Concussions! Youth Athletes at Risk: A Socio-behavioral Framework to Increase Recognition and Reporting of, & Response to Concussions in Middle School-Aged Athletes. Public

Abstract

Sporting activities remain an integral part of most societies. Therefore, it is of great benefit to discuss and create safer ways to play and enjoy sporting activities without the grave consequences that could occur from unreported or untreated concussions.

Rationale: In spite of what is known, regarding the attitudes, behavior, gender differences, and concussion rates in high school and collegiate athletes, there is a gap of knowledge that exists regarding determinants of, and behavior regarding concussions in athletes younger than high school. Therefore, this proposal aims to a) understand concussion-related behavior in middle school-aged children b) develop a social cognitive theory based, concussion prevention App based intervention c) increase the recognition and reporting of, and response to concussions among middle school-aged children and adolescents.

Research questions: 1) What are the social and behavioral determinants of concussion in youth athletes? 2) Are there gender differences in awareness, knowledge, attitude, behavior, perception, value, self-efficacy pertaining to sports concussions in middle school aged students? 3) How does an interactive App based intervention affect attitudes and behavior regarding sports-related concussions in middle school aged children?

Method: After IRB approval, a Pilot School in the Southeastern US will be conveniently selected. Middle School-aged participants with assents and parental consents will be recruited (n=384).

Intervention: An interactive concussion prevention app will be developed and used weekly for six months during a physical education class to increase recognition of concussion symptoms, and empower participants to report and respond to concussion symptoms.

Instruments: We will use a mixed-methods approach via pre-and post-intervention surveys and focus groups to capture data on middle school participants' knowledge, attitudes, and beliefs regarding concussions.

Analysis: We will use Epi-info and Stata statistical package for the primary analysis of the quantitative data. The trends and patterns of behavior regarding concussions will be analyzed according to the procedures outlined in Patton (2014). An evaluation of the intervention will be completed before disseminating the results. Lessons learned from this pilot study will be helpful in developing larger scale programs targeted at primary and secondary prevention of sports-related concussions in youth athletes.

Table of Contents

Chapter 1: Introduction. 1

Introduction and Rationale. 1

Statement of the Problem. 4

Theoretical framework. 6

Purpose Statement 8

Intervention. 9

Research Questions. 10

Significance Statement 11

Definition of Terms. 12

Chapter 2: Literature Review. 14

Concussion overview. 14

Epidemiology. 17

Sporting activity. 22

Gender differences. 25

Sports culture. 28

Socio-behavioral factors. 29

Applying theories and frameworks. 37

Concussion Education Programs. 52

Novel Concussion intervention program. 55

Review of Literature related to Methods. 56

Chapter 3: Methodology. 57

Grant announcement. 57

Grantor request. 59

Grant review process. 61

Grant proposal reviewers. 62

Protection of Human Rights. 69

Ethical Considerations. 71

Population and Sample. 72

Justification for subject Population. 73

Introduction to methodology. 74

Grant Proposal Time Chart. 75

Research design. 76

Procedures. 79

Instruments. 82

Intervention Program. 87

Data analysis. 98

Limitations. 99

Evaluation Plan. 101

Chapter 4: Reviewers Comments. 110

Reviewer 1. 110

Reviewer 2. 113

Reviewer 3. 121

Chapter 5: Final Grant Proposal Plan. 131

Appendices.

Appendix A: Time and Task Chart 163

Appendix B: Survey Questionnaire. 164

Appendix C: Focus Group Guide Questions. 174

Appendix D1: Individual level BDI Logic Model 177

Appendix D2: Logic Model-RcRn App Use. 179

Appendix D3: Logic Model-RcRn Evaluation Plan. 180

Appendix E1: Investigator 1-Biosketch. 181

Appendix E2: Investigator 2-Biosketch. 186

Appendix E3: Investigator 3-Biosketch. 188

Appendix F: Personnel Justification. 191

Appendix G: Facilities and other resources. 194

Appendix H: Protection of Human Subjects. 195

Appendix I: Letters of Support 196

Appendix J: External Grant Proposal Review Template 198

Appendix K: RFA 201

References. 204

List of Figures.

Figure 1: Social Ecological Model 51

Figure 2: RcRn App Framework. 92

Figure 3: RcRn App Schema. 94

List of Tables.

Table 1: Schedule of Activities. 95

Table 2: Roles and Responsibilities of the evaluation team. 102

Table 3: Data Plan Evaluation Criteria. 107

Table 4: Communication and Reporting Plan. 109

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Children Concussion prevention Socio-behavioral framework
Committee Chair / Thesis Advisor	Baldwin, Grant, CDC
Committee Members	Greenspan, Arlene, CDC
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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