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Background: Youth sports coaches play a critical role in proper concussion recognition and management, reinforcing the need for coach concussion education. As of 2021, most states have statutory and policy measures mandating concussion education for coaches. In practice, these mandates have been enacted through state legislatures and their respective youth sport governing bodies. Prior studies have found significant variations in the contents of state-level concussion risk reduction policies and have raised questions about their specificity., Objective: To expand on previous analyses to provide an overview of youth sports coach concussion education, highlighting variations in state policies and discrepancies between state mandates and youth sport governing bodies., Methods: This report utilized qualitative content analysis to characterize and compare U.S. state and governing body concussion education requirements for youth sport coaches. State concussion statutes were identified via the National Conference of State Legislatures and Open States databases, and governing body handbooks/bylaws were obtained via their websites. Two researchers independently coded the policies, and discrepancies were resolved through consensus meetings with additional youth traumatic brain injury experts., Results: We found significant variability in educational requirements and their implementation. A majority (68%; n = 34) of states require the completion of concussion education training for coaches. Notably, many states designate responsibility for enforcement and implementation of provisions to another party but just four state statutes delineate explicit consequences for noncompliance. Additionally, only 12 state statutes extend mandates to noninterscholastic sports, limiting their reach. In most cases, independent sanctioning authorities implement more stringent policies than the minimum acceptable standard established by state law., Conclusion: Our findings provide a coded data set of youth coach concussion laws and independent sanctioning authority guidelines that can be used in future research efforts. Further research investigating a relationship between the strength of coach concussion education policies and relevant youth and adolescent concussion-related metrics is required., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Background: Concussions are mild traumatic brain injuries that are often undiagnosed due to difficulties in identifying symptoms. To minimize the negative sequelae associated with undiagnosed concussion, efforts have targeted improving concussion reporting. However, knowing more about concussions does not indicate how likely an athlete is to report their concussion. Alternatively, the attitudes and beliefs of athletes and surrounding stakeholders have shown to be a better indication of whether an athlete intends to report their concussion. Prior research has shown that athletes report concussions less often when the injury is described using language that minimizes their severity, such as when it is referred to as a "ding." This study evaluated whether describing concussions using the word "brain" was associated with individuals' underlying attitudes and beliefs about the injury's severity., Objective: To measure the relationship between perceived concussion severity and the language used to describe concussions, specifically whether participants used the word "brain" in describing the injury., Methods: One-on-one semi-structured telephone interviews were conducted, and a cross sectional secondary qualitative analysis was performed to assess participants' perceived concussion severity and their use of the word "brain" to describe concussions., Design: Cross-sectional secondary qualitative analysis., Setting: One-on-one semistructured telephone interviews., Participants: In 2017, 94 individuals involved in high school sports, including athletes, coaches, educators, parents of athletes, and athletic directors were recruited via convenience sampling., Main Outcome Measures: Respondents' perceived severity of concussions., Results: Individuals who used a brain phrase to describe concussion also perceived concussions as more severe (p < .001). Specifically, those who described concussions with maximum severity had higher odds of using brain phrases than those who described concussions as having minimum (odds ratio [OR] = 0.05, 95% confidence interval [CI] = 0.002-0.299, p < .001) or moderate severity (OR = 0.24, 95% CI = 0.086-0.647, p = .003), with the most significant relationship found among coaches., Conclusions: These findings demonstrate the relationship between medical terminology and perceived severity of concussions. This relationship may play a role in concussion reporting behavior for coaches, athletes, and parents. Education programs using similar medical terminology may promote concussion reporting behaviors., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Undiagnosed concussions increase the risk of additional concussion and persistent symptoms from concussion. Because there are no reliable objective markers of concussion, self-reporting of subjective and non-visible symptoms are critical to ensuring proper concussion management. For this reason, educational interventions target concussion reporting, but the majority of studies have examined the efficacy of single