Social Norms and Concussion Disclosure Behavior: Clarification of Terms and Measurement Recommendations.

Non-disclosed sport-related concussion symptoms pose a significant risk to athletes' health and well-being. Many research investigations have focused on understanding the factors impacting athletes' concussion disclosure behaviors. One of the most robust predictors of the likelihood that an athlete will disclose concussion symptoms to their coaches, athletic trainers, parents, or peers is what researchers term "social norms." The extant literature regarding social norms influencing concussion disclosure behaviors is inconsistent on how the construct should be defined, conceptualized, or measured, often failing to distinguish between descriptive and injunctive social norms and their sources (direct and indirect). In this Technical Report, we provide an overview of these critical distinctions, their importance in assessments, and examples from the literature where scholars have correctly operationalized these constructs in athletic populations. We conclude with a brief set of suggestions for researchers seeking to measure social norms in future research.

A Quantitative Assessment of Staphylococcus aureus Community Carriage in Yuma, Arizona.

BACKGROUND: Disease control relies on pathogen identification and understanding reservoirs. Staphylococcus aureus infection prevention is based upon decades of research on colonization and infection, but diminishing returns from mitigation efforts suggest significant knowledge gaps. Existing knowledge and mitigation protocols are founded upon culture-based detection, with almost no information about pathogen quantities. METHODS: We used culture and a quantitative polymerase chain reaction assay on samples from 3 body sites to characterize colonization more comprehensively than previous studies by describing both prevalence and pathogen quantity. RESULTS: We show a much higher overall prevalence (65.9%) than previously documented, with higher quantities and prevalence associated with the nares, non-Hispanic males (86.9%), and correlating with colonization in other body sites. These results suggest that research and clinical practices likely misclassify over half of colonized persons, limiting mitigation measures and their impact. CONCLUSIONS: This work begins the process of rebuilding foundational knowledge of S aureus carriage with more accurate and wholistic approaches.

Quiet ego is associated with positive attitudes toward Muslims.

Well-known predictors of prejudice toward Muslims include social dominance and authoritarianism. However, a gap exists for variables reflecting a rejection or mitigation of ideological motivations associated with prejudice toward Muslims. We examined if quiet ego was related to positive attitudes toward Muslims, and whether this could be explained by lower levels of authoritarianism, social dominance, and the motivation to express prejudice. We explored this possibility across two studies of adults in the United States (N = 376; N = 519). In Study 1, regression results showed quiet ego was directly associated with positive attitudes toward Muslims. Study 2 utilized path analyses and found that the direct relationship between quiet ego and positive attitudes toward Muslims was explained by associations between quiet ego and lower endorsement of authoritarianism, social dominance, and the internal motivation to express prejudice toward Muslims. Moreover, these associations held when accounting for several correlates of intergroup attitudes.

Correlation Between EAT-10 and Aspiration Risk Differs by Dysphagia Etiology.

Agreement between self-reported dysphagic symptoms and actual swallowing physiology can vary widely across individuals. The Eating Assessment Tool-10 (EAT-10) is a self-report questionnaire commonly used to identify individuals with oropharyngeal dysphagia, but its interpretation for highly prevalent populations is poorly defined. Our primary objective was to determine if correlation strength between EAT-10 and Penetration-Aspiration Scale (PAS) scores differed by dysphagia etiology. Our secondary objective was to identify clinical factors that were associated with a mismatch between EAT-10 scores and videofluoroscopic findings. Outpatients with Parkinson disease (PD), stroke, and/or head and neck cancer (HNC) who completed EAT-10 and underwent videofluoroscopy were included (n = 203). EAT-10/PAS correlations were calculated by dysphagia etiology. We found that across the sample, higher EAT-10 scores were significantly correlated to higher PAS scores (rs = 0.31, p < 0.001). EAT-10 and PAS were moderately correlated in the HNC group (rs = 0.41, p < 0.001, n = 87), but correlations were modest in the PD (rs = 0.18, n = 41) and stroke groups (rs = 0.12, n = 59). Clinical characteristics of individuals with a "matched" profile (normal EAT-10 score and normal swallow physiology) and a "mismatched" profile (normal EAT-10 score and abnormal swallow physiology) were also compared. Individuals with a "mismatched" EAT-10/PAS profile appeared to be significantly older and had a worse Charlson Comorbidity Index than individuals with a "matched" profile. Within the HNC subgroup, EAT-10/PAS correlations for specific tumor sites, treatment types, and time since treatment are reported. Clinicians may consider these aspiration risk profiles when making recommendations for instrumented swallowing assessment.

