

    Article  PubMed  Google Scholar 

  • Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82.

    Article  Google Scholar 

  • Harmon, K. G., Drezner, J. A., Klossner, D., & Asif, I. M. (2012). Sickle cell trait associated with a RR of death of 37 times in national collegiate athletic association football athletes: a database with 2 million athlete-years as the denominator. British Journal of Sports Medicine, 46(5), 325–330.

  • Hendrickson, B. (2012, January 30). DII moves toward start of testing for sickle cell trait. Retrieved from

  • Jenerette, C. M., & Brewer, C. (2010). Health-related stigma in young adults with sickle cell disease. Journal of the National Medical Association, 102(11), 1050–1055.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jordan, L. B., Smith-Whitley, K., Treadwell, M. J., Telfair, J., Grant, A. M., & Ohene-Frempong, K. (2011). Screening U.S. college athletes for their sickle cell disease carrier status. American Journal of Preventive Medicine, 41(6 Suppl 4), S406–S412. doi:10.1016/j.amepre.2011.09.014.

    Article  PubMed  Google Scholar 

  • Jung, A. P., Selmon, P. B., Lett, J. L., & Petrella, J. K. (2011). Survey of sickle cell trait screening in NCAA and NAIA institutions. The Physician and Sportsmedicine, 39(1), 158–165. doi:10.3810/psm.2011.02.1873.

    Article  PubMed  Google Scholar 

  • Kark, J. (2000, December 20). Sickle cell trait. Retrieved from

  • Kark, J., Labotka, R., Gardner, J., & Ward, F. (2010). Prevention of exercise related death unexplained by preexisting disease associated with sickle cell trait (SCT) without hemoglobin screening or Hb specific management. Blood, 116(21), 945.

  • Kark, J., Posey, D., Schumacher, H., & Ruehle, C. (1987). Sickle-cell trait as a risk factor for sudden death in physical training. The New England Journal of Medicine, 317(13), 781–787.

  • Key, N., & Derebail, V. (2010). Sickle-cell trait: Novel clinical significance, (2010), Hematology, 418–422. doi:10.1182/asheducation-2010.1.418.

  • Koopmans, J., Cox, L. A., Benjamin, H., Clayton, E. W., & Ross, L. F. (2011). Sickle cell trait screening in athletes: Pediatricians’ attitudes and concerns. Pediatrics, 128(3), 477–483. doi:10.1542/peds.2011-0187.

    PubMed  Google Scholar 

  • Lane, P. (2001). Newborn Screening for Hemoglobin Disorders. Retrieved February 24, 2017, from

  • Lawrence, R., & Shah, G. (2014). Athletes’ perceptions of National Collegiate Athletic Association-mandated sickle cell trait screening: insight for academic institutions and college health professionals. Journal of American College Health, 62(5), 343–350.

  • MacQueen, K. M., McLellan, E., Kay, K., & Milstein, B. (1998). Codebook development for team-based qualitative analysis, Cultural Anthropology Methods 10(2), 31–36.

  • Miles, M. B., Huberman, A. M., & Saldana, J. (2013). Qualitative data analysis: A Methods sourcebook (Third ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Mitchell, B. L. (2007). Sickle cell trait and sudden death--bringing it home. Journal of the National Medical Association, 99(3), 300–305.

    PubMed  PubMed Central  Google Scholar 

  • Naik, R. P., & Haywood, C. (2015). Sickle cell trait diagnosis: Clinical and social implications. Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2015(1), 160–167. doi:10.1182/asheducation-2015.1.160.

  • National Collegiate Athletic Association. (2014). 2014–15 NCAA Sports Medicine Handbook. Retrieved from

  • National Institutes of Health, National, Heart, Lung, and Blood Institute. (2016, August 2). How Is Sickle Cell Disease Diagnosed? - NHLBI, NIH. Retrieved February 21, 2017, from

  • Natowicz, M. R., & Alper, J. S. (1991). Genetic screening: Triumphs, problems, and controversies. Journal of Public Health Policy, 12(4), 475–491.

    Article  CAS  PubMed  Google Scholar 

  • Njororai, W. W. S. (2012). Challenges of being a black student athlete on U.S. College Campuses. Journal of Issues in Intercollegiate Athletics, 5, 40–63.

  • NVivo qualitative data analysis software; QSR International Pty Ltd. Version 10. (2012).

  • Ojodu, J., Hulihan, M. M., Pope, S. N., & Grant, A. M. (2014). Incidence of sickle cell trait-United States, 2010. Morbidity and Mortality Weekly Report, 63(49), 1155.

    PubMed  Google Scholar 

  • Quick, H. (2011). Privacy for safety: The NCAA sickle cell trait testing policy and the potential for future discrimination. Iowa Law Review, 97, 665–692.

  • Stein, R. (2010, September 20). Colleges mandate sickle cell testing. The Washington Post. Retrieved from

  • Tarini, B. A., Brooks, M. A., & Bundy, D. G. (2012). A policy impact analysis of the mandatory NCAA sickle cell trait screening program. Health Services Research, 47(1 Pt 2), 446–461. doi:10.1111/j.1475-6773.2011.01357.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • The Sickle Cell Disease Association of America. (2015a). Sickle Cell Disease Global. Retrieved from

  • The Sickle Cell Disease Association of America. (2015b). Sickle cell trait and athletics: Executive summary. Retrieved July 20, 2015, from

  • Thompson, A. A. (2013). Sickle cell trait testing and athletic participation: a solution in search of a problem?. Hematology. American Society of Hematology. Education Program, (1), 632–637. doi:10.1182/asheducation-2013.1.632.

  • Tsaras, G., Owusu-Ansah, A., Boateng, F. O., & Amoateng-Adjepong, Y. (2009). Complications associated with sickle cell trait: A brief narrative review. The American Journal of Medicine, 122(6), 507–512. doi:10.1016/j.amjmed.2008.12.020.

    Article  PubMed  Google Scholar 

  • Wailoo, K. (2006). Stigma, race, and disease in 20th century America. Lancet, 367(9509), 531–533. doi:10.1016/S0140-6736(06)68186-5.

    Article  PubMed  Google Scholar 

  • Witt, G. (2010). Autopsy cites sickle cell trait in A&T death. Greensboro News & Record, p. A1. Accessed 24 May 2017.

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The authors are grateful to the athletic trainers and team physicians who took the time to participate in the study. We also appreciate the intellectual contributions of Doriane Coleman at Duke Law School, and Althea Grant at the Centers for Disease Control and Prevention, in the early phase of the project. This research was supported, in part, by a grant from the National Collegiate Athletic Association (NCAA), Indianapolis, Indiana. The NCAA is only a funding partner; not a driver of our research project or outcomes.

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Correspondence to Charmaine DM Royal.

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Author McDonald, Author Creary, Author Powell, Author Daley, Author Baker, and Author Royal declare that they have no conflicts of interest.

Human Studies and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained orally from all participants in the study.

Animal Studies

No animal studies were carried out by the authors for this article.

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McDonald, M.A., Creary, M.S., Powell, J. et al. Perspectives and Practices of Athletic Trainers and Team Physicians Implementing the 2010 NCAA Sickle Cell Trait Screening Policy. J Genet Counsel 26, 1292–1300 (2017).

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