educational interventions or compared interventions to one another. This randomized crossover study sought to identify whether there was benefit to administering multiple concussion education programs in tandem, back to back. The study randomized 313 male high school football players to first receive CrashCourse concussion education (CC) or Centers for Disease Control and Prevention video concussion education (CDC) followed by crossover with the other education. Athlete concussion-reporting intention, attitudes, subjective norms, perceived behavioral control, and enjoyment of education were assessed at baseline and after each intervention. There were statistically significant improvements across all measures, both after single intervention and crossover (all p  < 0.001). Secondary analyses examining differences between education found that athletes reported higher enjoyment of concussion education immediately after participating in CC, as compared to CDC ( p  < 0.001). These findings demonstrate an additive benefit to implementing CC and CDC education in tandem, without decrement in enjoyment of concussion education after experiencing dual educations; in fact, enjoyment of concussion education improved after receiving education programs back to back. These educational programs appear to complement one another, and the results support the use of multi-modal concussion education to differentially target and maximize concussion reporting., Competing Interests: P.S. is founder and CEO for the non-profit, TeachAids, where she receives a salary of $1 per year. The following authors have a non-reimbursed relationship as medical advisors for CrashCourse: D.H.D., M.Y., R.D.P., S.G., G.A.G., J.G., and L.M.S. C.M.B. previously received funding from the NCAA as a graduate student research grant recipient, the Datalys Center for Sports Injury Research and Prevention as a graduate student research grant recipient, and through the Football Players' Health Study at Harvard, which is funded by the NFL Players' Association. R.C. is a paid consultant to the NFL Head Neck and Spine Committee, NOCSAE, Concussion Legacy Foundation, royalties from book publications, and compensation from expert legal opinion. He is a member of the Mackey-White Committee of the NFL Players Association. R.Z. serves on scientific advisory boards for Oxeia BioPharma, ElMIndA, and MYOMO; serves on the editorial board of Journal of Neurotrauma; receives publishing royalties for Brain Injury Medicine: Principles and Practice (Demos, 2013) and Physical Medicine and Rehabilitation—A Comprehensive Review (Oakstone); and receives research support from the NIH, NIDILRR, USARMC, and the Football Players Health Study at Harvard funded, in part, by the NFL Players' Association., (© Daniel H. Daneshvar et al., 2021; Published by Mary Ann Liebert, Inc.)

Context: Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-reporting of concussion symptoms, therefore, reduces risk., Objective: To evaluate the effectiveness of 3 concussion-education programs in improving concussion-reporting intention., Design: Randomized controlled clinical trial., Setting: Three high schools in California., Patients or Other Participants: A total of 118 male football players (age = 14.88 ± 1.19 years)., Intervention(s): Participants were randomly assigned to receive concussion education via CrashCourse (CC), Centers for Disease Control and Prevention (CDC) video education materials (CDC-Vi), or CDC written education materials (CDC-Wr)., Main Outcome Measure(s): The primary outcome was concussion-reporting intention, which was assessed at baseline, immediately after education, and at 1-month follow-up. Secondary outcomes were concussion knowledge, concussion-reporting attitudes, perceived concussion-reporting norms, and perceived behavioral control., Results: Across all education formats, a total sample of athletes improved in concussion-reporting intention at immediate and 1-month follow-ups (mean improvements = 6.8% and 11.4%, respectively; F4,224 = 11.1, P < .001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, we noted differences in concussion-reporting intention by education format and time (F4,224 = 2.8, P = .03). Post hoc analysis showed that athletes who received CC had increased concussion-reporting intentions at immediate and 1-month follow-ups (baseline = 4.7, immediate follow-up = 6.1, 1-month follow-up = 6.0; F16,61.1 = 6.1, P = .007) compared with increases only at 1-month follow-up for CDC-Vi (baseline = 4.3, immediate follow-up = 5.2, 1-month follow-up = 5.8; F1.6,61.6 = 8.4, P = .001) and no improvement for CDC-Wr (P = .10). Secondary analyses indicated differences between CC and both CDC interventions in concussion knowledge and attitudes at immediate and 1-month follow-ups. We identified no differences in perceived behavioral control among interventions (F4,216 = 0.2, P = .93) or perceived concussion-reporting norms across (F4,224 = 0.3, P = .73) or among (F4,224 = 1.7, P = .15) interventions., Conclusions: All athletes exhibited an improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control at both immediate and 1-month follow-ups. However, athletes randomized to receive CC reported a greater intent to report concussion, more knowledge, and improved concussion-reporting attitudes when compared with those who received CDC-Vi and CDC-Wr., (© by the National Athletic Trainers' Association, Inc.)

