Abstract

Behavioral interventions to increase disclosure and proper management of concussion in youth sports have unrealized potential when it comes to preventing concussion. Interventions have focused on changing individual athlete behavior and have fallen short of the potential for sustained systemic behavioral change. One potentially critical reason for this shortfall is that other key determinants of risk behaviors at all levels of the socio-ecological model (e.g. interpersonal, community, policy) are not addressed in extant programming. There is a critical need for theory-driven interventions that address concussion prevention and education at the community level and target sustainable culture change. The Popular Opinion Leader (POL) intervention, a multi-level intervention model previously successfully employed in multiple public health contexts, is theoretically well positioned to affect such change. POL is based on the Diffusion of Innovations framework and involves identifying, recruiting, and training well-respected and trusted individuals to personally endorse prevention and risk-reduction within their social networks. Critical behavioral changes related to concussion disclosure and management have been shown to diffuse to others if enough opinion leaders endorse and support the behaviors. This article summarizes the concepts and principles of POL and describes how it could be adapted for and implemented in youth sport settings. For optimal impact, POL needs to adapt to several factors unique to youth sports settings and culture. First, adult involvement may be important, given their direct involvement in the athlete’s medical care. However, parents and coaches’ opinions on injury care-seeking, competition, and safety may affect their perceptions of POL. Second, youth sports are structured settings both physically and socioculturally. Games and practices may provide opportunities for the informal interactions that are critical to the success of POL. However, youth sport setting membership is transient as players get older and move to other sport settings; POL approaches need to be self-sustaining despite this turnover. Moreover, stakeholder value placed on athlete development and competition, alongside safety, must be considered. Formative research is needed to ensure that POL principles are translated into the youth sport setting while maintaining fidelity to the concepts and principles that have made POL successful for other health outcomes.

Highlights

  • BackgroundPublic concern has been intensified by recent research suggesting potential short- and long-term effects associated with recurrent concussion and head impact exposure in current and former athletes (Guskiewicz et al 2003, 2005, 2007; McCrea et al 2003)

  • Concussion has been documented in emergency department (ED) populations (Bakhos et al 2010; Coronado et al 2015; Bryan et al 2016) and youth (Bryan et al 2016; Dompier et al 2015), high school (Marar et al 2012; O’Connor et al 2017), collegiate (Zuckerman et al 2015), and professional (Benson et al 2011; Green et al 2015; Orchard et al 2013; Clark et al 2017) sport settings

  • Research has focused on increasing concussion knowledge and awareness at the youth sport level (Register-Mihalik et al 2017; Kroshus et al 2015a), and policy/ legislation has been introduced at the state and organization levels to mitigate concussion risk (Pop Warner Football 2018; Little League 2016), increased knowledge and awareness does not necessarily translate to better reporting behaviors

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Summary

Background

Public concern has been intensified by recent research suggesting potential short- and long-term effects associated with recurrent concussion and head impact exposure in current and former athletes (Guskiewicz et al 2003, 2005, 2007; McCrea et al 2003). Despite this increased public awareness, prevention efforts are hindered by notable gaps in our knowledge around: (Bakhos et al 2010) head impact prevention strategies and (Coronado et al 2015) injury identification, in the context of youth populations. Examining concussion risk relative to other settings is made more difficult by the lack of studies as well as the potential differences in methodologies among studies that may bias comparisons (Kerr et al 2017a)

12 Boys’ and Girls’ Sports 11-13
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