Restricted accessResearch articleFirst published online 2025-2
Understanding beliefs and perceptions of parents,coaches,and organizational leaders toward non-concussive head impact exposure in youth American football
Concussions are a prevalent public health concern; however, non-concussive head impacts without signs and symptoms of concussion may have a greater influence on brain health. The objective of this study was to apply components of the health belief model to perceptions of non-concussive head impacts and preventative efforts to reduce head impacts in youth American football and thematically analyze responses across parents with children participating in youth football, coaches, and organizational leaders. Parents, coaches, and organizational leaders of a local youth football league were invited to complete a one-time online anonymous survey assessing football and sport history, knowledge, beliefs, perceived susceptibility, perceived severity, self-efficacy, and demographics. Principal factor analysis was conducted prior to scoring measurements evaluated in this study. Parents perceived the susceptibility and severity of head impacts in football to be greater than coaches and organizational leaders; however, coaches and organizational leaders had greater beliefs and self-efficacy surrounding head impact safety efforts in football compared to parents. Understanding beliefs and perceptions of key stakeholders in the youth football community is critical to the development and implementation of prevention programs aimed at reducing head impact exposure in the sport.
BryanMARowhani-RahbarAComstockRD, et al.Sports- and recreation-related concussions in US youth. Pediatrics2016; 138: e20154635–e20154635.
2.
RosenthalJAForakerRECollinsCL, et al.National high school athlete concussion rates from 2005–2006 to 2011–2012. Am J Sports Med2014; 42: 1710–1715.
3.
StammJMBourlasAPBaughCM, et al.Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology2015; 84: 1114–1120.
4.
AloscoMLTripodisYJarnaginJ, et al.Repetitive head impact exposure and later-life plasma total tau in former National Football League players. Alzheimers Dement (Amst)2017; 7: 33–40.
5.
MontenigroPHAloscoMLMartinBM, et al.Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J Neurotrauma2017; 34: 328–340.
6.
TaggeCAFisherAMMinaevaOV, et al.Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. Brain2018; 141: 422–458.
7.
NowinskiCJRhimHCMcKeeAC, et al.‘Subconcussive’ is a dangerous misnomer: hits of greater magnitude than concussive impacts may not cause symptoms. Br J Sports Med2024; 58: 754–756.
8.
McAllisterTMcCreaM. Long-Term cognitive and neuropsychiatric consequences of repetitive concussion and head-impact exposure. J Athl Train2017; 52: 309–317.
9.
DavenportEMUrbanJEMokhtariF, et al.Subconcussive impacts and imaging findings over a season of contact sports. Concussion2016; 1(4): CNC19. DOI:https://doi.org/10.2217/CNC-2016-0003.
10.
MainwaringLFerdinand PennockKMMylabathulaS, et al.Subconcussive head impacts in sport: a systematic review of the evidence. Int J Psychophysiol2018; 132: 39–54.
11.
WallaceJAffagatoRBrookeM, et al.Racial disparities in parent knowledge of concussion and recognition of signs and symptoms. J Safety Res2020; 75: 166–172.
12.
WallaceJCovassinTMoranR. Racial disparities in concussion knowledge and symptom recognition in American adolescent athletes. J Racial Ethn Health Disparities2018; 5: 221–228.
13.
KroshusEKerrZYLeeJGL. Community-Level inequalities in concussion education of youth football coaches. Am J Prev Med2017; 52: 476–482.
14.
Haarbauer-KrupaJKRegister-MihalikJKNedimyerAK, et al.Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5–10 years. J Safety Res2021; 78: 203.
15.
GabrielEHMcCannRSHochMC. Use of social or behavioral theories in exercise-related injury prevention program research: a systematic review. Sports Med2019; 49: 1515–1528.
16.
Register-MihalikJKWilliamsRMMarshallSW, et al.Demographic, parental, and personal factors and youth athletes’ concussion-related knowledge and beliefs. J Athl Train2018; 53(8): 768–775. DOI:https://doi.org/10.4085/1062-6050-223-17..
17.
WallaceJCovassinTNogleS, et al.Knowledge of concussion and reporting behaviors in high school athletes with or without access to an athletic trainer. J Athl Train2017; 52: 228–235.
18.
KroshusEBaughCMDaneshvarDH, et al.Understanding concussion reporting using a model based on the theory of planned behavior. J Adolesc Health2014; 54(3): 269–274. DOI:https://doi.org/10.1016/J.JADOHEALTH.2013.11.011.
19.
SchmidtJDSuggsDWRawlinsMLW, et al.Coach, sports medicine, and parent influence on concussion care seeking intentions and behaviors in collegiate student-athletes. J Clin Transl Res2020; 5: 215.
20.
McGlashanAJFinchCF. The extent to which behavioural and social sciences theories and models are used in sport injury prevention research. Sports Med2010; 40: 841–858.
21.
Weber RawlinsMLWelch BaconCETomporowskiP, et al.Using the health belief model to predict concussion-reporting intentions and behaviour. Brain Inj2020; 34: 16455–16465.