Undiagnosed concussions increase risk of additional injuries and can prolong recovery. Because of the difficulties recognizing concussive symptoms, concussion education must specifically target improving athlete concussion reporting. Many concussion education programs are designed without significant input from athletes, resulting in a less enjoyable athlete experience, with potential implications on program efficacy. Athlete enjoyment of previous concussion education programs moderates the improvement in concussion-reporting intention after experiencing the research version of CrashCourse (CC) concussion education. Prospective cohort study. Level of evidence: Level IV. Quantitative assessment utilizing ANOVA with moderation analysis of 173 male high school football players, aged 13 to 17, who completed baseline assessments of concussion knowledge, concussion reporting, and attitudes about prior educational interventions. Athletes were subsequently shown CC, before a follow-up assessment was administered assessing the same domains. At baseline, only 58.5% of athletes reported that they enjoyed their previous concussion education. After CC, athletes were significantly more likely to endorse that they would report a suspected concussion (from 69.3% of athletes to 85.6%; P  < .01). Enjoyment of previous concussion education moderated concussion-reporting intention after CC ( P  = .02), with CC having a greater effect on concussion-reporting intention in athletes with low enjoyment of previous concussion education ( b  = 0.21, P  = .02), than on individuals with high enjoyment of previous concussion education ( P  = .99). Enjoyment of CC did not have a moderating effect on concussion-reporting intention. Athletes who previously did not enjoy concussion education exhibited greater gains in concussion-reporting intention than athletes who enjoyed previous education. Given the potential risks associated with undiagnosed concussions, concussion education has sought to improve concussion reporting. Because most athletes participate in concussion education programs due to league or state mandates, improving concussion-reporting intention in these low-enjoyment athletes is of particular relevance to improving concussion-reporting intention broadly.

Across four studies, two controlled lab experiments and two field studies, we tested the efficacy of immersive Virtual Reality (VR) as an education medium for teaching the consequences of climate change, particularly ocean acidification. Over 270 participants from four different learning settings experienced an immersive underwater world designed to show the process and effects of rising sea water acidity. In all of our investigations, after experiencing immersive VR people demonstrated knowledge gains or inquisitiveness about climate science and in some cases, displayed more positive attitudes toward the environment after comparing pre- and post-test assessments. The analyses also revealed a potential post-hoc mechanism for the learning effects, as the more that people explored the spatial learning environment, the more they demonstrated a change in knowledge about ocean acidification. This work is unique by showing distinct learning gains or an interest in learning across a variety of participants (high school, college students, adults), measures (learning gain scores, tracking data about movement in the virtual world, qualitative responses from classroom teachers), and content (multiple versions varying in length and content about climate change were tested). Our findings explicate the opportunity to use immersive VR for environmental education and to drive information-seeking about important social issues such as climate change.

Schools today face ever-increasing demands in their attempts to ensure that students are well equipped to enter the workforce and navigate a complex world. Research indicates that computer technology can help support learning, and that it is especially useful in developing the higher-order skills of critical thinking, analysis, and scientific inquiry. But the mere presence of computers in the classroom does not ensure their effective use. Some computer applications have been shown to be more successful than others, and many factors influence how well even the most promising applications are implemented. This article explores the various ways computer technology can be used to improve how and what children learn in the classroom. Several examples of computer-based applications are highlighted to illustrate ways technology can enhance how children learn by supporting four fundamental characteristics of learning: (1) active engagement, (2) participation in groups, (3) frequent interaction and feedback, and (4) connections to real-world contexts. Additional examples illustrate ways technology can expand what children learn by helping them to understand core concepts in subjects like math, science, and literacy. Research indicates, however, that the use of technology as an effective learning tool is more likely to take place when embedded in a broader education reform movement that includes improvements in teacher training, curriculum, student assessment, and a school's capacity for change. To help inform decisions about the future role of computers in the classroom, the authors conclude that further research is needed to identify the uses that most effectively support learning and the conditions required for successful implementation.