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Black Athletes Recognize Fewer Concussion Symptoms Than White Counterparts, Study Finds

A Black football coach trains a young Black athlete

Key Takeaways

  • Black college athletes report less concussion symptom knowledge (CSK) than their White peers.
  • While both relied on athletic trainers, Black college athletes reported accessing referees for CSK while their White counterparts reported school-based sources, medical websites, and the National Collegiate Athletic Association (NCAA) for CSK.
  • Black college athletes were less likely than their White peers to identify such concussion symptoms as feeling "in a fog," nausea or vomiting, and irritability or anger.

Concussions are often considered to be extremely challenging to manage. A recently published study in the Journal of Head Trauma Rehabilitation has demonstrated that Black college athletes report less concussion symptom knowledge (CSK) than their White counterparts.

With the high likelihood of suffering a concussion when playing college sports, this lower rate of CSK among Black athletes is concerning, especially given how discrimination may impact other health outcomes.

As more Americans begin to reckon with their complicity with white supremacy in the aftermath of George Floyd's killing, this research needs to be taken seriously. Black college athletes deserve equitable access to CSK.

The Study

For this study, CSK was assessed from a convenience sample of 768 NCAA college-athletes from 7 institutions across 3 geographic regions in the US from 17 NCAA-sanctioned sports based on completion of a questionnaire.

About 83% of participants were White and 17% were considered Black, as athletes who identified as mixed with Black ancestry were also included, while few selected other ethnic identities, limiting further comparisons.

These findings reflect similar research at the high school level, which demonstrates lower CSK among Black athletes, which may be related to schools of lower socioeconomic status, which may lack athletic trainers.

Meaningful Knowledge Transfer

Sports neurologist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute, Dr. Vernon Williams, MD, says, "We need to not only level the playing field relative to concussion education, but we also need to engage in meaningful knowledge transfer—connecting with athletes in culturally sensitive ways with messages our athletes relate to and a rational, positive outcome to be expected when the educational information is followed by the desired behavior."

Dr. Vernon Williams, MD

We need to not only level the playing field relative to concussion education, but we also need to engage in meaningful knowledge transfer—connecting with athletes in culturally sensitive ways with messages our athletes relate to...

— Dr. Vernon Williams, MD

Williams explains that Black athletes need information from people they can relate to, using language and other forms of communication they can trust. He cautions that attempts at providing facts, figures, and fear are not likely to prompt behavioral change as meaningful knowledge transfer, not just education, should be the goal. 

Williams highlights how Black athletes are disadvantaged by disparities in income, housing, education, and other measures associated with life, liberty, and the pursuit of happiness.

Williams says, "Black people are severely disadvantaged, and there are likely several contributing factors. These include, but not limited to, socioeconomic status, inferior school-based resources, lack of access to specialized healthcare providers, lack of access to credentialed coaching staff, and lack of access to culturally competent medical providers."

Williams continues, "Black athletes also face bias related to the interpretation of symptoms reported, differences in familiarity with medical/symptom-related terminology, and a host of other factors. The issue doesn’t start in college, but begin to separate us during youth sports, continue into high school, and are further exacerbated in college settings."

Concussions and Mental Health Impacts

Dr. Howard Pratt, D.O. at Community Health of South Florida, Inc., says, "It’s important to note that typically people don’t begin playing a high contact sport like football when they are adults. They can start playing football as young as five years old and can end up playing through college and into a professional career if they get that opportunity and that will compound their risk of concussions and mental illness."

Dr. Howard Pratt, D.O.

They can start playing football as young as five years old and can end up playing through college and into a professional career if they get that opportunity and that will compound their risk of concussions and mental illness.

— Dr. Howard Pratt, D.O.

Pratt explains how a climate of not admitting to being injured may be connected to fears of missing key games due to a concussion and not being seen by recruiters as a result, especially if you come from a lower socioeconomic background and this may be your way out, as the sport is not just a way of taking care of yourself, but for providing for your family.”

Pratt says, "After a person has repeated concussions, they can develop problems with controlling impulsivity, and depression can be more likely. And if they have any previous mental health issues, those can be made worse. This can all help lead to poor coping skills such as substance abuse.” 

What This Means For You

Black college athletes report lower CSK than their White peers, which is likely to delay identification and treatment of concussions, which can have mental health impacts. While the NCAA expects all athletes to be provided with CSK education, these findings demonstrate the need for a more targeted approach to address this gap. Given other health disparities faced by Black athletes, greater public health efforts are necessary to tackle disparities in income, housing, education, etc.

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  1. Wallace J, Beidler E, Kerr Z, Hibbler T, Anderson M, Register-Mihalik J. Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-AthletesJournal of Head Trauma Rehabilitation. 2021;36(3):139-148. doi:10.1097/htr.0000000000000672