Sports Medicine Research: In the Lab & In the Field: Athletic Trainers in High Schools Could Help to Bridge the Gap in Racial Disparities in Adolescent Athlete Health Care (Sports Med Res)
Monday, May 8, 2017

Athletic Trainers in High Schools Could Help to Bridge the Gap in Racial Disparities in Adolescent Athlete Health Care

Racial Disparities in Concussion Knowledge and Symptom Recognition in American Adolescent Athletes

Wallace J., Covassin T., Moran R. J Racial Ethn Health Disparities. 2017; ahead of print

Take Home Message: White athletes had more concussion knowledge compared to African Americans; however, African Americans that had access to an athletic trainer had greater knowledge of concussion sign and symptoms than those without an athletic trainer.

Concussion education is necessary to ensure athletes recognize the 22+ concussion signs and symptoms and the consequences of a second impact while symptomatic. In schools with no access to athletic trainers this education may be difficult to deliver or reinforce. Moreover, many youth American football participants are African American children who are more likely to have worse outcomes following a concussion, which may be a result of the absence to quality concussion education, care, and follow up that an athletic trainer provides. Unfortunately, there is a lack of research investigating the racial disparities that may exist. Therefore, the authors of this survey study aimed to identify if concussion knowledge differences exist between communities that service underserved, African-American athletes compared to white athletes, and to explore dissimilarities in concussion education knowledge between African American athletes with and without access to an athlete trainer. The authors developed a 40-question survey that assessed demographics (5 questions), knowledge of concussion, and self-understanding of concussion (35 questions). Total knowledge was calculated by summing the correct answers, where a score of 35 represented a greater amount of concussion knowledge. Five hundred and seventy-seven athletes (72% males; 65% African American; ~16 years old) participating in a school sport at 14 schools from 2 metropolitan cities in the state of Michigan between September 2014 and April 2015 completed the survey. All the athletes received concussion education as implemented by state concussion law. Of the African American participants only 41% had access to an athletic trainer. With respect to white participants, 84% had access to an athletic trainer. The authors revealed disparities in levels of concussion knowledge between African American and white athletes. However, African American athletes with access to an athletic trainer had higher scores compared with African American athletes with no access to an athletic trainer. The authors also found that African American athletes less frequently recognized all signs of symptoms of concussion compared to white athletes, and athletes that lack access to an athletic trainer are less likely to recognize all concussion signs and symptoms. Lastly, the authors found that after controlling for sex, grade, presence of athletic trainer, and school type, race was the main predictor of concussion knowledge; where African American athletes were predicted to have poorer knowledge of concussion scores than white athletes.

The authors found racial differences in knowledge of concussion. White adolescent athletes have more concussion knowledge than African American athletes. The authors found an alarming amount of African American athletes (~60%) lack access to an athletic trainer. This may be one reason that African American athletes had a difficulty identifying all the signs and symptoms of concussions compared with white athletes or those that had access to an athletic trainer. Therefore, the authors suggest that African American athletes without an athletic trainer may be less informed about the signs and symptoms of a concussion. This lack of education may lead to a lack of understanding about the importance of recognizing and reporting a potential concussion, which can lead to worse clinical outcomes (e.g., protracted recovery, increased risk of lower extremity injury, and neurocognitive deficits). Though all the athletes received some concussion education as part of the state law, the authors suggest that the athletes may not read or understand the material if they have no one to follow up with for questions. Furthermore, they may be missing out on further concussion education that an athletic trainer may provide such as baseline testing, prevention, and management programs that could help elevate concussion understanding. This study portrays a public health concern, where underserved adolescents are lacking access to proper medical professionals such as athletic trainers. If athletes are lacking proper health care to assist in the prevention, recognition and management of injuries such as concussions they are at a greater risk of poorer outcomes and possibly a catastrophic injury. Greater efforts need to be made to ensure underserved communities have access to athletic trainers to offer education, prevention programs, and treatment.

Question for Discussion: Do you believe athletic trainers could help bridge the gap in health disparities? Do you know of school that lack athletic trainers? If so, are they urban based?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:
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Wallace J, Covassin T, & Moran R (2017). Racial Disparities in Concussion Knowledge and Symptom Recognition in American Adolescent Athletes. Journal of Racial and Ethnic Health Disparities PMID: 28389906

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