Concussion Management Policy Implementation in High Schools:
Examining Policy Through a Disproportionality Lens
Courtney W Hess1, Julia K Campbell2, Holly Hackman3, Laura Hayden4 and Jonathan Howland3,5
1Anesthesiology, Perioperative, Pain Medicine, Stanford University School of Medicine, Palo Alto, United States; 2The University of North Carolina at Chapel Hill, Chapel
Hill, United States; 3Boston Medical Center, Boston, United States; 4University of Massachusetts Boston, Boston, United States and 5Boston University Chobanian &
Avedisian School of Medicine, Boston, United States
Abstract
Background and Objectives: Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly
evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess
the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation
represent systematic disparities consistent with the disproportionality literature.
Methods: A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied
so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and
were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.
Results: Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of
marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete
groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low
implementation scores had a greater percentage of students who identified as African America…
New open access: Even when state governments pass strong high school concussion management policies, implementation can be variable, find authors @drcourtneyhess.bsky.social, Julia K Campbell, Holly Hackman, Laura Hayden and Jonathan Howland.
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