Precision mentoring (PM): a proposed framework for increasing research capacity in health-related disciplines.

PROBLEM: Research productivity is expected of academic faculty, and mentoring can facilitate it. This paper presents a framework for using mentoring to develop researchers in health disciplines. APPROACH: We utilized recent literature reviews, and experience developing researchers at an emerging research institution within the Research Centers for Minority Institutions (RCMI) program, to propose a precision mentoring (PM) framework for research development. OUTCOMES: Although we cannot precisely determine how much improvement was due to the PM framework, over the 4 years of our program, the quality and quantity of pilot project proposals (PPP) has increased, the number of external proposals submitted and funded by PPP investigators has increased, and the number of faculty participating in our program has increased. Surveys distributed to our 2021-22 PPP applicants who did not receive funding (n = 5/6 or 86.7%) revealed that new investigators most frequently sought mentoring related to career guidance (e.g., institutional culture, pre-tenure survival strategies), grant proposal basics (e.g., working with funding agencies, reviewing aims, balancing priorities, and enhancing scientific rigor), and identifying funding opportunities. NEXT STEPS: We recommend shifting the mentoring paradigm such that: (a) mentees are pre-screened and re-screened for their current skill set and desired areas of growth; (b) mentoring occurs in teams vs. by individuals; (c) mentors are trained and rewarded, and (d) attention is paid to enhancing institutional culture.

Mentoring New and Early-Stage Investigators and Underrepresented Minority Faculty for Research Success in Health-Related Fields: An Integrative Literature Review (2010-2020).

Mentoring to develop research skills is an important strategy for facilitating faculty success. The purpose of this study was to conduct an integrative literature review to examine the barriers and facilitators to mentoring in health-related research, particularly for three categories: new investigators (NI), early-stage investigators (ESI) and underrepresented minority faculty (UMF). PsychINFO, CINAHL and PubMed were searched for papers published in English from 2010 to 2020, and 46 papers were reviewed. Most papers recommended having multiple mentors and many recommended assessing baseline research skills. Barriers and facilitators were both individual and institutional. Individual barriers mentioned most frequently were a lack of time and finding work-life balance. UMF mentioned barriers related to bias, discrimination and isolation. Institutional barriers included lack of mentors, lack of access to resources, and heavy teaching and service loads. UMF experienced institutional barriers such as devaluation of experience or expertise. Individual facilitators were subdivided and included writing and synthesis as technical skills, networking and collaborating as interpersonal skills, and accountability, leadership, time management, and resilience/grit as personal skills. Institutional facilitators included access to mentoring, professional development opportunities, and workload assigned to research. Advocacy for diversity and cultural humility were included as unique interpersonal and institutional facilitators for UMF. Several overlapping and unique barriers and facilitators to mentoring for research success for NI, ESI and UMF in the health-related disciplines are presented.

The impact of resistance training on body composition, muscle strength, and functional fitness in older women (45-80 years): A systematic review (2010-2020).

As women age, they typically experience a progressive decrease in skeletal muscle mass and strength, which can lead to a decline in functional fitness and quality of life. Resistance training (RT) has the potential to attenuate these losses. Although well established for men, evidence regarding the benefits of RT for women is sparse and inconsistent: prior reviews include too few studies with women and do not adequately examine the interactive or additive impacts of workload, modalities, and nutritional supplements on outcomes such as muscle mass (MM), body composition (BC), muscle strength (MS), and functional fitness (FF). The purpose of this review is to identify these gaps. Thirty-eight papers published between 2010 and 2020 (in English) represent 2519 subjects (mean age = 66.89 ± 4.91 years). Intervention averages include 2 to 3 × 50 min sessions across 15 weeks with 7 exercises per session and 11 repetitions per set. Twelve studies (32%) examined the impact of RT plus dietary manipulation. MM, MS, and FF showed positive changes after RT. Adding RT to fitness regimens for peri- to postmenopausal women is likely to have positive benefits.

Grief and Solidarity Reactions 1 Week After an On-Campus Shooting.

