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

Take-Home Message

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.

Study Goal

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.

Clinical Implications

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?

Related Posts

  1. Treatable Conditions Should be Explored in Former Athletes with CTE-Like Symptoms
  2. CTE Found In People with No History of Contact Sports
  3. When it Comes to Chronic Traumatic Encephalopathy (CTE): Perhaps Mother Doesn’t Know Best
  4. Could Playing Contact Sports in High School and College Increase Risk of CTE?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

Evidence-Based Assessment of Concussion Course - 5 EBP CEUs