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Costs and contexts: factors affecting self-report of concussion in a military academy
  1. Christopher D’Lauro1,
  2. Brian Rudolph Johnson1,
  3. Craig A Foster1,
  4. Gerald McGinty2,
  5. Darren Campbell3
  1. 1Department of Behavioural Sciences and Leadership, United States Air Force Academy, Colorado, USA
  2. 2Air Force Athletic Department, United States Air Force Academy, Colorado, USA
  3. 310th Medical Group, United States Air Force Academy, Colorado, USA


Objective To understand the factors affecting the decision to self-report a concussion – particularly among sub-groups like athletes and future pilots.

Design Survey.

Setting A United States military academy.

Participants Voluntarily participatingcadets (n=2,503, 23.9%=female).

Assessment of risk factors NCAA Division I athlete status, future pilot status, gender, school year were examined as factors affecting self-report.

Outcome measure Anticipated Self-Report (ASR) of concussion on a scale from 1–9 (most to least likely to self-report). Cadets completed a 2-page survey matching ASR to demographic risk factors (above), and to self-report questions assessing Costs, Rewards, Attitude, Subjective Norms, Self-Efficacy, and Social Support.

Main results Cadets demonstrated an overall willingness to self-report a concussion – indicated by a mean ASR score of 6.07 (95% CI=5.97–6.17, SD=2.47, median=7.00, n=2.332) above the scale midpoint. Costs (r=−0.61, p<0.001), Rewards (r=0.67, p<0.001) and Attitude (r=0.70, p<0.001) were highly, significantly predictive of ASR. Cadet sub-populations revealed the importance of specific costs. Aspiring pilots – concerned about concussions affecting their pilot qualification status –steadily decreased ASR by year, while non-pilot cadets retained consistent ASR, shown by Future Pilot x Class Year ANOVA (F(3,2196)=11.78, p<0.001). NCAA Athletes, conversely, showed no ASR differences from non-athletes, t(2251)=0.16, p=0.87, CI =±0.23.

Conclusions Symptom self-report is a crucial factor in all stages of concussion care. Costs and rewards affecting self-report may have unique contexts that drive unexpected self-report patterns. Here, aspiring pilots showed lower self-report behaviour while athletes showed average self-report behaviour – based on perceived costs to career aspirations. These data will be used to design interventions to increase to concussion self-report.

Competing interests All authors received funding from the National Collegiate Athletic Association and Department of Defense (NCAA Mind Matters Challenge).

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