A - 32 Framing Racial Disparities within Sports Related Concussion from an Ecological Systems Perspective: a Content Analysis of Literature on Black Athletes’ Risk and Protective Factors
Authors: Caiquo J , Butler C , Woolridge T , Babikian T 
Published: July 2024

Abstract

Purpose
There is an apparent phenomenon where Black adult and pediatric athletes face disparities within their care, treatment, and recovery from mild traumatic brain injury (mTBI), or concussion while playing their sport: previous literature has demonstrated that Black athletes who have experienced sports-related concussions (SRC) are less likely to demonstrate concussion knowledge and symptom identification, as well as intention to report injury and overall poorer psychosocial outcomes following injury. Overall, the axis of privilege and marginalization associated with Race, can impact presentation for care, receiving diagnoses, symptom reporting and tracking, and the process of recovery or return to baseline functioning. However, empirical findings from publications do not elucidate why nor how these various factors compound. The purpose of this literature review was to (I) identify salient literature on racial differences for Black athletes with SRC, and (II) create a framework that encapsulates the “why”and “how” sociocultural experiences of power, access, and biases can impact Black athletes. The authors used Ecological Systems Theory (EST; Bronfenbrenner, 1979) to create a novel organization-systems model of identified findings and theory that demonstrate and support racial disparities within SRC and larger mTBI literature.

Method
A comprehensive literature search was employed to identify recent empirical studies and theoretical perspectives on racial disparities in mTBI for Black populations and athletes (N = 30). Publications for literature review were identified through the following Boolean search parameter on Google Scholar: [((race OR racial) OR (Black* OR African* OR BIPOC*)) AND (*brain injury OR “mild traumatic brain injury” OR mTBI OR concussion) AND (sport* OR athlet*)], where publications of interest were compiled and annotated by authors.
Inclusion criterion for publication was established by the team as: (a) focusing on an element of concussion or mild traumatic brain injury, such as patient risk for injury, diagnosis, recovery or post-injury outcomes, (b) participants‚Äô racial background (race) must have been either an independent variable included within an analysis for quantitative designs, or be a salient topic or variable of interest within qualitative designs, and (c) published between 2018 and 2023. Publications from all journals and topic areas were included if the paper met above criterion.

Results
Approximately, two major patterns emerged that may underlie current empirical data on diagnoses, injury recovery and post injury outcomes. The two patterns illustrate how both clinicians and athletes (1) biased, unconscious beliefs that posit Black athletic bodies as invincible to injury & pain, and athletes (2) indirect and direct access to concussion knowledge and resources, can moderate the likelihood of SRC injury risk, diagnosis, recovery and post-injury outcomes for Black athletes across various athletic age and ability levels.

Conclusions
Ultimately, the organizational EST model for each pattern provides a clear thread on how historical, and macro-level policy and perceptions, can impact micro-level clinical care and decision-making for Black athletes and their experiences with SRC. Future directions suggest an application of EST models or further qualitative investigation with clinicians and Black athletes to understand more microsystem-level perceptions, beliefs, and thought processes that spur and impact clinical care.