Understanding factors influencing concussion knowledge and attitudes among youth sport athletes and parents

It is estimated that over 35 million children ages 5-18 participate in organized sports each year. In this age group, concussion is one of the most discussed injuries as it can affect all aspects of life. Despite increased awareness and increased knowledge of issues concerning concussion, few studies have addressed the youth sport population. Specifically, no studies have concurrently addressed how individuals feel about concussion, what individuals know about concussion and what behaviors are occurring around the injury in this age group. These are important concepts to understand, as we work to develop community based, sustainable interventions that incorporate multiple levels of the sports framework (Figure 1), aimed at preventing concussion and improving outcomes following injury.  Many thanks to Dr. Johna Register-Mihalik for contributing this week’s EXSS Impact Blog post.

Figure 1

Figure 1

Why did you do this study?

Traumatic brain injury (TBI), specifically concussion, is one of the most complex injuries (Figure 2) to prevent and manage in sports medicine. In addition, it is considered an elusive injury as it is often not “visible”. As a result, concussion is one of the most discussed injuries concerning youth aged athletes. To further compound the importance and complexity of TBI in sports, according to the Centers for Disease Control, there are between 1.6 and 3.8 million sport-related TBIs that occur each year.


Figure 2

Previous work conducted through the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center here in the Department of Exercise and Sport Science has corroborated previous studies in finding that over 50% of concussions in high school sports go unreported and therefore cannot be diagnosed and properly managed. In addition, this previous work found that knowledge levels about concussion, as well as attitudes about concussion, were moderate at best among high school student-athletes and that more favorable attitudes were associated with improved reporting behaviors more so than better knowledge.

Despite this heightened interest and data from the high school setting pointing to significant disclosure issues, few studies have addressed knowledge of concussion, attitudes about concussion and behaviors around concussion in the youth sport community. Therefore, the purpose of our study was to examine knowledge and attitudes concerning concussion among youth aged athletes and their parents, in an effort to better understand concussion-related issues in this vulnerable population. Among athletes, due to their young age, we only examined basic knowledge concepts. For parents, extensive knowledge and attitude concepts were examined.

What did you do and what did you find in this study?

We measured knowledge and attitudes using a pre-validated survey instrument in both youth athletes and their parents. We found that athlete knowledge, and parental knowledge and attitude were moderate at best, despite the data being collected after wide scale implementation of community based concussion education efforts through various state laws and organizations. For athletes, we observed higher knowledge scores among older athletes and athletes from North Carolina compared to Arizona. For parents, younger individuals had better knowledge, but worse attitudes concerning concussive injuries. Parents with a personal history of concussion also had more favorable attitudes about concussion. Among parents, there was no correlation between their knowledge level and their attitudes about concussion.

How do these findings impact the public?

Our findings suggest that overall knowledge in the sample of youth athletes as well as knowledge and attitudes in the parent sample were moderate at best, with a wide range scores. These findings and recent literature reiterate that current educational efforts in youth sport need to be improved and that a one size fits all approach may not be an effective mandate regarding concussion education among youth athletes and their parents. The disconnection of knowledge and attitudes among the parents further clarifies that increasing knowledge alone is unlikely to change behaviors as attitudes and behaviors share a close link. Healthcare providers and health educators should consider these factors when educating parents about concussion.

When combined with other youth sports injury prevention studies among young athletes based here in the Department of Exercise and Sport Science, these findings further elucidate the importance of properly developed and implemented injury prevention paradigms in youth sport. Future research should work to develop multidisciplinary and collaborative interventions that not only effectively improve knowledge and attitude, but also change behaviors concerning concussion, as well as other injuries in these young athletes.

*Research completed in collaboration with A.T. Still University/WakeMed Health & Hospitals and through funding provided by the National Operating Committee on Standards for Athletic Equipment


Register-Mihalik JK, McLeod TC, Marshall SW, Mayfield RM, Linnan LA, Mihalik JP, De Maio VJ, Guskiewicz KM. Influence of demographic factors and concussion history on concussion knowledge and attitudes among youth sport parents. 2014 National Athletic Trainers’ Association Annual Meeting. Journal of Athletic Training. 49(3), S142. (June 25-28, 2014).

Register-Mihalik JK, Guskiewicz KM, Valovich McLeod TC, Mayfield RM, Linnan LA, Mihalik JP, De Maio VJ, Marshall SW. Influence of demographic factors and concussion history on concussion knowledge among youth athletes. 2014 American College of Sports Medicine Annual Meeting. Medicine & Science in Sports and Exercise. 46(5S), 161-165. (May 27-May 31, 2014).