Abstract

Context: There are limited data concerning differences in concussion education exposure and how education exposures relates to care-seeking and symptom disclosure, specifically in Division I student-athletes.

Objective: Investigate demographic characteristics associated with concussion education exposure and examine whether overall education exposure (yes vs. no) and education source exposure number (multiple sources vs. single source) affects concussion care-seeking and disclosure factors in Division I student-athletes.

Design: Cross-sectional survey.

Setting: Classroom or online.

Participants: NCAA Division I student-athletes (n=341).

Main Outcome Measure(s): Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion education groups. Prevalence ratios (PR) and 95% confidence intervals (CI) quantified the association between student-athlete characteristics and 1) overall concussion education exposure and 2) source exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MD) and 95%CI to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion education exposure and exposure to multiple sources. Separate multivariable binomial regression models estimated adjusted PRs and 95%CI to assess associations of intention, perceived control, and care-seeking/disclosure behaviors and overall concussion education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history.

Results: Overall, n=276 (80.9%) reported previous concussion education, with 179 (64.9%) exposed to multiple sources. Student-athletes that participated in a contact sport (adjusted PR=1.24, 95%CI=1.06,1.44) and those who had a concussion history (adjusted PR=1.19, 95%CI=1.09,1.31) had higher prevalence of previous concussion education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR=0.82, 95%CI=0.68, 0.99). Overall concussion education exposure was significantly associated with more favorable perceived social norms surrounding concussion care-seeking (adjusted MD=1.37, 95%CI=0.13,2.61).

Conclusions: Findings highlight potential differences in overall concussion education exposure and provide clinicians with information on groups who may benefit from targeted additional education.

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Author notes

Christine E. Callahan, MS, Doctoral Student: UNC Chapel Hill, CB 8700, Chapel Hill, NC 27599; chriscal@live.unc.edu; 919-962-0409

Melissa C. Kay, PhD, LAT, ATC, Assistant Professor: 118 College Drive, #5122, Hattiesburg, MS 39406; melissa.kay@usm.edu; 601-266-6508

Zachary Y. Kerr, PhD, MPH, Assistant Professor, Director: 313 Woolen Gym, CB 8700, Chapel Hill, NC 27599; zkerr@email.unc.edu; 919-962-0409

Madison T. Hinson, Student: UNC Chapel Hill, CB 8700, Chapel Hill, NC 27599; maditay@live.unc.edu; 919-962-0409

Laura A. Linnan, ScD, Senior Associate Dean, Professor, Director: 307 Rosenau Hall, CB 7440, Chapel Hill, NC 27599; linnan@email.unc.edu; 919-843-8044

Heidi Hennink-Kaminski, PhD, Senior Associate Dean, Associate Professor: UNC Hussman School of Journalism and Media, Carrol Hall, CB 3365, Chapel Hill, NC, 27599; h2kamins@email.unc.edu; 919-962-2555

Paula Gildner, MPH, Senior Research Project Manager: Sheryl Mar South Building, CB 7505, 521 S. Greensboro St., Carrboro, NC 27510; pgildner@unc.edu; 919-966-9412

Stephen W. Marshall, PhD, Director, Professor: Sheryl Mar South Building, CB 7505, 521 S. Greensboro St., Carrboro, NC 27510; smarshall@unc.edu; 919-966-3916

Megan N. Houston, PhD, ATC, Director: Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996; megan.n.houston.ctr@mail.mil; 845-938-6826

Kenneth L. Cameron, PhD, MPH, ATC FNATA, Director: Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996; kenneth.l.cameron.civ@mail.mil; 845-938-6618

Johna Register-Mihalik, PhD, LAT, ATC FACSM, Assistant Professor: address, email, and phone below