The Underreporting of Concussion: Differences Between Black and White High School Athletes Likely Stemming from Inequiti
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The Underreporting of Concussion: Differences Between Black and White High School Athletes Likely Stemming from Inequities Jessica Wallace 1 & Abigail Bretzin 2 & Erica Beidler 3 & Tamaria Hibbler 4 & Danae Delfin 1 & Haleigh Gray 1 & Tracey Covassin 4 Received: 22 May 2020 / Revised: 1 September 2020 / Accepted: 2 September 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Previous studies have found that Black high school athletes have poorer knowledge about concussions and have fewer sports medicine healthcare resources than White athletes, but research on concussion disclosure by race is still needed. Therefore, the purpose of this study was to examine racial differences in concussion reporting behaviors between Black and White high school athletes. This cross-sectional study administered surveys to 577 high school athletes (64.5% Black; 72.3% males; 16.02 ± 1.2 years) from 14 schools (title I, n = 9; non-title I, n = 5). The survey included self-reported items on concussions and bellringers experienced during games and practices and the number of these episodes that were reported to an authoritative figure. Reasons for reporting and not reporting were also assessed. Results found that White athletes were more likely to recall experiencing a bell-ringer in games compared with Black athletes. They were also more likely to report a bell-ringer or concussion that occurred in a game. There was a significantly higher proportion of Black athletes compared with White athletes that did not report their bell-ringer experienced in games and concussions experienced in practices. White athletes were more likely than Black athletes to disclose a concussion because they thought they had a concussion, while there were no racial differences in the reasons for not reporting. The findings of this study highlight the critical role that race, as a social determinant of health, may play in concussion reporting in high school athletes. Future public health efforts should seek to further understand and overcome inequities in healthcare resources for concussion education and management. Keywords Concussion . Race . Reporting behaviors . Underreporting . Health equity . Inequities
Introduction While concussions are a prevalent issue in athletics, basic knowledge and understanding of concussion as a traumatic brain injury (TBI) is a necessary first step to reporting the injury. Though concussion diagnoses are a result of a
multimodal approach, recognition is heavily dependent on subjective symptom severity reporting from the injured athlete [1]. Athletes who fail to report concussion symptoms, intentionally or not, place themselves at risk for a prolonged recovery at best, and catastrophic injury at worst [2–5]. Athletes must be able to recognize the signs and symptoms of a
* Jessica Wallace [email protected]
Tracey Covassin [email protected]
Abigail Bretzin [email protected]
1
Department of Health Science, University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL 35487, USA
Erica B
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