The impact of interpersonal violence extends beyond the victims and perpetrator(s). The purpose of this research was threefold: (a) to identify whether college students' very early reactions to an on-campus shooting were associated with well-known predictors of distress, (b) to examine whether grief and distress reactions were distinguishable in the early days following a shooting, and (c) to investigate whether a compassionate self-identity was uniquely associated with grief but not distress. Beginning just 3 days after an early morning shooting that killed one student and injured three others, university students (N = 408) completed an online questionnaire. Grief, but not distress, was associated with a sense of solidarity with other students and a compassionate self-identity. General distress was associated with prior mental health difficulties and exposure to the shooting. Acute stress was positively associated with being female, having prior mental health difficulties, media exposure, perceived similarity to victims, less victim blame, social support, and social strain. Results suggest that grief reactions that arise in the early days following a collective loss may serve as important psychosocial resources in coping with interpersonal violence.

Educational Attainment and Staphylococcus aureus Colonization in a Hispanic Border Community: Testing Fundamental Cause Theory.

This study was carried out to evaluate hypotheses generated by fundamental cause theory regarding the socioeconomic status (SES) gradient in colonization with Staphylococcus aureus among Hispanic and non-Hispanic adults living in a border community. Participants (n = 613) recruited in naturally occurring small groups at public and private sites throughout Yuma County, AZ, completed a sociodemographic survey and swabbed their palms, noses, and throats to sample microbial flora. Positive S. aureus colonization among non-Hispanic white participants was nominally higher (39.0%; 95% confidence interval [CI] = 32.4 to 46.1%) than that in Hispanics (31.3%; 95% CI = 26.4 to 36.8%), but there was no education gradient for the sample overall (incidence rate ratio = 1.00; 95% CI = 0.90 to 1.12) or within each ethnic group separately. The education gradient between Hispanic and non-Hispanic whites was statistically equivalent. Results were consistent when home ownership was used as the SES indicator. These data show that S. aureus colonization is not linked to two different SES indicators or Hispanic ethnicity. S. aureus colonization may be considered a less preventable health risk that is outside the influence of SES-based resources.IMPORTANCE Unlike some types of S. aureus infections, S. aureus colonization is not associated with ethnicity or educational attainment and thus may be outside the influence of socioeconomic status-based resources typically mobilized to avoid or mitigate preventable health risks. This assessment of a clinically silent risk that usually precedes infections may illustrate a boundary of fundamental cause theory.

Improving Concussion Education: Consensus From the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge.

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and MSA settings with a priori thresholds for retaining, discarding, and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and MSA cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes, and (5) organizational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioral health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Improving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge.

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Self-Evaluation Strategies in College Women Trying to Lose Weight: The Relative Use of Objective and Social Comparison Information.

We examined patterns of self-evaluative information use in a sample of college women who were trying to lose weight (N = 306). Participants described their weight loss experiences and answered questions about their self-evaluative activity via an online survey. The analysis strategy examined the relative use of four types of self-evaluative information (objective, upward social comparison, lateral social comparison, and downward social comparison) to meet three basic self-evaluative motives (accurate self-assessment, self-enhancement, and self-improvement). We also examined the role that dissatisfaction, uncertainty, importance, and self-esteem played in the relative use of information and the relationship of these factors on weight loss success. Our findings support previous research showing the primacy of accurate and self-improvement motives in the domain of weight loss and the usefulness of lateral social comparison information for meeting all three motives. Women evaluating their weight reported using upward social comparison information most often, followed by objective information. Lateral and upward social comparison information were rated as more useful than downward social comparison information for meeting accuracy and self-improvement motives. Both lateral and downward social comparison information were reported as especially useful for self-enhancement, with upward social comparison information rated as least useful. Our study utilized an integrative approach for understanding self-evaluative processes in the area of college women's weight loss. We found general support for our hypotheses regarding well-documented patterns of social comparison information usefulness for meeting three self-evaluative motives. Our data also support earlier research arguing that it is important to view information use in the context of multiple self-evaluative motives.

Psychosocial experiences of concussed collegiate athletes: The role of emotional support in the recovery process.

