Community-Level Inequalities in Concussion Education of Youth Football Coaches

Introduction USA Football has made the Heads Up Football (HUF) concussion education program available for coaches of youth football players. Existing evidence about the effectiveness of the HUF coach education program is equivocal. For HUF and other programs, there is growing concern that even effective interventions can increase inequalities if there is different uptake or impact by SES or other demographic factors. Understanding how adoption is patterned along these lines is important for understanding equity issues in youth football. This study tested the hypothesis that there will be lower adoption of HUF among coaches of youth football players in lower-SES communities. Methods The authors conducted a cross-sectional study of the association between community-level characteristics and number of USA Football youth league coaches who have completed HUF. Data were collected in 2014 and analyzed in 2015–2016. Results Implementation of the HUF program was patterned by community-level socioeconomic characteristics. Leagues located in communities with a higher percentage of families with children aged