Socioeconomic status and outcomes after sport-related concussion: a preliminary investigation

OBJECTIVEA significant proportion of patients experience long-term symptoms after sport-related concussion (SRC), and several factors have been associated with this protracted recovery. Limited data exist on the role of socioeconomic status (SES) on SRC outcomes. The objective in this study was to conduct a preliminary investigation to determine the effect of SES on outcomes after SRC in student-athletes treated at a regional sports concussion center.METHODSA retrospective cohort study of 282 middle school, high school, and collegiate student-athletes was conducted. An attempt was made to contact all patients seen at a comprehensive SRC center between January 2012 and May 2015 for in-depth interviews. Subsequent demographic data were collected. The SES was defined as follows: cost of living percentile, median income percentile, percentage of college graduates, percentage of homeowners, county type, and insurance status. Outcomes after SRC were defined as follows: days of symptom duration, days of missed school, and days of missed practice. Statistically controlled covariates included sex, race, age, body mass index, concussion history, neuropsychiatric history, and type of sport.RESULTSA total of 282 student-athletes consented and were studied. The median age was 15.8 years (range 11.6–22.2 years) and 61.4% of student-athletes were male. A previous concussion was incurred by 34.0% of student-athletes. Football was the most common sport (32.3%), followed by soccer (16.3%), and basketball (15.6%). The median symptom duration was 21 days (range 1–365 days); the median missed school days was 2 (range 0–90 days); and median for days of missed practice was 10 (range 0–150 days). After multivariate Cox regression analysis, no relationship between any of the 6 SES variables and symptom duration or missed practice was seen. However, individuals with private insurance had more missed days of school than those with public insurance (hazard ratio 0.46, 95% CI 0.26–0.83, p = 0.009).CONCLUSIONSIn a preliminary study of middle school, high school, and collegiate student-athletes, SES had no impact on the outcomes of symptom duration and missed practice. However, for individuals with private insurance, the return to school was slower than for those with public insurance. This pilot study reveals the complex relationship between SES and SRC recovery, which demands further study with more accurate and validated assessments of SES.

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Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015741 ◽

2021 ◽

pp. 000348942110157

Author(s):

Jennifer L. McCoy ◽

Ronak Dixit ◽

R. Jun Lin ◽

Michael A. Belsky ◽

Amber D. Shaffer ◽

...

Keyword(s):

Otitis Media ◽

Otitis Media With Effusion ◽

Private Insurance ◽

Chronic Otitis Media ◽

The United States ◽

Socioeconomic Disparities ◽

Tube Placement ◽

Median Income ◽

Public Insurance ◽

Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

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In-School, Out-of-School, and Weekend Physical Activity Levels Vary Across Sociodemographic Subgroups of US Adolescents

Journal of Physical Activity and Health ◽

10.1123/jpah.2020-0157 ◽

2021 ◽

Vol 18 (4) ◽

pp. 418-425

Author(s):

Ashleigh M. Johnson ◽

Kelley Pettee Gabriel ◽

Nalini Ranjit ◽

Harold W. Kohl ◽

Andrew E. Springer

Keyword(s):

Physical Activity ◽

High School ◽

Middle School ◽

Socioeconomic Status ◽

Time Of Day ◽

Potential Interaction ◽

Activity Levels ◽

Sociodemographic Disparities ◽

Race Ethnicity ◽

Out Of School

Background: In response to conflicting findings for activity levels across sociodemographic groups, this study examined differences in adolescents’ in-school, out-of-school, and weekend physical activity (PA) by sociodemographic subgroups using representative US data. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating study. Multiple regression models compared in-school, out-of-school, and weekend PA by gender and race/ethnicity, and examined potential modification of associations by grade (middle vs high school) and socioeconomic status (lower vs higher). Results: Final analytic sample was 1413 adolescents (Mean age = 14.5 y, 51.3% female, 64.5% white). Compared with whites, in-school PA was significantly higher among blacks and those classified as other race/ethnicity for middle school (69.8 and 71.0, respectively, vs 66.4 min/d), and among Hispanics for high school (52.7 vs 48.4 min/d). Hispanics’ (vs whites’) out-of-school PA was significantly lower for middle school (63.7 vs 66.6 min/d), but higher for high school (54.0 vs 51.8 min/d). In-school PA was significantly higher among adolescents of lower (vs higher) socioeconomic status among males and Hispanics (all Ps < .05). Conclusions: The relation of race/ethnicity with PA varies by grade and time of day/week. Socioeconomic status findings contradict previously reported findings. Efforts to increase PA based on sociodemographic disparities should consider potential interaction effects.

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Concussion Knowledge, Attitudes, and Self-Reporting Intentions in Youth Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-232-19 ◽

2020 ◽

Vol 55 (10) ◽

pp. 1027-1034

Author(s):

Avinash Chandran ◽

Aliza K. Nedimyer ◽

Zachary Y. Kerr ◽

Cathleen O'Neal ◽

James Mensch ◽

...