Objective: Understand from whom concussed football players seek and receive emotional support, and whether this support is associated with injury perceptions. Participants: Football players (N = 26) from three NCAA Division I programs. Methods: With approval from the head athletic trainer, concussed athletes (2017 season) completed short surveys within 4-6 days of diagnosis and when cleared to return. Results: Concussed athletes perceived their injury as a normal consequence of playing football, not serious, and reported little, if any, depression and anxiety. Athletes reported the most support from athletic trainers; the least from coaches and teammates. Emotional support was associated with fewer adverse psychosocial reactions, more sport-injury related growth, and greater intentions to report future concussion symptoms. Conclusion: Results from this pilot study suggest that emotional support during the concussion recovery process should be understood and fostered by university officials charged with the health and well-being of collegiate football players.

The Indirect Influence of Organizational Safety Climate on Football Players' Concussion Reporting Intentions.

Most of the health interventions designed to increase athletes' reporting of potential concussion symptoms have focused only on the individual athlete. Unfortunately, interventions targeted at athletes' knowledge and understanding of concussion risk has not reliably increased their reporting behavior, leading to increased calls for "changing the culture of concussion reporting." To date, no studies have examined the role of organizational safety climate has on concussion-symptom reporting behavior. We hypothesized that players' perception of organizational safety climate would be indirectly related to their concussion symptom reporting intentions, via the influence of safety culture on supportive social norms and self-efficacy, two well-known predictors of concussion reporting intentions. We used structural equation modeling techniques to create robust latent measures of our model variables and then examined the indirect influence of football program safety climate on football players' symptom reporting intentions. Surveys were completed by NCAA Division I football players (N = 223) before and after the 2017 football season. We tested a confirmatory factor analysis and hypothesized latent variable model with preseason data, made small adjustments to our model (adding correlated error terms), and then confirmed using postseason data. We also examined a competing, alternative model. Results support the indirect and influence of perceived safety climate on concussion reporting intentions primarily via the relationship between safety climate and social norms, and to a lesser extent between safety climate and self-efficacy. Discussion focuses on the importance of considering the addition of interventions aimed at systems-level influences to facilitate supportive social norms and athlete self-efficacy regarding concussion symptom reporting.

Investigation of strategies to improve concussion reporting in American football.

While research on sport-related concussion has increased dramatically over the past decade, research investigating concussion reporting is in its early stages. The purpose of this project was to assess concussion reporting and work with stakeholders to develop and assess strategies to improve reporting. We used a multi-site, repeated measures design with three NCAA Division I football programs, including 223 athlete participants. A modified community-based participatory research (CBPR) approach was used to develop intervention strategies (Fall 2017 season) with stakeholders designed to increase concussion reporting intentions. Preseason and postseason surveys were administered to determine effectiveness. Main outcome measures included concussion knowledge, intervention effectiveness, and reporting intention measures. For all three programs, concussion knowledge was unrelated to reporting intentions. Two of the three programs implemented the intervention strategies and for these programs there was evidence that the interventions were effective. Specifically, athletes from these two programs perceived more support from coaches about reporting (P< 0.05; t= 2.83), received education more frequently (P< 0.05; t= 2.67), and reported being more likely to report concussion symptoms (P< 0.05; t= 2.14). Our study demonstrates that working with stakeholders to develop site-specific strategies to improve concussion reporting is an effective approach to help improve reporting behaviours.

Relationship of athletic and academic identity to concussion reporting intentions.

BACKGROUND: Understanding concussed athletes' motivations for reporting concussion symptoms is important for health care professionals who are charged with the care, management, and prevention of future injury. OBJECTIVES: To examine if athletic and academic identity predict concussion symptom reporting intentions above and beyond traditional socio-cognitive predictors. DESIGN: Cross-sectional study using self-report measures during the 2016 collegiate football season. METHOD: In a sample of National Collegiate Athletic Association (NCAA) Division I American football athletes (N = 205) we examined the relationship of athletic and academic identity with three indices of symptom reporting behavior: reporting during a game, reporting 24 h after a game, and reporting on behalf of a teammate. We used descriptive statistical analyses, correlations, and linear regression to examine hypotheses. RESULTS: Controlling for traditional predictors, athletic identity was associated with a lower likelihood to report symptoms during a game (ß = -0.22, t = -3.28, p < .001) or within 24 h (ß = -0.28, t = -4.12, p < .001). Academic identity was positively associated with reporting intentions during a game (ß = 0.12, t = 1.68, p < .05), 24 h later (ß = 0.13, t = 1.85, p < .05), and on behalf of a teammate (ß = 0.22, t = -3.36, p < .001). CONCLUSIONS: Athletic and academic identities offer additional insight into athletes' motivation for concussion symptom reporting intentions, above and beyond traditional socio-cognitive predictors. Discussion focuses on the benefit of incorporating these important self-identities into educational health interventions to improve their impact.

