This is the second in a series of exclusive ľֱ reports focusing on Heads Up, the CDC's sports concussion awareness and prevention program launched in 2003. These reports analyze the program's design and efficacy. In part 1, published Dec. 8, we reported that many experts in the field found Heads Up wanting and compared Heads Up with Heads Up Football.
Since the CDC launched Heads Up, numerous researchers and reports have examined its effectiveness.
In that time, a pattern has emerged: studies co-authored by CDC officials and/or funded by the agency have yielded positive findings, whereas those by independent researchers have mostly been substantially more critical.
"CDC encourages program evaluation as a critical component of health communication and education efforts," a CDC spokeswoman told ľֱ, explaining why CDC co-evaluates its own campaign. "Program or campaign evaluation is commonly conducted by the developer of a program or campaign. These efforts help campaign developers, such as CDC, ensure that the materials are updated, revised, and/or improved as needed based on evaluation findings."
Those internal and agency-commissioned evaluations paint a highly positive picture of the program. Its most recent publication, , concluded: "CDC's HEADS UP initiatives have achieved numerous accomplishments. In particular, this approach has advanced public awareness of concussion recognition, response, and prevention throughout the United States."
Summations like that are typical of the CDC-sponsored studies. But those by outsiders have been more likely to highlight the program's shortcomings. "Young athletes continue to demonstrate gaps in their knowledge of concussions," read the conclusion to one, a theme repeated throughout the recent independent literature on sports concussion awareness and education.
ľֱ performed a textual analysis of 12 publications by independent researchers and 10 with CDC ties (eight of which listed Heads Up director Kelly Sarmiento, MPH, as co-author). We focused on discussions, conclusions and other interpretive sections in each publication, searching for key phrases and words expressing assessment, especially adjectives and adverbs connoting positive or negative meanings, and verbs such as "demonstrate" or "show."
The color-coded chart below summarizes the findings and links to the studies or their published abstracts. Green indicates a mostly positive review of Heads Up or general sports concussion awareness and education efforts; red signifies a mostly negative review; blue designates an overall neutral or inconclusive finding.
For example, the conclusion that "'Heads Up' materials demonstrated that youth sports coaches were able to appropriately prevent, recognize, and respond to sports-related concussions after reviewing the materials" -- the bolded type indicating judgmental expressions -- helped earn the 2012 CDC co-authored publication "" a "mostly positive" designation.
A 2015 , meanwhile, found "a didactic-based preseason concussion education likely has minimal benefits. Other factors besides knowledge are likely influencing student-athlete concussion reporting behavior," helping earn it a designation of "mostly negative."
Author affiliations at the time of publication(s):
Sarmiento, R. Lee, Mitchko, Wong, Huitric, Hayes, Muthuswamy, Baldwin, Breiding, Sleet, Parker, Gilchrist - CDC
Klein - SRA International
Hoffman - ICF International, Academy for Educational Development.
Sawyer - Academy for Educational Development, Family Health International 360.
Hamdallah - Academy for Educational Development.
Pruzan - Academy for Educational Development, independent.
Bloodgood, Cohen, Donnell, Dmitrovsky - ICF International.
Inokuchi, Shawver, Olson - Family Health International 360.
Covassin - Michigan State University.
Elbin - University of Pittsburgh School of Medicine.
White - John Tyler Community College.
Schuster - National Federation of State High School Associations.
Chrisman, Schiff, Rivara - University of Washington.
Mannings, Kalynych, Joseph, Smotherman, Kraemer - College of Medicine, University of Florida.
Donaldson, Newton, McCrory, P. White, Davis, Makdissi, Finch - Federation University Australia, Deakin University, Cabrini Hospital.
Caron, Bloom, Falcão, Sweet - McGill University.
Bennie -Western Sydney University.
Kroshus - Harvard School of Public Health.
Baugh, Daneshvar - Boston University School of Medicine.
Hawrilenko - Clark University.
Hunt - Ohio State University.
Kurowski, Pomerantz, Ho, Gittelman - Cincinnati Children's Hospital, University of Cincinnati College of Medicine.
Schaiper - Cincinnati Children's Hospital.
Mrazik, Perra, Naidu, Dennison - University of Alberta.
Brooks - University of Calgary, Alberta Children's Hospital.
Yeates - University of Calgary.
Babul - University of British Columbia.
Gleadhill, James, J. Lee - Charles Darwin University, Griffith University (Australia)
Maher-Sturgess - Monash University (Australia).