%0 Journal Article %A Christopher D’Lauro %A Brian Rudolph Johnson %A Craig A Foster %A Gerald McGinty %A Darren Campbell %T Costs and contexts: factors affecting self-report of concussion in a military academy %D 2017 %R 10.1136/bjsports-2016-097270.166 %J British Journal of Sports Medicine %P A64-A64 %V 51 %N 11 %X 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). %U https://bjsm.bmj.com/content/bjsports/51/11/A64.2.full.pdf