22.
CranmerGALaBelleS. Using the disclosure decision-making model to understand high school football players’ disclosures of concussion symptoms. Int J Sport Commun2018; 11: 241–260.
23.
ChrismanSPDWhitlockKBKroshusE, et al.Parents’ perspectives regarding age restrictions for tackling in youth football. Pediatrics2019; 143(5): e20182402. DOI:https://doi.org/10.1542/PEDS.2018-2402.
24.
SarmientoKWaltzmanDBorradaileK, et al.A qualitative study of youth football coaches’ perception of concussion safety in American youth football and their experiences with implementing tackling interventions. Int Sport Coach J2021; 8: 244–252.
25.
NanosKNFrancoJMLarsonD, et al.Youth sport-related concussions: perceived and measured baseline knowledge of concussions among community coaches, athletes, and parents. Mayo Clin Proc2017; 92: 1782–1790.
26.
KayMCRegister-MihalikJKFordCB, et al.Parents’ and child’s concussion history as predictors of parental attitudes and knowledge of concussion recognition and response. Orthop J Sports Med2017; 5: 232596711774237.
PfallerAYBrooksMAHetzelS, et al.Effect of a new rule limiting full contact practice on the incidence of sport-related concussion in high school football players. Am J Sports Med2019; 47: 2294–2299.
29.
EliasonPHGalarneauJMKolstadAT, et al.Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med2023; 57: 749–761.
30.
WaltzmanDWomackLSThomasKE, et al.Trends in emergency department visits for contact sports–related traumatic brain injuries among children — United States, 2001–2018. MMWR Morb Mortal Wkly Rep2020; 69: 870–874.
31.
StemperBDShahASHarezlakJ, et al.Comparison of head impact exposure between concussed football athletes and matched controls: evidence for a possible second mechanism of sport-related concussion. Ann Biomed Eng2019; 47: 2057–2072.
32.
UrbanJEDavenportEMGolmanAJ, et al.Head impact exposure in youth football: high school ages 14 to 18 years and cumulative impact analysis. Ann Biomed Eng2013; 41: 2474–2487.
33.
MarksMEHolcombTDPritchardNS, et al.Characterizing exposure to head acceleration events in youth football using an instrumented mouthpiece. Ann Biomed Eng2022; 50: 1620–1632.
34.
RowsonBDumaSM. A review of on-field investigations into the biomechanics of concussion in football and translation to head injury mitigation strategies. Ann Biomed Eng2020; 48: 2734–2750.
35.
McKeeAC. The neuropathology of chronic traumatic encephalopathy: the status of the literature. Semin Neurol2020; 40: 359–369.
36.
AloscoMLSternRA. The long-term consequences of repetitive head impacts: chronic traumatic encephalopathy. Handb Clin Neurol2019; 167: 337–355.
37.
SarmientoKDonnellZBellE, et al.A qualitative study of barriers and opportunities for concussion communication and management among parents of youth sports athletes. J Concussion2019; 3: 205970021986186.
38.
JerebineAMohebbiMLanderN, et al.Playing it safe: the relationship between parent attitudes to risk and injury, and children’s adventurous play and physical activity. Psychol Sport Exerc2024; 70: 102536.
39.
OlsenLLLinYIshikawaT, et al.Comparison of risk engagement and protection survey (REPS) among mothers and fathers of children aged 6-12 years. Inj Prev2019; 25: 438–443.
40.
WaltzmanDSarmientoKDaughertyJ. Factors that may influence Americans’ views on when children should start playing tackle football. J Athl Train2024; 59: 22–29.
41.
KerrZYNedimyerAKKayMC, et al.Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US. J Sport Health Sci2021; 10: 113–121.
42.
HibshmanNYengo-KahnAWisemanA, et al.Child participation in collision sports and football: what influences parental decisions?Phys Sportsmed2022; 50: 171–180.
43.
SarmientoKDonnellZHoffmanR. A scoping review to address the culture of concussion in youth and high school sports. J Sch Health2017; 87: 790–804.
44.
KroshusEBaughCMHawrilenkoMJ, et al.Determinants of coach communication about concussion safety in US collegiate sport. Ann Behav Med2015; 49: 532–541.
45.
SarmientoKDaughertyJDePadillaL. Youth and high school sports coaches’ experience with and attitudes about concussion and access to athletic trainers by sport type and age of athlete coached. J Safety Res2019; 69: 217–225.
46.
KelleyMEEspelandMAFloodWC, et al.Comparison of head impact exposure in practice drills among multiple youth football teams. J Neurosurg Pediatr2019; 23(3): 381–389. DOI:https://doi.org/10.3171/2018.9.PEDS18314
47.
CampolettanoETRowsonSDumaSM. Drill-specific head impact exposure in youth football practice. J Neurosurg Pediatr2016; 18: 536–541.
48.
UrbanJEFloodWCZimmermanBJ, et al.Evaluation of head impact exposure measured from youth football game plays. J Neurosurg Pediatr2019; 24(2): 190–199. DOI:https://doi.org/10.3171/2019.2.PEDS18558.
