Development and Psychometric Testing of the Self-Efficacy for Heart-Healthy Lifestyle Behaviors (SE-HeartLife) Scale in Cardiovascular Disease Prevention.

Concussion, a mild traumatic brain injury, is a common childhood injury impacting millions of youth under the age of 18 every year. These injuries significantly impact the day-to-day lives of the pediatric population and therefore require timely and accurate diagnosis, treatment, follow-up, and ongoing support to limit potential sequela impacting recovery outcomes. Despite the high rates of children sustaining a concussion through sports, around one-third experience a concussion through non-sports-related mechanisms such as non-organized play in recreational settings (). Differences in concussion diagnosis and care have been observed across mechanisms of injury. Youth injured outside of organized sports are more likely to experience later presentation to specialty care, less concussion-specific diagnostic evaluation, greater symptom burden, more frequent visio-vestibular abnormalities, and greater disruption to daily functioning, including school participation and sleep (; ). Further concussion disparities have been identified in the literature. Non-Hispanic black youth have been noted to be less likely to sustain a concussion from sports-related activities. Differences in exposure and type of sport participation related to socioeconomics can contribute to racial and ethnic disparities in concussion education and incident reporting (; ), access to care, diagnosis, and follow-up (; ). “Youth sport” broadly includes organized athletic activities like club sports or high school teams (e.g., soccer team), as well as informally organized sports activities that occur at recreational centers or in after-school programming. Youth living in under-resourced areas or in families with lower incomes have been challenged by the rising costs of organized sports participation (), more frequently are in need of after-school or summer childcare, and as a result, may access this type of less structured programming. In addition, this type of free play and less formal sports activity is part of the fundamental structure for typical days for all youth during school. In recreational and educational settings, responsible parties such as school nurses, youth athletic program leaders, like coaches and recreation center staff, play a key role in injury prevention and identification. Youth athletic program leaders are responsible for teaching proper techniques and strategies for concussion prevention, such as the age-appropriate introduction of sport-specific strategies like heading the ball in soccer (e.g. intentional contact by the head to redirect the ball) and body checking in hockey (e.g. intentional physical contact used to separate an opponent from the puck). If an injury occurs, youth athletic program leaders need skills in injury recognition, removal from play, and communication with parents regarding next steps. Youth athletic program leaders are also responsible for integrating their athletes back into play after an injury. A systematic review of literature published between 2010 and 2018 by revealed coaches are often knowledgeable about physical signs and symptoms of concussions, but there are gaps in knowledge regarding the emotional symptoms of concussion, return-to-play protocols, and differences in concussion recovery between adults and children (). There has been much more attention paid to youth concussion in more recent years. Understanding if these gaps remain is important, allowing targeted interventions, such as those directed towards increasing youth athletic program leader communication with youth athletes and their families on concussion topics, can be implemented ().