title: Community-Level Inequalities in Concussion Education of Youth Football Coaches.
abstract: BACKGROUND
  USA Football has made the Heads Up Football (HUF) concussion education program available for coaches of youth football players. Existing evidence about the effectiveness of the HUF coach education program is equivocal. For HUF and other programs, there is growing concern that even effective interventions can increase inequalities if there is different uptake or impact by SES or other demographic factors. Understanding how adoption is patterned along these lines is important for understanding equity issues in youth football. This study tested the hypothesis that there will be lower adoption of HUF among coaches of youth football players in lower-SES communities.
  
  
  METHODS
  The authors conducted a cross-sectional study of the association between community-level characteristics and number of USA Football youth league coaches who have completed HUF. Data were collected in 2014 and analyzed in 2015-2016.
  
  
  RESULTS
  Implementation of the HUF program was patterned by community-level socioeconomic characteristics. Leagues located in communities with a higher percentage of families with children aged <18 years living below the poverty line and a smaller percentage of non-Hispanic white residents tended to have leagues with smaller percentages of HUF-certified coaches.
  
  
  CONCLUSIONS
  As interventions are developed that reduce the risks of youth football, it is important to consider not just the effectiveness of these interventions, but also whether they reduce or exacerbate health inequities. These results suggest that relying on voluntary adoption of coach education may result in inequitable implementation. Further study is required to identify and remedy organizational and contextual barriers to implementation of coach education in youth sport.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington; Harborview Injury Prevention and Research Center, Seattle, Washington. Electronic address: ekroshus@uw.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Kroshus
authors.affiliation: Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.affiliation: Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina.
authors.forename: Joseph G L
authors.initials: JGL
authors.lastname: Lee
mesh_terms: D001924:Brain Concussion; D003430:Cross-Sectional Studies; D004496:Education, Continuing; D005538:Football / Q000193:education / Q000293:injuries*; D006266:Health Education; D006801:Humans; D000067009:Youth Sports / Q000193:education*