Improving Concussion-Reporting Behavior in National Collegiate Athletic Association Division I Football Players: Evidence for the Applicability of the Socioecological Model for Athletic Trainers.

CONTEXT: Few researchers have examined the views of important stakeholders in football student-athletes' spheres of influence and whether their views map well in a systems approach to understanding concussion-reporting behavior (CRB). OBJECTIVE: To examine the extent to which stakeholders' beliefs about what influences football players' CRBs reflect system-level influences that go beyond individual-level factors. DESIGN: Qualitative study. SETTING: Four National Collegiate Athletic Association Division I university athletic programs. PATIENTS OR OTHER PARTICIPANTS: A total of 26 individuals (athletic directors = 5, athletic trainers [ATs] = 10, football coaches = 11). DATA COLLECTION AND ANALYSIS: Semistructured interviews with stakeholders were transcribed and analyzed using the socioecological model according to the Miles and Huberman coding methods. RESULTS: Stakeholders largely identified individual-level factors (attitudes), followed by exosystem-level factors (university policies and support for ATs), with fewer microsystem- and mesosystem-level factors (coach influence and communication between coaches and ATs, respectively) and almost no macrosystem-level factors (media influence, cultural norms about aggression and toughness in football). CONCLUSIONS: Promising evidence indicates growing stakeholder awareness of the importance of exosystem-level factors (eg, medical personnel and CRB policies) in influencing CRB rates. However, frontline stakeholders and policy makers may benefit from practices that bridge these influences (eg, coach involvement and communication), allowing for a more integrated approach to influence student-athletes' willingness to improve their CRBs.

Quiet ego, self-regulatory skills, and perceived stress in college students.

OBJECTIVE: Examine the unique contributions of self-control and grit subscales (perseverance, interest consistency) as potential mediators of the relationship between quiet ego characteristics and less perceived stress in college students. PARTICIPANTS: Data from 1117 college students were collected between October, 2015 and May, 2016. METHODS: The sample was split randomly into exploratory and confirmatory samples. Multiple mediator models were tested with PROCESS module (SPSS v. 24) in both samples. RESULTS: Hypotheses were largely confirmed with self-control fully mediating the link between quiet ego and perceived stress in both samples. CONCLUSIONS: Although many self-regulatory constructs may argue for their positive impact on college student outcomes, interventions that strengthen self-control, and not grit, may be most promising to reduce perceived stress. Further, interventions to strengthen quiet ego characteristics may be beneficial for strengthening self-control in college students.

Challenged and changed: Quiet ego and posttraumatic growth in mothers raising children with autism spectrum disorder.

Posttraumatic growth theory posits that when life circumstances are perceived as stressful, secondary appraisal processes can be recruited in ways to facilitate both coping efforts and personal growth. Using a mixed-methods approach, we found mothers' most challenging experiences involved child behavior (e.g. aggression, communication, and social issues) and psychosocial impacts (e.g. lack of social support, perceived judgment of others, perceived loss, and personal distress). Descriptions of most rewarding experiences reflect posttraumatic growth frameworks including constructive perceptions about themselves, life, and their relationships as well as evidence for what Maercker and Zoellner call illusory types of posttraumatic growth. Quantitative data were subjected to a hierarchical regression analysis for self-reported posttraumatic growth and included mothers' demographics, child functioning, and psychosocial measures. As predicted, posttraumatic growth was positively associated with social support from mothers' most important network member and quiet ego characteristics, a type of eudaimonic motivation. Contrary to expectation, neither autism spectrum disorder-related rumination nor time since diagnosis (or their interaction) was associated with posttraumatic growth. Discussion focuses on the practical implications of our findings that posttraumatic growth-related coping includes both constructive and illusory forms and the importance of social support and eudaimonic motivation in facilitating positive forms of secondary coping.