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Context: Concussions in student-athletes are a serious problem. Most states have enacted legislation mandating concussion education for student-athletes, under the assumption that education leads to better self-reporting of concussions and improved knowledge of symptoms.Objectives: (1) To determine the effect of state-based concussion legislation on the proportion of student-athletes receiving concussion education and to assess the moderation of this effect by gender and sport and (2) to assess the effect of concussion education on student-athletes' knowledge of concussion symptoms and likelihood of seeking treatment after a concussion.Design: Cross-sectional study. Setting: Private university. Patients or Other Participants: A total of 249 National Association of Intercollegiate Athletics collegiate athletes attending St Xavier University; 160 were surveyed prelegislation and 89 were surveyed postlegislation.Main Outcome Measure(s): Participants completed an anonymous survey that assessed previous involvement in concussion-education programs, degree of self-reporting after a concussion, and ability to enumerate symptoms.Results: The number of athletes who reported having received education increased after the implementation of concussion legislation; however, almost 25% still reported not having received education. Athletes who played football were more likely to report having received education than those who played volleyball. The student-athletes' ability to name a diversity of concussion symptoms or to report seeking medical attention after a concussion did not improve in the postlegislation period relative to the prelegislation period.Conclusions: Legislation has been passed in all 50 states to address concussions in student-athletes; however, improvements are still needed. Concussion education must be delivered in a uniform, effective manner to all student-athletes across sports and genders. Concussion education should emphasize the diversity of symptoms, especially cognitive and behavioral symptoms. We must develop and disseminate evidence-based educational programs that are clinically proven to be effective in improving athletes' knowledge and behaviors.Key Words: legislation, student-athletes, traumatic brain injuries Key PointsMore student-athletes reported receiving concussion education after legislation was passed; however, nearly 25% of athletes reported not receiving such education. Athletes with as well as those without concussion education exhibited poor awareness of the cognitive and behavioral symptoms of concussion. Evidence-based concussion education should be delivered to all student-athletes.

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Most states in the United States have enacted legislation mandating concussion education for student-athletes; however, it is not clear if such legislation leads to all students receiving the mandated education or if this education is associated with greater awareness of concussion symptoms. This work investigates whether collegiate student-athletes report receiving legislatively-mandated concussion education, and whether this varies by gender and sport. This study also investigates what methods are being used to deliver education, who is providing the education, and if receiving education is associated with an increase in ability to name the various signs and symptoms of concussion. One hundred and fifty-seven collegiate athletes from a private Midwestern university completed anonymous surveys asking about participation in high school concussion education programs, the type of education received, and who provided it. Participants were also asked to name concussion symptoms. Despite legislative mandates, 20% of student-athletes reported not receiving concussion education in high school, with women more likely to report not receiving education relative to men. The percentage reporting not receiving legislatively-mandated concussion education did not decrease over the five year period since legislation went into effect. The most common education method reported was casual conversation, and the most common providers were athletic trainers and coaches. Athletes reporting education showed no difference in ability to name concussion signs and symptoms, compared to those who reported no education. The type of education provided and the role of the person providing the education was not associated with ability to name a cognitive or behavioral signs and symptom. Legislatively-mandated concussion education is either not being delivered to all student-athletes or is not being delivered in a manner that can be remembered and reported. Education as currently being delivered is not effective in increasing awareness of diverse cognitive and behavioral signs and symptoms of concussion.

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