title: Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes.
abstract: OBJECTIVE
  Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Classroom.
  
  
  METHODS
  A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey.
  
  
  METHODS
  Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career.
  
  
  METHODS
  The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude.
  
  
  RESULTS
  A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333).
  
  
  CONCLUSIONS
  Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.
authors.affiliation: *Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ‡Athletic Training Programs and School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona; Departments of §Health Behavior; and ¶Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Johna K
authors.initials: JK
authors.lastname: Register-Mihalik
authors.forename: Tamara C
authors.initials: TC
authors.lastname: Valovich McLeod
authors.forename: Laura A
authors.initials: LA
authors.lastname: Linnan
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D012574:Schools; D011795:Surveys and Questionnaires