Keyword(s):

High School ◽

Socioeconomic Status ◽

Student Athletes ◽

Female Student ◽

School Level ◽

High School Athletes ◽

School Location ◽

Sociological Factors ◽

Urban Versus ◽

Reporting Intentions

Context Although it has been suggested that developmental and sociological factors play a role in concussion reporting, the empirical evidence related to this is limited. Objective To examine the influences of sex, school level, school location, concussion-reporting history, and socioeconomic status on concussion-related knowledge, attitudes, and reporting intentions among middle school and high school athletes. Design Cross-sectional study. Setting Master students and High School athletes attending pre-participation examinations (PPEs) were asked to complete paper-based surveys. Patients or Other Participants Overall, 541 athletes representing 18 sports returned fully completed surveys. Main Outcome Measure(s) Outcomes were concussion-related knowledge, perceived seriousness, positive feelings about reporting, and self-reporting intentions. We examined group differences in these outcomes across levels of the explanatory variables of sex, school level (middle school versus high school), school location (urban versus rural), concussion self-reporting history (yes or no), and socioeconomic status (free or reduced-price lunch versus no free or reduced-price lunch) using Wilcoxon rank sum tests. Then we used multivariable ordinal logistic regression models to identify predictors of higher score levels for each outcome. Odds ratio (OR) estimates with 95% confidence intervals (CIs) excluding 1.00 were deemed significant. Results Odds of higher levels of knowledge were higher in urban versus rural school student-athletes (ORAdjusted = 1.81; 95% CI = 1.03, 3.17), and lower in student-athletes on free or reduced-price lunch versus those not on free or reduced-price lunch (ORAdjusted = 0.52; 95% CI = 0.36, 0.77). Similarly, odds of higher levels of seriousness were lower in male versus female student-athletes (ORAdjusted = 0.48; 95% CI = 0.32, 0.72). Further, odds of higher levels of self-reporting intentions were lower among male versus female student-athletes (ORAdjusted = 0.53; 95% CI = 0.37, 0.75). Conclusions Developmental and sociological factors were differentially associated with concussion-related knowledge, attitudes, and self-reporting intentions. These results can inform medical providers, parents, and coaches with regard to context-specific clinical assessments of concussion symptoms.

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The Present and Future of High School Admission System for Student-athletes: A Discourse on Mandatory Application of Middle School GPA for High School Entrance

Korean Journal of Sport Studies ◽

10.23949/kjpe.2019.07.58.4.13 ◽

2019 ◽

Vol 58 (4) ◽

pp. 175-191

Author(s):

Minjung Kwon ◽

Yeonkyung Jin ◽

Woosuk Kim

Keyword(s):

High School ◽

Middle School ◽

Student Athletes ◽

School Entrance ◽

Admission System

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Development of an iPhone application for sideline concussion testing

Neurosurgical FOCUS ◽

10.3171/2011.8.focus11186 ◽

2011 ◽

Vol 31 (5) ◽

pp. E4 ◽

Cited By ~ 8

Author(s):

Guillaume A. Curaudeau ◽

Nikhil Sharma ◽

Richard A. Rovin

Keyword(s):

High School ◽

Middle School ◽

At Risk ◽

Student Athletes ◽

Professional Athletes ◽

Monitoring Programs ◽

Iphone Application

Professional athletes are taking concussion very seriously, and missed play due to concussion is no longer stigmatized. One fortuitous consequence is increased awareness of the detrimental effects of concussion among student athletes. Whereas professional athletes have access to formal in-competition evaluation and out-of-competition monitoring programs, the majority of student athletes, especially at the middle school and high school levels, do not. The authors therefore set out to create an easy-to-use iPhone application for sideline concussion testing and serial monitoring of these at-risk athletes.

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Adolescent Students Who Stutter: A Qualitative Exploration of School Experiences

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00085 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1327-1336

Author(s):

Tiffany R. Cobb ◽

Derek E. Daniels ◽

James Panico

Keyword(s):

High School ◽

Middle School ◽

Peer Relationships ◽

Speech Therapy ◽

School Setting ◽

Image Data ◽

School Experiences ◽

Adolescent Students ◽

Therapy Decision ◽

Qualitative Phenomenological

Purpose The purpose of this study was to explore the ways in which adolescent students who stutter perceive their school experiences. Method This study used a qualitative, phenomenological research design. Semistructured interviews were conducted with 7 adolescent students who stutter (3 in middle school and 4 in high school). Participants were interviewed about their school experiences, including the effects of stuttering on academics, learning, teacher relationships, peer relationships, speech therapy experiences, and self-image. Data analysis consisted of transcribing interviews and analyzing them for emerging themes. Results Findings revealed that participants described a variety of experiences around the school setting. Participants reported less favorable middle school experiences. Middle school participants reflected more on teasing, bullying, and feelings of embarrassment, whereas high school participants revealed that teachers, staff, and peers were receptive and accepting of them and their stuttering. All participants reported that their speech therapy helped with classroom participation. Conclusions As a result of the participants' varied experiences, it is important to listen to and incorporate the voices of students who stutter into school, classroom, and therapy decision-making practices.

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