{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:56:55Z","timestamp":1790337415807,"version":"4.1.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2017,9,25]],"date-time":"2017-09-25T00:00:00Z","timestamp":1506297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race\/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player\u2019s career was before or after a 1976 rule change to limit contact (\u201cspearing\u201d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white\/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found ( P = .08). Compared with those in the pre\u2013spearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post\u2013spearing rule change group than the pre\u2013spearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players\u2019 intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546517728264","type":"journal-article","created":{"date-parts":[[2017,9,25]],"date-time":"2017-09-25T04:00:45Z","timestamp":1506312045000},"page":"22-29","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes"],"prefix":"10.1177","volume":"46","author":[{"given":"Zachary Y.","family":"Kerr","sequence":"first","affiliation":[{"name":"Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johna K.","family":"Register-Mihalik","sequence":"additional","affiliation":[{"name":"Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa C.","family":"Kay","sequence":"additional","affiliation":[{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.D.","family":"DeFreese","sequence":"additional","affiliation":[{"name":"Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Guskiewicz","sequence":"additional","affiliation":[{"name":"Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,9,25]]},"reference":[{"key":"bibr1-0363546517728264","unstructured":"Association of American Medical Colleges. Diversity in the physician workforce: facts and figures 2014. Available at: http:\/\/aamcdiversityfactsandfigures.org\/about-this-report\/. Accessed March 13, 2017."},{"key":"bibr2-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1177\/1941738110383963"},{"key":"bibr3-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516677793"},{"key":"bibr4-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1016\/j.ptsp.2013.08.002"},{"key":"bibr5-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh221"},{"key":"bibr6-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200305001-00277"},{"key":"bibr7-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000175725.75780.DD"},{"key":"bibr8-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e3180383da5"},{"key":"bibr9-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.03.016"},{"key":"bibr10-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31823240f2"},{"key":"bibr11-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512456193"},{"key":"bibr12-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515612082"},{"key":"bibr13-0363546517728264","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2014.904049"},{"key":"bibr14-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092498"},{"key":"bibr15-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.04.011"},{"key":"bibr16-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1097\/01.jsm.0000432853.77520.3d"},{"key":"bibr17-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1016\/S0027-9684(15)31009-9"},{"key":"bibr18-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200401000-00003"},{"issue":"4","key":"bibr19-0363546517728264","first-page":"554","volume-title":"Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012","volume":"48","author":"McCrory P","year":"2013"},{"key":"bibr20-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e318291d3b3"},{"key":"bibr21-0363546517728264","unstructured":"National Football League. NFL, NFLPA announce policy to enforce concussion protocol. Available at: http:\/\/www.nfl.com\/news\/story\/0ap3000000676669\/article\/nfl-nflpa-announce-policy-to-enforce-concussion-protocol. Published July 25, 2016. Accessed November 23, 2016."},{"key":"bibr22-0363546517728264","unstructured":"National Football League. Protecting players: NFL Head, Neck and Spine Committee\u2019s protocols regarding diagnosis and management of concussion. Available at: https:\/\/www.playsmartplaysafe.com\/focus-on-safety\/protecting-players\/nfl-head-neck-spine-committees-protocols-regarding-diagnosis-management-concussion\/. Accessed November 23, 2016."},{"key":"bibr23-0363546517728264","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-48.3.20"},{"key":"bibr24-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181653d58"},{"key":"bibr25-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.9.997"},{"key":"bibr26-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi188"},{"key":"bibr27-0363546517728264","unstructured":"University of Central Florida, College of Business Administration. The Institute for Diversity and Ethics in Sports. The 2016 racial and gender report card: National Football League. Available at: http:\/\/nebula.wsimg.com\/1abf21ec51fd8dafbecfc2e0319a6091?AccessKeyId=DAC3A56D8FB782449D2A&disposition=0&alloworigin=1. Accessed March 13, 2017."},{"key":"bibr28-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0b013e31827ec9e3"},{"key":"bibr29-0363546517728264","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546517728264","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0363546517728264","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546517728264","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:51:19Z","timestamp":1777369879000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0363546517728264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,25]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1177\/0363546517728264"],"URL":"https:\/\/doi.org\/10.1177\/0363546517728264","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,25]]}}}