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Updated: Mar 17, 2026
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School
Johna K Register-Mihalik1, Tamara C Valovich McLeod, Laura A Linnan
1*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.
Objective:
Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior.
Design:
Cross-sectional survey.
Setting:
Classroom.
Participants:
A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey.
Independent Variables:
Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career.
Main Outcome Measures:
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.
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