The completeness and potential effectiveness of preparticipation screening for high school student athletes in the United States was critiqued in 1997 and judged largely inadequate for raising the suspicion of potentially lethal cardiovascular diseases. Eight years later, the 2005 history and physical examination questionnaires approved in the states as guides to examiners were compared with those available in 1997 to determine whether changes had taken place in the preparticipation cardiovascular screening process for United States high school athletes. The 1997 and 2005 screening questionnaires were analyzed with respect to the 12 items recommended by the American Heart Association (AHA). The approved screening examiners in each state were also systematically analyzed. In 1997, 43 states had approved questionnaire forms, including 12 (28%) with zero or only 1 to 4 AHA items and 17 (40%) with >or=9 items. In 2005, 48 states had approved forms, but only 1 (2%) had <or=4 AHA items, and 39 (81%) had >or=9 items (p=0.005). Between 1997 and 2005, the mean cumulative number of items on all forms increased from 6.8+/-4 to 9.7+/-2, a 43% improvement (p<0.01). Although 21 states showed no or little change (addition of 0 to 2 AHA items), 20 (42%) showed substantial increases of >or=5 items. Over the 8-year period, the number of states approving nonphysician examiners, including nurse practitioners (21 to 37) physician assistants (21 to 35), and naturopathic clinicians or chiropractors (11 to 18), increased by 64% (p<0.01). In conclusion, the completeness of state-approved history and physical examination preparticipation screening questionnaires for high school students engaged in organized competitive sports improved markedly over the period from 1997 to 2005. Paradoxically, however, legislation in several states has increased the number of nonphysicians performing screening examinations (including chiropractors and naturopathic clinicians).