Safe sport is creating an environment for all athletes to compete and train at their best without worrying about harassment and abuse. (anonymous athlete—Youth Olympic Games 2020).

Safe sport is defined by the International Olympic Committee (IOC) as “an athletic environment that is respectful, equitable, and free from all forms of nonaccidental violence (harassment and abuse) to athletes”1 Although there are many physical and psychosocial benefits of sport participation, harassment and abuse experienced during sport can have a negative impact on athlete health and well-being. The IOC consensus statement authors identify 5 forms of harassment and abuse in sport: psychological abuse, physical abuse, neglect, sexual abuse, and sexual harassment. Much has been accomplished in the field with the introduction of the Safeguarding Framework at the 2016 Olympic Games,2 and the launch of the IOC Toolkit to assist International Federations and National Olympic Committees with the creation and implementation of athlete safeguarding policies and procedures.3 There has also been an increase in scientific publications illuminating the prevalence of harassment and abuse. In addition, knowledge translation initiatives have been developed to inform athletes of their right to safe sport that were implemented at the Youth Olympic Games (YOG) in both the Summer 20184 and the Winter 2020 editions.5

Athletes' right to a sporting experience free of harassment and abuse is underpinned by several statutory frameworks, including the Olympic Charter,6 and the IOC Code of Ethics.7 The Olympic Agenda 2020+5 identifies safe sport as a strategic priority8 ensuring targeted human and financial resources. Safeguarding is also embedded in the Athletes' Rights and Responsibilities Declaration,9 the Basic Universal Principles of Good Governance of the Olympic and Sports Movement,10 and the Olympic Movement Medical Code.11

Although safeguarding prevention and response measures should reflect the principle that everyone has a right to safe sport, research indicates that some athletes are at a higher risk, and therefore may require further specific measures, interventions, and support. Athletes at a higher risk include elite, disabled, lesbian/gay/bisexual/trans-sexual, and youth athletes.1

In a review commissioned by UNICEF, Brackenridge et al,12 underscore the importance of the protection of children in the sport context through the adoption of ethical guidelines and codes of conduct. Nite and Nauright13 highlight the importance of an integrated approach to the prevention of child maltreatment in sport, which considers social, institutional, and cultural factors. In conjunction with the 2015 IOC Youth Athlete Development Model, Mountjoy et al,14 developed a youth athlete-oriented safeguarding framework and recommendations. Youth athletes have the right to participate in sport in a safe and enjoyable environment. Their rights, which apply to the sporting context, are enshrined in the United Nations Convention on the Rights of the Child which states that:

Parties shall take all appropriate legislative, administrative, social, and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. (Article 19).15

It is therefore incumbent on all stakeholders in sport to adopt measures and principles to prevent and respond to any incident of harassment and abuse in sport that are evidence-based, athlete-centered, and that consider the unique needs of vulnerable groups such as youth athletes.

HOW COMMON IS HARASSMENT AND ABUSE IN YOUTH SPORT?

The first prevalence study assessing harassment and abuse in youth athletes was a 1997 Canadian retrospective survey that revealed that 1.9% reported sexual abuse in sport under the age of 16 years.16 An Australian study reported a sport-related sexual abuse prevalence of 9.7% before the age of 18 years.17 A UK study of 60′623 youth athletes showed that 3% experienced sexual harm; 29% sexual harassment; 24% physical harm; and 75% emotional harm during their sport experience.18 Evans et al,19 reported that 14% of 359 Canadian youth athletes experienced bullying during sport. A retrospective survey of 4000 Belgian and Dutch adults showed that 44% experienced at least one form of harassment in sport; 11% physical, 33% psychological, and 14% sexual abuse before the age of 18 years.20 A study of 480 athletes at the World Athletics U20 World Championships revealed that 18% of men (M) and 15% of women (F) recorded sexual abuse, 23%M/21%F verbal abuse, and 12%M/7%F physical abuse during their sport experience.21 All these studies were conducted in a single geographic location or sport.

The YOG, held every 4 years, brings together athletes aged 15 to 18 years from around the world. A survey of 1254 summer athletes from 32 sports and 206 countries implemented during the Summer YOG2018 held in Buenos Aires showed that 46% had a poor understanding of the term “Safe Sport.” Thirty-four percent reported that harassment and abuse “likely” or “very likely” occurred in their sport; a further 19% were “unsure.” Almost two-thirds (63%) did not know where to report allegations.4 Another study using the same methodology was conducted in the Winter YOG2020 held in Lausanne, Switzerland on 1784 athletes from 79 countries. This study demonstrated that only 10% of athletes were able to correctly define the term “Safe Sport,” and 30% expressed a lack of understanding of the concept of harassment and abuse. A third (32%) identified that harassment and abuse “likely” or “very likely” occur in their sport, and that 26% did not know where to report allegations.5 These studies on a global representation of elite youth athletes identify significant gaps that require attention and action: (1) the youth athlete voice is needed to enhance understanding and promote awareness of youth athletes' rights to safe sport; and (2) prevention initiatives are required to address harassment and abuse in youth sport around the world.