49.
HolcombTDMarksMEStewart PritchardN, et al.Characterization of head acceleration exposure during youth football practice drills. J Appl Biomech2023; 39: 157–168.
50.
KerrZYKroshusELeeJGL, et al.Coaches’ implementation of the USA football “heads up football” educational program. Health Promot Pract2018; 19(2): 184–193. DOI:https://doi.org/10.1177/1524839917700398.
51.
KerrZYGildnerPParkerSK, et al.Sport culture and communication among middle school athletes, parents, and staff: A qualitative study. PLoS One2023; 18(3): e0282252. DOI:https://doi.org/10.1371/JOURNAL.PONE.0282252.
52.
KerrZYChandranANedimyerAK, et al.Concussion incidence and trends in 20 high school sports. Pediatrics2019; 144(5): e20192180. DOI:https://doi.org/10.1542/PEDS.2019-2180.
53.
BretzinACPollard-McGrandyAMDavisER, et al.Avenues for prevention using the epidemiology of sport-related concussion from a large high school surveillance study. Neurosurg Focus2024; 57: E3.
54.
SchmidtJDJohnsonRSLempkeLB, et al.Youth tackle football head-impact estimation by players and parents: is the perception the reality?J Athl Train2023; 58: 285–292.
55.
GuilfoyleLKennyICO’SullivanK, et al.Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review. Br J Sports Med2024; 58: 144–154.
56.
KempeHRasmussen-BarrEvon RosenP. Coaches’ experiences of injury prevention in youth elite athletes: an interview study of 10 coaches. Phys Ther Sport2023; 63: 112–117.
57.
HawkinsonLEYatesLMinnigMC, et al.Understanding youth sport Coaches’ perceptions of evidence-based injury-prevention training programs: a systematic literature review. J Athl Train2022; 57: 877.
58.
TorgJSGuilleJTJaffeS. Injuries to the cervical spine in American football players. J Bone Joint Surg Am2002; 84: 112–122.
59.
SwartzEEMyersJLCookSB, et al.A helmetless-tackling intervention in American football for decreasing head impact exposure: a randomized controlled trial. J Sci Med Sport2019; 22: 1102–1107.
60.
ChampagneAADistefanoVBoulangerMM, et al.Data-informed intervention improves football technique and reduces head impacts. Med Sci Sports Exerc2019; 51: 2366–2374.
61.
SwartzEEBroglioSPCookSB, et al.Early results of a helmetless-tackling intervention to decrease head impacts in football players. J Athl Train2015; 50: 1219–1222.
62.
KerrZYYearginSWValovich McLeodTC, et al.Comprehensive coach education reduces head impact exposure in American youth football. Orthop J Sports Med2015; 3: 232596711561054.
63.
KerrZYYearginSValovich McLeodTC, et al.Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthop J Sports Med2015; 3: 2325967115594578. DOI:https://doi.org/10.1177/2325967115594578.
64.
KelleyMEKaneJMEspelandMA, et al.Head impact exposure measured in a single youth football team during practice drills. J Neurosurg Pediatr2017; 20(5): 489–497. DOI:https://doi.org/10.3171/2017.5.PEDS16627.
65.
CampolettanoETGellnerRARowsonS. High-magnitude head impact exposure in youth football. J Neurosurg Pediatr2017; 20: 604–612.
66.
FeissRSLutzMMoodyJR, et al.A systematic review of coach and parent knowledge of concussion. J Concuss2020; 4. DOI:https://doi.org/10.1177/2059700219900053.
67.
CusimanoMDZhangSTopolovec-VranicJ, et al.Factors affecting the concussion knowledge of athletes, parents, coaches, and medical professionals. SAGE Open Med2017; 5: 205031211769479.
68.
LinACSalzmanGABachmanSL, et al.Assessment of parental knowledge and attitudes toward pediatric sports-related concussions. Sports Health2015; 7: 124–129.
McKeeACSteinTDHuberBR, et al.Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathol2023; 145: 371.
71.
NowinskiCJBureauSCBucklandME, et al.Applying the Bradford Hill criteria for causation to repetitive head impacts and chronic traumatic encephalopathy. Front Neurol2022; 13: 938163.
72.
DaneshvarDHNairESBaucomZH, et al.Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat Commun2023; 14(1): 3470. DOI:https://doi.org/10.1038/S41467-023-39183-0.
73.
SeifertJShahASHarezlakJ, et al.Time delta head impact frequency: an analysis on head impact exposure in the lead up to a concussion: findings from the NCAA-DOD care consortium. Ann Biomed Eng2022; 50: 1473–1487.
74.
RowsonSCampolettanoETDumaSM, et al.Accounting for variance in concussion tolerance between individuals: comparing head accelerations between concussed and physically matched control subjects. Ann Biomed Eng2019; 47: 2048–2056.
75.
KoerteIKWiegandTLTBonkeEM, et al.Diffusion imaging of sport-related repetitive head impacts-A systematic review. Neuropsychol Rev2023; 33: 122–143.
