Relating Athlete Perceptions of Concussion to Head Impact Biomechanics in Youth Football

Introduction: Football has high rates of concussions and repetitive subconcussive head acceleration events (HAEs; i.e., collisions not associated with acute signs and symptoms of concussions) when compared to many other youth sports.1 Concussion knowledge and beliefs have been assessed among athletic trainers, teachers, parents, and older athletes using theoretical models of health behavior;2-5 however, these constructs are not well-understood among youth athletes. Therefore, the objective of this study was to examine youth football athletes’ head kinematics and explore their beliefs surrounding concussions and concussion reporting, using the Health Belief Model.

Materials and

Methods: Thirty-eight athletes (ages 11-13) across three youth football teams participated in this study. Athletes wore instrumented mouthpieces at all contact sessions to collect head kinematic data. One team followed coach-prescribed practices (control). Two teams followed an evidence-based practice intervention program, COmmunities Aligned to reduce Concussion and Head impact exposure (COACH). At the end of their respective season, each athlete completed a survey evaluating athlete knowledge and beliefs surrounding concussions and concussion reporting guided by the Health Belief Model.5 The survey was previously developed and validated for collegiate athletes;5 therefore, wording was adapted to be suitable for middle-school-aged athletes. The survey contained the following sections: knowledge about concussions, perceived susceptibility of experiencing a concussion, perceived severity of concussions, perceived benefits of reporting a concussion, perceived barriers to reporting a concussion, cues to action for concussion reporting, and symptom and concussion reporting intentions. Items in each survey section were rated on a Likert scale from one to seven with one indicating disagreement/unwillingness and seven indicating agreement/willingness. Section composite scores were calculated by averaging the section items. Summary statistics were computed for survey and head kinematic data.

Results, Conclusions, and Discussions: The coach of one team determined practice activities. The coaches of two additional teams followed the COACH program, which was not developed to target the constructs of the Health Belief Model. Athletes experienced between 17 and 461 HAEs throughout their respective seasons. Athletes experienced mean [95CI] HAEs per athlete per practice of 3.9 [3.5, 4.2] and HAEs per athlete per competition of 6.3 [5.5, 7.2]. Athletes had perceived severity of 5.8 [5.5, 6.1] and perceived susceptibility of 3.7 [3.5, 3.9] of concussions, indicating that athletes believe concussions are serious but might not fully understand the prevalence of concussions. Athletes had concussion knowledge of 4.3 [4.2, 4.5], perceived benefits of 4.0 [3.7, 4.4], and perceived barriers of 2.6 [2.3, 2.8] of reporting concussions; youth athletes had lower perceived benefits of reporting concussions, but slightly higher perceived barriers to concussion reporting compared to collegiate athletes.5 Athletes had cues to action of 5.7 [5.3, 6.0], concussion reporting intentions of 5.6 [5.2, 5.9], and symptom reporting intentions of 4.4 [4.0, 4.9]; the youth athletes had lower concussion and symptom reporting intention composite scores than collegiate athletes.5 Fifteen athletes (39%) suspected having a concussion within the last year, with two athletes not reporting the suspected injury to their parent or coach. Four athletes, all from the same team, had clinically diagnosed concussions during their football season. All other athletes that suspected having a concussion either did not see a physician or were not diagnosed with a concussion. Athletes who reported experiencing their concussion(s), had higher composite scores for all survey sections except perceived barriers than athletes who did not experience a concussion. Figure 1 depicts mean HAEs per athlete per session and mean survey section composite scores by intervention status.

Youth athletes had generally had lower survey section composite scores than a past study with college athletes.5 Potential relationships between survey section composite scores and athlete head kinematics will be explored. These data improve our understanding of athlete beliefs surrounding concussions and could be used to inform concussion reporting interventions.

Acknowledgements (Optional): We would like to thank the youth football organizations for participating, and Tina Strates for assisting with this study. NIH NICHD (5K25HD101686 and 5F31HD110224) funded this study.

References: [1] Stern RA et al., PM&R, 3(10 Suppl 2): S460-S467, 2011. [2] O’Connor S et al., RQES, 95(1): 118-126, 2023. [3] Lininger MR et al., J Athl Train, 54(1):21, 2019. [4] Meyer CM et al., Res Q Exerc Sport, 95(1):218-226, 2024. [5] Weber-Rawlins ML et al., Brain Injury, 34(12):16455-16465, 2020.