A CALL TO ACTION Empowering the Youth Athlete Voice in Safeguarding

“Nothing about us, without us” is a slogan that signifies the fight for self-empowerment that inspires the freedom of marginalized people. Although originally coined for the disability rights movement, it is applicable in youth athlete safeguarding. The athletes participating in both the Summer (2018) and Winter (2020) YOGs demonstrated a lack of understanding the term “#SafeSport” identifying the need to engage youth in safeguarding initiatives. The concept of stakeholder engagement is not new to sport, as it exists in current sport Knowledge Translation Frameworks.22 Related guiding principles documents by the World Health Organization,23 UNICEF,12 and the United Nations24 all underscore the importance of youth engagement in the planning and delivery of all youth-related initiatives.

An example of youth involvement in a safeguarding intervention is the “And You…?” program that was codesigned by youth athletes and implemented at the Winter YOG2020 in Lausanne. The objective of this project was to raise awareness of harassment and abuse among youth athletes. The 3 main messages were (1) harassment and abuse in sport is common and can exist in many forms; (2) it is necessary to identify abuse by trusting one's feelings and emotions; and (3) if you are a victim of harassment and abuse, it is important to seek help to stop the abuse. Engineers developed an immersive environment experience, during which, athletes were asked to describe their feelings, their perception of the vignettes, and their course of action. This educational tool was designed to be used as a legacy initiative post-Games in Swiss youth sport, school, and vocational training.

Prevention

To adapt the injury prevention model from sport medicine literature, the first step of primary prevention is to quantify the problem to inform prevention interventions.25 Standardized prevalence research methodology is required to achieve this objective, to facilitate aggregation of data across geographical boundaries, and to strengthen systematic reviews. Primary prevention also includes the development and implementation of safeguarding policies, procedures, and education in all sport organizations1 Secondary prevention is contingent on early detection through the availability and use of reporting mechanisms, and the management of allegations. The results of the Winter YOG2020 survey identify the elite YOG athletes' lack of knowledge of reporting mechanisms.4

The Role of the Sport Medicine Clinician

The sport medicine clinician has an important role to play in the prevention of harassment and abuse in sport. In primary prevention, he/she should advocate for the presence of safeguarding policies and procedures in all youth sports. The sport medicine clinician can raise awareness through delivering educational initiatives for athletes, their entourage, and parents. Importantly, in the provision of health care for youth athletes, all members of the youth athlete's sport medicine support team should follow the ethical code of conduct guidelines outlined in the Olympic Movement Medical Code (OMMC)11:

OMMC 1.6.5 Health care providers must oppose any sports or physical activity that is not appropriate to the stage of growth, development, general condition of health, and level of training of children. Relevant national legislation mandating that health care providers must report situations when a child is at risk must be understood and acted on by sport medicine professionals. When advising on appropriate training and competition, they must act in the best interest of the health of children, without regard to any other interests or pressures from the entourage (eg, coach, management, family, etc.) or other athletes.

The sport medicine clinician also has an integral role in secondary prevention of harassment and abuse in youth sport. All sport medicine clinicians should have the clinical competency to identify the signs and symptoms of harassment and abuse, manage disclosures of allegations, and to function as a member of a multidisciplinary team to help mitigate the physical and mental health sequelae,26,27 which should be embedded in sport medicine residency fellowship training programs.28 In the youth athlete sport setting, sport medicine clinicians should advocate against practices that may be detrimental to the developing athletes' health including age-inappropriate training, the neglect to accommodate training programs for stage of maturation, hazing practices, intentional age cheating, systematic doping, and medical mismanagement.14

CONCLUSIONS

The prevention of harassment and abuse in youth sport is everyone's responsibility. Collaborative efforts are required to foster safe sporting environments and to prevent the negative impacts of harassment and abuse on athletes' long-term health and well-being. The results from the study conducted at the Winter YOG2020 are a “Call to Action.” Youth athletes from around the world should be invited to the planning tables to ensure that safeguarding initiatives developed are relevant to their context, reflect their voices and experiences, and are engaging for the youth athletes, so that #SafeSport can be enjoyed by all.

Safe sport is integral to ensuring a sport is able to be enjoyed by all athletes and their supporters (anonymous athlete—Youth Olympic Games 2020).

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