Soc Sci Med. 2015 Apr 20;134:66-75. doi: 10.1016/j.socscimed.2015.04.011. [Epub ahead of print]

Concussion under-reporting and pressure from coaches, teammates, fans, and parents.

Kroshus E1, Garnett B2, Hawrilenko M3, Baugh CM4, Calzo JP5.

Author information

• 1Harvard School of Public Health, Department of Social and Behavioral Science, USA; National Collegiate Athletic Association, Sport Science Institute, USA; Harvard University, Edmond J. Safra Center for Ethics, USA. Electronic address: emk329@mail.harvard.edu.
• 2University of Vermont, College of Education and Social Services, Department of Education, USA. Electronic address: bgarnett@uvm.edu.
• 3Clark University, Department of Clinical Psychology, USA. Electronic address: mhawrilenko@clarku.edu.
• 4Harvard University, Edmond J. Safra Center for Ethics, USA; Harvard University, Interfaculty Initiative in Health Policy, USA; Boston Children's Hospital, Division of Sports Medicine, USA. Electronic address: cbaugh@g.harvard.edu.
• 5Boston Children's Hospital, Division of Adolescent & Young Adult Medicine, USA; Harvard Medical School, Department of Pediatrics, USA. Electronic address: jerel.calzo@childrens.harvard.edu.

Abstract

Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact-from coaches, teammates, parents, and fans-and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes' parents, rather than focusing solely on modifying the individual's reporting cognitions.