Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Laura Hayden

Second Advisor

Steven D. Vannoy

Third Advisor

Jonathan L. Howland


Sport participation has well-documented benefits for youth, yet concussion is one negative consequence of sport engagement that warrants attention. Research has been ongoing to better understand concussion etiology, recovery, and intervention, and some of that scholarship has now also been codified into legislation; however, legislation is varied across the United States and implementation of legislation has been scarcely evaluated. Researchers in other school domains have demonstrated disparities in the application and outcome of policies such that a policy may disproportionately help some students and harm others, based on a variety of sociodemographic variables (e.g., race, gender). As such, the purposes of the current study were, to (a) examine the current implementation of concussion management policies across Massachusetts public high schools and (b) assess the relationship between school-level sociodemographic variables and policy implementation, and (c) examine whether differences in implementation practices are systematic and associated with the sociodemographic profiles of schools. A cross-sectional survey was designed to assess which concussion policies and best practices were being implemented at least 90% of the time in Massachusetts high schools. A school nurse in every public high school (N= 304), except for those employed by the Boston Public School system, was sent the survey, and 68.1% (n= 201) eligible responses were included in analyses. Responses were tallied such that higher scores indicated more practices being consistently implemented. School demographic data were collected using the Massachusetts Department of Elementary and Secondary Education website and linked to survey responses. Descriptive statistics, correlations, regression, kmeans clustering, and groupwise comparisons were conducted to accomplish the abovementioned study purposes. Overall, current implementation of concussion management practices was reported as variable, and was associated with the sociodemographic variables of schools. Results are consistent with existing trends in the literature such that as schools’ rates of students who identify with a marginalized racial identity, as economically disadvantaged, and as English language learners increased, their implementation practice scores decreased. Moreover, results of the kmeans cluster analysis and groupwise comparisons revealed discrete groups of schools (high and low implementation), and significant differences between the profiles of schools in each group. These results are also consistent with existing disproportionality literature as schools with low implementation scores were more racially diverse, taught more students with economic disadvantage, as well as more students who are identified as English language learners. These findings lay a foundation for examining concussion management policy implementation through a disparities lens, and prompt future research as well as some considerations for professional practice.


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