Implementation of concussion legislation and extent of concussion education for athletes, parents, and coaches in Washington State

Am J Sports Med. 2014 May;42(5):1190-6. doi: 10.1177/0363546513519073. Epub 2014 Feb 7.


Background: Most states in the United States have passed laws regarding concussions, but little is known regarding the implementation of these laws. Hypothesis/

Purpose: The purpose of this study was to survey high school coaches 3 years after the passage of a concussion law to evaluate the variation in concussion education and knowledge in the context of this law as well as measure the effects of sport (football vs soccer) and urban versus rural locations. The hypothesis was that concussion education and knowledge would be more extensive in football compared with soccer and in urban locations compared with rural locations.

Study design: Descriptive epidemiology study.

Methods: A mixed-methods (paper and online) survey was conducted in 2012 to 2013 on a random sample of public high school football, girls' soccer, and boys' soccer coaches in Washington State, stratified by urban and rural locality. The survey covered the extent of concussion education for coaches, athletes, and parents as well as coaches' concussion knowledge and experience.

Results: Of 496 coaches contacted, 270 responded (54.4%). Nearly all coaches answered concussion knowledge questions correctly, and nearly all coaches received education via ≥2 modalities (written, video, slide presentation, test, and in person). Athlete education was less extensive, with 34.7% exposed to ≥2 modalities and 29.5% only signing a concussion information form. Parent education was even more limited, with 16.2% exposed to ≥2 modalities and 57.9% only signing a concussion information form. Significantly more football than soccer coaches gave their athletes an in-person talk about concussions (59.1% vs. 39.4%, respectively; P = .002) and provided concussion education to athletes via ≥2 modalities (44.1% vs. 29.7%, respectively; P = .02). Concussion education for coaches and parents was similar between sports, and concussion education for all parties was similar in urban and rural localities.

Conclusion: Three years after the passage of a concussion law in Washington State, high school football and soccer coaches are receiving substantial concussion education and have good concussion knowledge. Concussion education for athletes and parents is more limited. Football players receive more extensive concussion education than do soccer players.

Clinical relevance: Clinicians should be aware that athletes and parents may not be receiving significant concussion education.

Keywords: adolescents; athletics; concussion; education; legislation; return to play.

MeSH terms

  • Adolescent
  • Adult
  • Athletes / statistics & numerical data*
  • Athletic Injuries / diagnosis*
  • Brain Concussion / diagnosis*
  • Faculty / statistics & numerical data*
  • Female
  • Football / education
  • Football / injuries
  • Health Education
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Parents*
  • Rural Population
  • Soccer / education
  • Soccer / injuries
  • Sports Medicine / education
  • Sports Medicine / legislation & jurisprudence*
  • Surveys and Questionnaires
  • Urban Population
  • Washington
  • Young Adult