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ObjectivesDetermine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes.MethodsA cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9–14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season.ResultsOf 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen’s d=0.35).Conclusions and relevancePre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting.Trial registration numberNCT04099329.

ABSTRACTResearch suggests adult stakeholder (coach, referee and administrator) communication about concussion influences the likelihood of athletes reporting concussive symptoms. The goal of this study was to develop a conceptual model to describe factors contributing to adult stakeholder (AS) concussion communication with youth athletes, to inform future concussion education interventions. We conducted a qualitative interview study with n = 63 AS in youth American football and football (soccer) in Washington and Georgia, analysing interviews using a coding structure based on the Theory of Planned Behavior. Across our sample, AS could describe concussion symptoms and mechanism in detail (Knowledge). AS believed that playing with a concussion could be dangerous, though many had experienced a concussion themselves and not had any negative outcomes (Attitudes). AS believed they were responsible for concussion safety (Normative beliefs), but described that messaging from institutions did not emphasise the role of AS in concussion safety. AS were comfortable in their ability to engage in concussion communication (Self-efficacy), but some expressed concern that talking about concussion might not improve safety but instead result in overreport of symptoms (Controllability). In conclusion, AS have good knowledge of concussion safety, but no clear mandate from their institution to discuss concussion with youth athletes, and concerns that such communication would not improve safety. Future research should utilise these findings to improve the effectiveness of concussion educational interventions for coaches, referees and administrators.