Factors that influence concussion knowledge and self-reported attitudes in high school athletes

BACKGROUND: Many organizations and health care providers support educating high school (HS) athletes about concussions to improve their attitudes and behaviors about reporting. The objectives of this study were to determine if previous education, sport played, and individual factors were associated with better knowledge about concussion and to determine if more knowledge was associated with improved self-reported attitudes toward reporting concussions among HS athletes. METHODS: We conducted a survey of HS athletes aged 13 years to 18 years from two large, urban HSs. Players were recruited from selected seasonal (fall and winter) as well as men and women's sports. During preseason, each participant was given a survey asking about his or her previous education, current knowledge, and self-reported attitudes and behaviors about reporting concussions. Bivariate and multivariate linear regression was used to evaluate the association of age, sex, sport, and previous concussion education with knowledge and self-reported attitudes and behaviors about reporting concussions. RESULTS: Surveys were completed by 496 athletes. The median age was 15 years, and 384 (77.4%) were male. A total of 212 (42.7%) participated in football, 123 (24.8%) in soccer, 89 (17.9%) in basketball, and 72 (14.5%) in wrestling. One hundred sixteen (23.4%) reported a history of concussion. Improved knowledge regarding concussions was not associated with improved self-reported behaviors (p = 0.63) in bivariate regression models. The multivariate model demonstrated that older age (p = 0.01) and female sex (p = 0.03) were associated with better knowledge. Younger age (p = 0.01), female sex (p = 0.0002), and soccer participation (p = 0.02) were associated with better self-reported behaviors around reporting concussions. CONCLUSION: Previous education on concussions was less predictive of knowledge about concussions when controlling for other factors such as sport and sex. Younger age, female sex, and soccer participation were more likely to be associated with better self-reported behaviors. Future studies need to focus on the development of interventions to improve concussion-specific knowledge and behaviors.