Term of Award

Fall 2010

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)


Jiann-Ping Hsu College of Public Health

Committee Chair

Mondi Mason

Committee Member 1

Cassandra Arroyo

Committee Member 2

Alison Scott


Individuals with Sickle Cell Trait have died suddenly after extreme exertion during military training, athletic practice or games (Kerle & Nishimura, 1996; Harrelson, Fincher & Robinson, 1995; Howe & Bowden, 2007). One of those deaths, Dale Lloyd, a football player at Rice University, prompted a change in the National Collegiate Athletic Association's (NCAA) Sports Medicine Handbook Guideline 3c: The Student Athlete with Sickle Cell Trait. Effective August 2010, the NCAA Division I Proposal No. 2009-75-B mandated sickle cell trait testing in all Division I athletes unless documented results of a prior test are provided to the institution or the student-athlete declines the test and signs a written release. It is well-documented that in the United States, Sickle Cell Disease/Sickle Cell Trait primarily affects African Americans more than any other race or ethnicity (NIH, 2008). Sickle cell screening programs have been scrutinized since the 1970s (Pemberton & Wailoo, 2006) because of insensitivity to race. The recent change in NCAA Guideline 3c has been scrutinized partially for the same reason. The purpose of this mixed methods study was threefold. It was necessary to 1) determine perceptions of SCT and NCAA mandated SCT testing from college coaches and athletes' points of view; 2) determine the necessary components of the Sickle Cell Orientation and Education (S.C.OR.E) intervention that will be developed to educate intercollegiate athletes, as well as their coaches, about sickle cell trait from pre-participation screening to sickle cell trait diagnosis, and 3) to highlight the potential implications of an NCAA policy that mandates SCT testing. The PRECEDE-PROCEED (PRE-PRO) model of program planning was utilized to determine the necessary components of the intervention (Green & Kreuter, 1999). Constructs of the Health Belief Model (HBM) and Critical Race Theory (CRT) were utilized as the theoretical framework for this study. It was found that knowledge, perceived importance of an athlete knowing his/her SCT status, perception of NCAA 3c resulting in unfair treatment of athletes, perception of receiving less playing time, and perception of risk of having SCT were all associated with athletes' outlooks on SCT and NCAA SCT testing. Overall, athletes and coaches did not perceive that athletes with SCT would be discriminated against. Individual, organizational, and policy recommendations were made to address this issue.