A grounded theory of youth athlete concussion under-reporting decisions

BACKGROUND

Sport-related concussions leave youth vulnerable to significant health, physical, social, and educational disruptions. Many youth athletes under-report concussions, but the scope of the issue for this population is not well understood, nor are the underlying motivations for (under)reporting. It is necessary to examine the relationship between sport-related concussion knowledge and reporting and invite athletes to share their decision-making processes. The purpose of the research was to understand how athletes' attitudes, experiences and beliefs regarding concussions influence their under-reporting decisions and behaviours.

METHODS

We conducted semi-structured interviews with 17 elite athletes, aged 16-18 years, from individual and team sports. Data were analyzed using constructivist grounded theory and a substantive theoretical model of sport-related concussion under-reporting was developed.

RESULTS

The model demonstrates personal, social, cultural, and biophysical processes that contribute to under-reporting decisions and identifies multiple interconnected processes that contribute to 'high-risk' situations of under-reporting. Youth athletes navigate various barriers and facilitators to under-reporting, including their own desire to play, perceived stigma, concussion sense-making, and social influences. Results suggest that under-reporting by youth athletes implicates a collective, rather than individual, responsibility.

CONCLUSIONS

A theoretical grounded model for youth sport-related concussion under-reporting highlights the complexity of the decision-making process. This study offers a new framework for understanding why youth athletes may hide concussion symptoms. The model offers potential to be used to develop concussion interventions and tools for improved decision-making, and to address issues of risk and responsibility concerning concussion reporting.

Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students

BACKGROUND

Concussions affect millions of youths in the United States each year, and there is concern about long-term health effects from this injury.

PURPOSE

To examine the association between sports- or physical activity-related concussion and health risk behaviors among middle and high school students in 9 states.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Data from the 2019 middle school and high school Youth Risk Behavior Survey were used for this analysis. Nine states were identified that included the same question on concussion and similar questions on health risk behaviors in their 2019 Youth Risk Behavior Survey. Students were asked to self-report whether they had ≥1 sports- or physical activity-related concussions during the 12 months preceding the survey. Self-reported concussion was the primary outcome of interest. Other variables included sex, race/ethnicity, played on a sports team, were physically active 5 or more days/week, ever tried cigarette smoking, ever used an electronic vapor product, academic grades, drank alcohol, were in a physical fight, seriously considered attempting suicide, made a suicide plan, and attempted suicide.

RESULTS

Among the 9 states, 18.2% of middle school students and 14.3% of high school students self-reported ≥1 sports- or physical activity-related concussions. Among both middle school and high school students, the prevalence of ≥1 sports- or physical activity-related concussions was higher among students who played on a sports team, were physically active 5 or more days per week, had ever tried cigarette smoking, had ever used an electronic vapor product, had seriously considered attempting suicide, had made a suicide plan, and had attempted suicide compared with those who had not engaged in those behaviors. The prevalence of sports- or physical activity-related concussion was consistently higher among middle school students than high school students across sex, race/ethnicity, and adverse health behaviors.

CONCLUSION

Middle school students with a history of concussion warrant attention as an at-risk population for concussions and adverse health behaviors. Health care providers may consider screening students for adverse health behaviors during preparticipation examinations and concussion evaluations.

Concussion Nondisclosure in Youth Sports

CONTEXT

Researchers conducting studies about sport-related concussion (SRC) reporting behaviors and reasons for nondisclosure primarily focus on older athletic populations. Youth athletes participating in contact sports are also at risk for SRC; however, little is known about their SRC disclosure patterns and reasons for nondisclosure.

OBJECTIVE

To examine the self-reported SRC history and reasons for SRC nondisclosure of youth athletes aged 8-14 years.

DESIGN

Cross-sectional study.

SETTING

Youth athletes in organized football, ice hockey, lacrosse, or soccer.

PATIENTS OR OTHER PARTICIPANTS

A total of 411 youth athletes (boys = 70.0% [n = 287/410]; median age = 11 [interquartile range = 10-13] years).

MAIN OUTCOME MEASURE(S)

A 15-minute survey including self-reported demographics, diagnosed and nondisclosed SRC history, and reasons for nondisclosure of suspected SRCs.

RESULTS

Ten percent of respondents (n = 41/411) recounted ≥1 diagnosed SRC, 12.7% (n = 52/411) did not report a suspected SRC, 13.1% (n = 53/404) indicated they continued to practice, and 12.3% (n = 50/406) reported they continued to play in a game after a suspected SRC. Significant associations between sport and nondisclosure existed (P values < .001) but not with self-reported concussion history (P = .14). In sex-comparable analyses, boys' lacrosse players had a higher frequency of nondisclosure than girls (P = .05). The most common reasons for nondisclosure were not wanting to lose playing time (66.7%, n = 32/48), miss a game (56.3%, n = 27/48), and let the team down (43.8%, n = 21/48) and uncertainty over injury severity and the presence of SRC (43.8%, n = 21/48).

CONCLUSIONS

Ten percent of youth athletes self-reported at least 1 diagnosed SRC. However, they also described continuing to practice or play in a game after a suspected SRC. Reasons for nondisclosure at this age were similar to those reported in high school and collegiate athletes. Recent researchers suggested negative consequences of continued play with SRC, especially in the acute stages. Anyone conducting future educational initiatives should emphasize these risks and focus on reasons why athletes of both sexes withhold reporting.