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.

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.

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
by: Jeff Driban

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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