Factors and expectations influencing concussion disclosure within NCAA DivisionⅠathletes:A mixed methodological approach

Background:Participation in sports is associated with many benefits to all aspects of health;however,it also comes with the risk of injury,particularly concussions.Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms.Although recent research has explored factors affecting concussion disclosure,use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs.Therefore,the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association(NCAA)athletes that may influence concussion disclosure.Methods:This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports,all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview.Eligible athletes were at least 18 years old and on an NCAA roster.The surveys focused on previous concussion-related disclosure behaviors,knowledge,attitudes,beliefs,norms,and intentions about disclosing concussion.Interviews focused on the athletes’experiences related to concussion disclosure.Survey data were analyzed using descriptive statistics and Mann-Whitney U tests.Interviews were analyzed using a Consensual Qualitative Research tradition.Results:Participants had good concussion knowledge(median=46.0),positive attitudes(median=38.0),strong beliefs(median=13.0),and strong intentions to disclose concussion symptoms(median=7.0).None of the constructs differed by participants’gender.Although quantitative findings were mostly positive,interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult.Educational efforts,sport culture,and medical professional presence were the primary facilitators discussed by participants.Stigma,pressure,and a lack of team support were perceived as disclosure barriers.Conclusion:The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions.Interventions must prioritize stakeholder-and team-based perspectives on concussion to establish a network supportive to disclosure.

Exertional heat illness risk factors and physiological responses of youth football players

Objective:To determine which intrinsic and extrinsic exertional heat illness(EHI)risk factors exist in youth American football players and observe perceptual and physiological responses of players during events(games and practices).Methods:Cross-sectional cohort study observing 63 youth football players,varying in position.Independent variables were league(weightrestricted(WR,n=27)and age-restricted(AR,n=36))and event type.Dependent variables were anthropometrics,work-to-rest ratio,and wet bulb globe temperature.Descriptive variables included preparticipation examination and uniform configuration.A subset of 16 players participated in physiological variables(heart rate and gastrointestinal temperature).Data collection occurred on 7 AR and 8 WR nonconsecutive practices and the first 3 games of the season.Results:Mean values for anthropometric variables were higher(p<0.05)in the AR league than the WR league.Work time(χ^2(1,111)=4.232;p=0.039)and rest time(χ^2(1,111)=43.41;p<0.001)were significantly greater for games,but ratios were significantly higher for practices(χ^2(1,111)=40.62;p<0.001).The majority of events(77%)observed were in black and red flag wet bulb globe temperature risk categories.A total of 57%of the players had a preparticipation examination,and up to 82%of events observed were in full uniforms.Individual gastrointestinal temperature and heart rate responses ranged widely and no players reached critical thresholds.Conclusion:Extrinsic(disproportionate work ratios,environmental conditions)and intrinsic(higher body mass index)EHI risk factors exist in youth football.Certain risk factors may be influenced by event and league type.National youth football organizations need to create thorough guidelines that address EHI risk factors for local leagues to adopt.

Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US

Background:Developing appropriate concussion prevention and management paradigms in middle school(MS)settings requires understanding parents’general levels of concussion-related knowledge and attitudes.This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children(aged 10-15 years).Methods:A panel of 1224 randomly selected U.S.residents,aged ≥18 years and identifying as parents of MS children,completed an online questionnaire capturing parental and child characteristics.The parents’concussion-symptom knowledge was measured using 25 questions,with possible answers being“yes”,“maybe”,and“no”.Correct answers earned 2 points,“maybe”answers earned 1 point,and incorrect answers earned 0 point(range:0-50;higher scores=better knowledge).Concussion care-seeking attitudes were also collected using five 7-point scale items(range:5-35;higher scores=more positive attitudes).Multivariable ordinal logistic regression models identified predictors of higher scores.Models met proportional odds assumptions.Adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs)(excluding 1.00)were deemed statistically significant.Results:Median scores were 39(interquartile range:32-44)for symptom knowledge and 32(interquartile range:28-35)for care-seeking attitude.In multivariable models,odds of better symptom knowledge were higher in women vs.men(aOR=2.28;95%CI:1.71-3.05),white/non-Hispanics vs.other racial or ethnic groups(aOR=1.88;95%CI:1.42-2.49),higher parental age(10-year-increase aOR=1.47;95%CI:1.26-1.71),and greater competitiveness(10%-scale-increase aOR=1.24;95%CI:1.13-1.36).Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs.other racial or ethnic groups(aOR=1.45;95%CI:1.06-1.99)and in older parental age(10-year-increase aOR=1.24;95%CI:1.05-1.47).Conclusion:Characteristics of middle school children’s parents(e.g.,sex,race or ethnicity,age)are associated with their concussion-symptom knowledge and care-seeking attitudes.Parents’variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.