Randomized evaluation of CDC HEADS UP concussion education materials for youth sport coaches.

Kroshus E, Zhou H, Ledsky R, Sarmiento K, DePadilla L. J Neurotrauma. 2023 Jan 24. doi: 10.1089/neu.2022.0504. Epub ahead of print. PMID: 36694461.

Take-Home Message

After introducing youth sports coaches to the Centers for Disease Control and Prevention (CDC) HEADS UP materials during a season, more coaches reported better concussion knowledge and communication with athletes about concussion safety than before the season.


Coaches play a key role in shaping how athletes learn and report concussions. One of the most prominent and comprehensive forms of concussion education for youth coaches is the CDC HEADS UP Program online training. While the educational content has been evaluated, we lack randomized control trials to assess how the CDC HEADS UP Program influences behavioral changes during a sports season.

Study Goal

The authors investigated youth sports coach communication with youth athletes about concussion safety during a sports season in the presence of the CDC HEADS UP Program and a typical education strategy.


The authors randomized 75 YMCA branches in 15 regional associations (764 youth sport coaches) into either receiving the CDC HEADS UP training or control (their typical education strategy). The coaches answered demographic questions such as sex, sport they coach, and history of making a concussion diagnosis. The CDC youth sports materials have four main components: 1) an online training module completed before the start of the season, 2) supplementary resources (stickers, poster, fact sheet), 3) 8 weekly CDC Heads up messages for coaches to relay to the athletes, and 4) guidance for how local organizations can integrate HEADS UP resources and messaging with existing YMCA “values.” The coaches completed surveys before and after a competitive season. The authors then assessed communication behavior with three questions:

  1. “Did you meet with your athletes?” (yes/no)
  2. “Did you review with your athletes the YMCA rules regarding concussion safety?” (yes/no),
  3. “How often did you speak informally with athletes on your team about concussion safety?” (never/occasionally/frequently).

The authors also evaluated communication intention by assessing how likely they are to hold a team meeting to talk formally or informally about concussion safety. They also evaluated concussion identification (sign/symptom knowledge), concussion management (likeliness to return an athlete to sport), and exposure to non-intervention concussion information (app, TV/movie, website information).


A total of 537 coaches (82% male, 93% coached high contact sport, 20% made a concussion diagnosis call) completed pre-season surveys (432 in intervention, 105 in control) and 411 completed post-season surveys (295 in intervention, 116 in control). Unfortunately, only 184 coaches completed pre- and post-season surveys (148 in intervention, 36 in control). Overall, demographic data were similar between groups, though coaches in the intervention group were more likely to coach a high-contact sport.

After introducing coaches to the HEADS UP program, more coaches communicated with athletes about concussion safety than before the season. Those in the control group may also have more coaches communicate with athletes, but most likely, this improvement was less than in the Heads Up group. Concussion knowledge and communication intention were greater at the end of the season among coaches who received the HEADS UP program. The authors did not observe this improvement among coaches in the control group.


The CDC HEADS UP Program is the most commonly used concussion education program in the United States. The program has important content and increases a coach’s knowledge immediately after completing the program. This study suggests the program may also improve communication and knowledge throughout a season. However, to know for sure, we will need a large randomized trial that compares changes in communication behavior and knowledge throughout a season between a group of coaches that completed the HEADS UP Program and another group that received a typical education. Understanding how well the HEADS UP Program performs in the real world will help us determine if additional educational material may be needed during the season. In the meantime, this study offers more support for the CDC Heads UP youth sports materials.

Clinical Implications

Clinicians should encourage youth sports organizations to incorporate and adapt the CDC HEADS UP Program. If a clinician is concerned about the effectiveness of the material, then they can supplement the material with their resources.

Questions for Discussion

Do you use CDC Heads Up Materials to educate your student-athletes in coaches? If so, have you seen similar results in communication and knowledge? If not, what do you use for your concussion education?

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Written by Jane McDevitt
Reviewed by Jeffrey Driban

Evidence-Based Assessment of Concussion Course - 5 EBP CEUs