Association Between Neighborhood Characteristics and Parent-Reported Lifetime History of Concussion Among Adolescents in the United States

OBJECTIVE: Examine the association between neighborhood characteristics and parent-reported lifetime concussion history. SETTING: National Survey of Children's Health, a nationally representative survey of parents of children ages 0-17 years in the United States. PARTICIPANTS: Parent/guardian(s) (hereafter: parents) with children ages 0-17 years. DESIGN: Cross-sectional. MAIN MEASURES: Neighborhood disorder was assessed via items asking whether the child's neighborhood had (1) sidewalks or walking paths, (2) a park or playground, (3) a recreation center/community center/Boys & Girls Club, (4) a library or bookmobile, (5) litter or garbage on the streets or sidewalks, (6) poorly kept or rundown housing, and (7) vandalism such as broken windows or graffiti. Neighborhood cohesion was assessed via items asking whether (1) people in the neighborhood help each other out, (2) neighbors watch out for each other's children, (3) children live in a safe neighborhood, (4) families know where to go for help in the community when difficulties arise, and (5) children are safe at school. Lifetime concussion was assessed with a parent-reported response to a single question. RESULTS: Parent responses for 119 008 children and adolescents (mean age 11.6 years; 48.9% girls) were included. Overall, 5.2% of children and adolescents had a parent-reported history of concussion. The mean neighborhood disorder and cohesion scores were 1.7 (SD = 1.5) and 17.0 (SD = 2.8), respectively. In a multivariable model including both neighborhood disorder and cohesion while adjusting for age, sex, race/ethnicity, household socioeconomic status, past-year sports participation, lifetime ADHD diagnosis, greater neighborhood cohesion was associated with lower odds of lifetime concussion (adjusted odds ratio [95% confidence interval] = 0.96 [0.94-0.98], P < .001). CONCLUSIONS: Safer and more supportive built environments, and greater community social cohesion, may help reduce concussion risk. Future longitudinal studies are needed to clarify causal pathways and identify potential community-level intervention targets to reduce concussion risk disparities.