The burden of unsubstantiated messaging: collegiate athletes’ chronic traumatic encephalopathy mechanism beliefs
Beidler E, Bogar K, Wallace J, McAllister-Deitrick J, Anderson M, Schatz P. Inj. 2021 Aug 24;35(10):1259-1266. doi: 10.1080/02699052.2021.1972146
Over half of the collegiate athletes believe that chronic traumatic encephalopathy (CTE) is caused by a premature return to play or multiple concussions, which suggests concussion education programs need to be updated.
We need data-driven and theory-backed endeavors to update our concussion education programs to address limited knowledge retention, stagnant reporting behaviors, and incorrect belief formation (e.g., CTE caused by contact sport participation). To inform this process, we need to determine what student-athletes believe and what factors influence those beliefs.
The authors investigated the relationship between collegiate athletes’ beliefs about CTE mechanisms and factors such as sex, diagnosed concussion history, formal education, and additional concussion information sources.
The authors surveyed 838 collegiate athletes (62% male; ~20 years of age) from 7 NCAA Divisions I, II, and III institutions. Participants were excluded if they were actively recovering from a concussion, had a concussion within the past 3 months, or failed to complete the survey. The survey included items regarding demographics, diagnosed concussion history, previous sport-related education (formal), additional sources of concussion information, and beliefs on multiple concussions and premature return to play as risk factors for CTE.
Nearly 50% of the student-athletes reported receiving formal concussion education, and less than half reported that they received this education from a healthcare professional (athletic trainers, doctors, sports medicine team). Outside of formal education, the student-athletes sought information from athletic trainers (70%), school-based professionals (66%), or coaches (55%). To a lesser extent, student-athletes obtained concussion information from NCAA (46%), family (35%), social media (31%), or the news (19%). Thirty percent of the athletes reported a history of a concussion.
Most athletes endorsed sustaining multiple concussions (58%) or premature return to play (59%) as causes for CTE. An athlete who was male; had a history of concussion; or received concussion information from formal concussion education, the NCAA, or sports news was more likely to believe these factors caused CTE.
Even though NCAA policy mandates concussion education, only 50% of the student-athletes recalled receiving formal concussion education. It was also surprising that the student-athletes that received formal education reported that they believed multiple concussions lead to CTE. However, over half of the collegiate athletes believed these unsubstantiated CTE claims (premature RTP and multiple concussions). CTE mechanism beliefs were more pronounced in males, athletes with a history of concussion, and those who acquired information from NCAA or sports news. Hence, the NCAA could update their concussion education programs to clarify what we know and do not know about CTE.
The authors suggested we need to deliver a more memorable, scientifically substantiated concussion education program to collegiate athletes. Therefore, medical professionals with advanced concussion training should engage policymakers to promote quality education programs that offer factual details about the level of evidence surrounding concussions (e.g., causes of CTE).
Questions for Discussion
Have you heard of someone being diagnosed with CTE? What do you want to know about CTE diagnosis?
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Written by: Jane McDevitt
Reviewed by: Jeffrey Driban
It spreads through the brain. It will spread as you age.” Lee Goldstein One of the authors of the study, BU Professor of Neurology and Pathology Ann McKee, said the results confirmed a suspicion raised by the team’s analysis of human brains. “We know from our own pathologic work that about 20 percent of the brain donors with CTE never had a concussion,” she said, “so there’s always been a bit of a disconnect between concussion and the development of CTE.” Goldstein’s team also found CTE in mice with few hits to the head.
Researchers say a new study provides the “best evidence to date” that hits to the head — even ones that do not lead to concussions — cause CTE, the degenerative brain disease found in contact-sport athletes, members of the military and others who suffer repetitive head trauma. The Boston University study published Thursday in the neurology journal “Brain” emphasizes that focusing on the link between concussions and CTE is misguided, as the results of the study show preventing all hits to the head is the key to preventing CTE. The study also found that CTE can begin earlier than previously thought.