concussion attitudes, health disparities, high school athletes, reporting behaviors, public health


Medicine and Health Sciences


Objective: Studies related to attitudes of concussion have been growing in athletic populations. While racial and socioeconomic disparities exist in knowledge and awareness of concussion, it remains unclear the effect of disparities on attitudes of concussion and reporting behaviors. The purpose of this study was to examine racial and socioeconomic disparities on attitudes towards concussion and the decision to remain in play with a suspected concussion.

Design: This cross-sectional study included 577 athletes between the ages of 13-19 (16.0 ± 1.2) years from 14 high schools. Participants completed a knowledge and attitudes instrument assessing general attitudes of concussion using 7 Likert-scale attitude questions followed by 2 additional questions assessing the decision to continue play while symptomatic. Differences in attitudes of concussion between race and socioeconomic school type were examined using independent t-tests. A multivariable linear regression model was utilized to determine which demographic factors were associated with athletes’ attitude scores. Multivariable logistic regression models were utilized to determine what demographic variables were associated with athletes’ continuation of play in a practice or a game.

Results: Differences in attitude scores between race were observed, with black athletes demonstrating lower scores than white athletes (pp=.04) and sex (OR: 0.59, 95% CI [0.36,0.96], p=.03) were, with females less likely to remain in a practice than males. Further, race and socioeconomic school type were not significantly associated with remaining in a game; however, attitude (OR: 0.97, 95% CI [0.95,0.99], p=.01) and sex (OR: 0.56 95% CI [0.35,0.90], p=.02) were, with females less likely to remain in a game than males.

Conclusions: Disparities exist between race and socioeconomic school type on attitude of concussion. Black athletes and athletes attending Title I high schools had poorer attitude scores compared to white athletes and athletes attending non-Title I schools. Race was significantly associated with lower concussion attitude scores. The poorer, yet moderate concussion attitude scores suggest concussion education efforts be concentrated towards closing the disparity gap. Further, addressing concussion attitudes would likely also help to shift athletes’ decisions to remain in a practice or game while symptomatic.