Research Article
Sports- and Physical Activity–Related Concussion and Risk for Youth Violence

https://doi.org/10.1016/j.amepre.2020.10.018Get rights and content

Introduction

Sports and physical activities are an important cause of traumatic brain injury among adolescents. Childhood traumatic brain injury has been associated with cognitive impairment, emotional problems, and impaired behavior control, and these neuropsychological changes may place these youth at increased risk for engagement in violence-related behaviors.

Methods

Data from the 2017 National Youth Risk Behavior Survey (N=14,765), a nationally representative survey of U.S. high school students, were analyzed in 2019 to examine the associations between sports- and physical activity–related concussion and violence-related behaviors occurring in the community and at school. Multivariable logistic regression models were used to calculate sex-stratified, adjusted (for race/ethnicity, grade, athlete status, impaired cognitive functioning, feeling sad/hopeless, and current substance use) prevalence ratios. Prevalence ratios were considered statistically significant if p<0.05.

Results

Male students (17.1%) were more likely than female students (13.0%) to experience a sports- and physical activity–related concussion during the 12 months preceding the survey. Compared with students who did not have a concussion, those who experienced ≥1 sports- and physical activity–related concussion were more likely to be in a physical fight (male students, adjusted prevalence ratio=1.45; female students, adjusted prevalence ratio=1.55), carry a weapon (male students, adjusted prevalence ratio=1.24; female students, adjusted prevalence ratio=1.79), and fight at school (male students, adjusted prevalence ratio=1.40; female students, adjusted prevalence ratio=1.77). In addition, male students were more likely to carry a gun (adjusted prevalence ratio=1.62) and carry a weapon at school (adjusted prevalence ratio=1.73).

Conclusions

Although the direction of these associations is unknown, return-to-school programs may benefit from inclusion of assessment and counseling around issues of psychological and social functioning, conflict resolution, and coordination with violence prevention programs.

Section snippets

INTRODUCTION

Sports- and physical activity–related concussions (SPACs) are a growing concern because of the sizable increase in the number of emergency room visits1,2 and the risk for impact on the developing brain.3 When evaluating concussions, a form of mild traumatic brain injury (TBI) symptom reports are used to establish the diagnosis and to define recovery for young athletes to return to play.4, 5, 6, 7, 8 Recent research indicates that recovery time varies from 4 days to >30 days.4 However, youth

Study Sample

The 2017 National Youth Risk Behavior Survey (YRBS) collected cross-sectional data on priority health-risk behaviors from a nationally representative sample of public and private high school students in Grades 9–12. The survey used a 3-stage probability sampling methodology that has been previously described.24 A weighting factor was applied to each student record to adjust for varying probabilities of selection at each stage of sampling, student nonresponse, and the oversampling of Black and

RESULTS

The 2017 national YRBS had a school response rate of 75% and a student response rate of 81% for an overall response rate of 60% (N=14,765). Among U.S. high school students, approximately 49.3% (95% CI=46.7, 51.9) were male, and 50.7% (95% CI=48.1, 53.3) were female; 53.5% (95% CI=48.4, 58.5) were non-Hispanic White; 13.4% (95% CI=11.0, 16.3) were non-Hispanic Black; 22.8% (95% CI=19.2, 26.9) were Hispanic (of any race); and 10.3% (95% CI=8.9, 11.7) were of other race/ethnicity; 27.3% (95%

DISCUSSION

This study examines the relationships between self-reported SPAC and violence-related behaviors at school and in the community among a nationally representative sample of U.S. high school students. Approximately 15.1% of all high school students, primarily male students and athletes, self-reported ≥1 SPACs during the past 12 months. Although the data are cross-sectional and cannot establish a causal link, violence-related risk behaviors examined in this analysis were associated with

CONCLUSIONS

Sports and other physical activities are an important cause of TBI among adolescents. Childhood TBI has been associated with cognitive impairment, emotional problems, and impaired behavior control, and these neuropsychological changes may place these youth at an increased risk for engagement in violence-related behaviors. Although not establishing a causal relationship, these findings demonstrate associations between experiencing a SPAC and participation in violence-related behaviors such as

ACKNOWLEDGMENTS

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

No financial disclosures were reported by the authors of this paper.

REFERENCES (49)

  • JG Baker et al.

    Factors associated with problems for adolescents returning to the classroom after sports-related concussion

    Clin Pediatr (Phila)

    (2015)
  • M McCrea et al.

    Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study

    JAMA

    (2003)
  • PK Kriz et al.

    Neurocognitive deficits of concussed adolescent athletes at self-reported symptom resolution in the Zurich Guidelines Era

    Orthop J Sports Med

    (2017)
  • T Silberg et al.

    Parents and teachers reporting on a child's emotional and behavioural problems following severe traumatic brain injury (TBI): the moderating effect of time

    Brain Inj

    (2015)
  • L Li et al.

    The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review

    Dev Med Child Neurol

    (2013)
  • HT Keenan et al.

    Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: the influence of age and injury severity

    J Neurotrauma

    (2018)
  • HG Taylor et al.

    Symptoms of persistent behavior problems in children with mild traumatic brain injury

    J Head Trauma Rehabil

    (2015)
  • JE Max et al.

    Psychiatric disorders in children and adolescents 24 months after mild traumatic brain injury

    J Neuropsychiatry Clin Neurosci

    (2015)
  • TL Jackson et al.

    The relationship between early childhood head injury and later life criminal behavior: a longitudinal cohort study

    J Epidemiol Community Health

    (2017)
  • A McKinlay et al.

    Predicting adult offending behavior for individuals who experienced a traumatic brain injury during childhood

    J Head Trauma Rehabil

    (2014)
  • CL Karver et al.

    Age at injury and long-term behavior problems after traumatic brain injury in young children

    Rehabil Psychol

    (2012)
  • ME Narad et al.

    Secondary attention-deficit/hyperactivity disorder in children and adolescents 5 to 10 years after traumatic brain injury

    JAMA Pediatr

    (2018)
  • LY Yang et al.

    Association of traumatic brain injury in childhood and attention-deficit/hyperactivity disorder: a population-based study

    Pediatr Res

    (2016)
  • J Haarbauer-Krupa et al.

    Prevalence of parent-reported traumatic brain injury in children and associated health conditions

    JAMA Pediatr

    (2018)

    • Cited by (11)

    • Exposure to neighborhood violence and insufficient sleep among adolescents in the United States: Findings from a population-based study

      2024, Children and Youth Services Review

    • Associations Between Exposure to School Violence and Weapon Carrying at School

      2023, American Journal of Preventive Medicine

    • Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

      2022, Psychiatry Research
      Citation Excerpt :

      The initial response options were “0 times”, “1 time”, “2 times”, “3 times”, and “4 times”. Consistent with other studies (Lowry et al., 2021; Sarmiento et al., 2020), adolescents who had a concussion from playing a sport or being physically active at least once during the past 12 months were recoded as 1, whereas adolescents who did not have a concussion from playing a sport or being physically active were coded as 0. Control variables examined in this study included multiple risk and protective factors.

    • Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth

      2024, Child Psychiatry and Human Development

    • The associations between sport- and physical activity-related concussions and suicidality, suicide capability, and hopelessness among high school adolescents

      2023, Journal of Adolescence

    • Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students

      2023, American Journal of Sports Medicine
    View all citing articles on Scopus
    View full text
    © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.