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Study finds racial disparities in concussion symptom knowledge among college athletes

( May 7, 2021 - Among collegiate football players and other athletes, Black athletes recognize fewer concussion-related symptoms than their White counterparts, reports a study in the May/June issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published in the Lippincott portfolio by Wolters Kluwer.

"Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion symptom knowledge than White collegiate-athletes," according to the new research by Jessica Wallace, PhD, MPH, LAT, ATC, of University of Alabama, Tuscaloosa, and colleagues. The study also finds racial differences in the sources of concussion symptom knowledge.

Need for 'equitable strategies' to communicate concussion information In the study, 768 collegiate athletes - about 83 percent White and 17 percent Black - completed a standard assessment of concussion symptom knowledge. Participants included 196 football players, of whom 59 percent were White and 41 percent were Black.

Scores on the concussion symptom knowledge questionnaire were compared for Black and White athletes, with adjustment for other characteristics. The athletes were also asked about their sources of information about concussion symptoms.

"Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes," according to the authors. The difference was small: average scores on the 34-point questionnaire were 27.7 for White athletes and 25.9 for Black athletes. However, the between-group difference remained statistically significant after adjustment for other factors. The findings were similar for football players compared to all athletes.

Concussion symptom knowledge varied for a range of sleep, mood, physical, and cognitive symptoms of concussion. In particular, Black athletes were less likely to correctly recognize the symptoms of feeling like "in a fog," nausea or vomiting, and feeling more irritable/angry.

Most athletes identified athletic trainers as a main source of concussion information. White athletes were somewhat more likely to mention other school-based professionals (such as teachers or nurses), online medical sources, or the National Collegiate Athletic Association (NCAA). Black athletes were more likely to cite referees as a source of concussion information.

Basic knowledge of concussion symptoms is fundamental to prompt recognition and reporting of concussions. Studies have suggested that 50 to 80 percent of concussions may go unreported.

In previous studies, Dr. Wallace and colleagues reported racial disparities in concussion knowledge among high school and youth athletes. Concussion knowledge was lowest for athletes attending schools of lower socioeconomic status and without access to athletic trainers.

These differences in concussion knowledge may extend to the college level, the new study suggests. The disparity may be related to historic and systemic bias/discrimination and inequitable access to healthcare and other resources, or to racial distrust in medical resources and healthcare overall. "All of these contributing factors of inequity and disparity at the community level, youth sports level, and high school sports level could impact exposure and/or receptiveness to concussion education materials that may ultimately explain the lower concussion symptom knowledge of Black collegiate-athletes," Dr. Wallace and coauthors write.

The researchers emphasize the need for strategies to ensure equitable access to concussion education and prevention that do not perpetuate disparity: "Moving forward, a conscious attempt is needed to redevelop concussion education initiatives as racially, culturally, and linguistically inclusive, addressing the needs of all collegiate athletes equally and equitably."

The NCAA provides educational resources on concussion:

Click here to read "Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes." DOI: 10.1097/HTR.0000000000000672


About The Journal of Head Trauma Rehabilitation The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of "knowledge informing care" and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America.

About the Brain Injury Association of America The Brain Injury Association of America is the country's oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.

About Wolters Kluwer Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit and follow us on LinkedIn and Twitter @WKHealth.

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[] Study finds racial disparities in concussion symptom knowledge among college athletes