Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research.

BACKGROUND: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. OBJECTIVE: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. METHODS: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. RESULTS: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). CONCLUSIONS: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons.

Content comparison of campus medical amnesty policies.

Objective: To describe common components of medical amnesty (MA) policies and examine how MA policies differ across institutions. Participants: 50 U.S. colleges and universities with current MA policies. Methods: A checklist was developed to compare and assess the campus MA policies of 50 institutions. Descriptive statistics, chi-square, and regression analyses were used to examine common policy components and differences across types of institutions. Results: 40% of policies did not include a purpose statement. 42% of policies had no mention about how to use the policy. 48% did not mention restrictions on amnesty. 32% did not mention follow-up actions. 24% of policies mentioned extending amnesty for additional person(s) present. There were no significant differences in policy components across school characteristics. Conclusions: Many policies lacked detail, highlighting the need for guidelines and best practices to develop MA policies. Future research could examine the effects of these policy components on help seeking intentions.

Masculine Drinking Norms and Alcohol Use in a National Sample of NCAA Male Student-Athletes.

Objectives: Participation in sports can increase young adults' risk for heavy alcohol use and related consequences. Among student-athletes, more men report heavy drinking than women. These gender differences may reflect men's expression of masculinity which can encompass excessive consumption. While a growing body of research indicates that general masculine norms are positively associated with alcohol use and consequences among men, the extent to which alcohol-specific masculine norms can increase student-athletes' risk for elevated drinking and related outcomes is not yet known. Thus, we examined how masculine drinking norms are associated with alcohol use and related consequences while accounting for demographics and multiple dimensions of general masculine norms. Methods: 1,825 NCAA student-athletes (White=79%, Mage=20.1/SDage=1.3; 50 colleges/universities) completed a confidential online survey which included questions regarding masculine drinking norms of excess and control and conformity to general masculine norms. Results: We created latent constructs and tested a path model in SEM. Results indicated that, after accounting for demographics and multiple dimensions of general masculine norms, the masculine drinking norm of excess was positively associated with alcohol use and consequences. Conversely, control was negatively related to alcohol use but unrelated to consequences. Compared to control and other dimensions of general masculine norms, excess was most strongly related to alcohol use and consequences. Conclusions: A move from assessing general masculine norms toward alcohol-specific masculine norms can further researchers' and practitioners' knowledge of masculine norms and their link to drinking behaviors, and enhance the application of masculine norms in alcohol intervention and prevention programs.

Effects of Workplace Variables on Workers Intentions to Misuse Prescription Opioids.

OBJECTIVE: Workers in industries with high rates of opioid dispensing as well as those with high rates of non-fatal work-related injuries are at greater risk for opioid misuse, which can lead to addiction, overdose, or death. METHODS: Using secondary cross-sectional data collected from 856 healthcare workers, this pilot study examines a conceptual model for workers' intentions to seek out prescription opioids and intentions to use opioids at higher doses over longer periods. RESULTS: Results showed significant protective effects of beliefs, injunctive and subjective norms, and behavioral control on intentions to seek out opioids. On intentions to use higher doses over a longer time, knowledge, beliefs, behavioral control, patient-provider communication, workplace safety, and workplace autonomy had significant protective effects. CONCLUSIONS: Findings from this study could be used to inform future multilevel interventions to prevent opioid misuse among employee populations.

Racial, ethnic, and sex differences in heavy drinking and negative alcohol-related consequences in a national sample of NCAA student-athlete drinkers.

Objective: Athletic involvement is linked to increased risk for heavy alcohol use among college students. We examined whether student-athletes from diverse racial/ethnic backgrounds differ with respect to heavy drinking and related consequences. Method: Participants were 15,135 student-athlete drinkers (50.7% female) from 170 NCAA member institutions who participated in an online study. Results: Findings from our hierarchical linear models indicated that being a male student-athlete was associated with an increased likelihood of high intensity drinking (10/8 + drinks/per sitting for males/females) for White, Asian American/Pacific Islander, and Black student-athletes, but not for Hispanic student-athletes. Additionally, being a female student-athlete was associated with higher levels of negative alcohol-related consequences across all racial/ethnic groups. Finally, at similar drink quantities, compared to being a White student-athlete, being an Asian American/Pacific Islander student-athlete was associated with higher levels of alcohol-related consequences. Conclusions: Student-athlete drinkers are not homogeneous with respect to heavy drinking and related consequences.

The Role of Theory in the Prevention of Sexual Violence in Sport.

Sexual violence (SV) remains at epidemic proportions in the U.S. and growing evidence demonstrates that youth and adults engaged in sport are at increased risk of victimization and perpetration of SV. Unfortunately, sport SV prevention strategies are rarely built on theory or theoretically grounded evidence, despite demonstrated effectiveness of such approaches. This study aimed to answer to questions: 1) Which theories are relevant to the development of effective SV prevention strategies in sport?; and 2) How has theory been incorporated into existing SV prevention literature on sport safety? A scoping review of the literature plus expert input identified 29 theories pertinent to SV prevention in sport. A systemized review of the literature regarding SV prevention in sport resulted in the identification and characterization of 41 published articles. Authors then examined theory's role in prevention literature. This study identified 29 theories pertinent to SV prevention in sports and applicable across the behavioral spectrum. Most theories were rooted in the Behavioral (41%), Situational (24%) or Social/Attitudinal (21%) areas. Less common were theories grounded in Feminist (14%) domains. Theories were predominantly focused at the individual (42%), organizational (29%), and interpersonal (18%) ecological levels. Of the 41 sport prevention articles, 33 (83%) referred to a theory either explicitly or implicitly. Though most theories have been incorporated into prevention efforts, closer examination indicates that the majority were descriptive, unlikely to use a sophisticated methodology (10%; e.g., experimental, quasi-experimental), and rarely intended to assess a specific prevention program/strategy or policy (21%). Strong theoretical foundations are available for SV prevention research focused on sports, and their application appears to show value across the developmental spectrum of athletes. There remains a need for greater focus on theory-driven research intended to develop prevention strategies and policies designed to enhance athlete safety.

Introduction - The Prevention of Sexual Violence in Sport: A Real Game Changer.

This Special Issue focuses on the prevention of sexual violence in sport. It begins with an examination of the role of theory in the prevention of sport related sexual violence, identifies critical gaps in the literature, features a number of cutting-edge sexual violence prevention studies, and provides a practically oriented investigation that demonstrates the importance of incorporating a socioecological framework and policy structures in the prevention of sexual violence in sport. This Special Issue was designed to encourage greater development and study of empirically based approaches to prevent sexual violence in sport in response to the paucity of available strategies to enhance athlete safety and well-being.

Prevention of Sexual Violence in sport: A Socioecological Review.

Sexual violence in sport is prevalent and represents a serious public health concern. The social-ecological model for health promotion has been used successfully as a framework to identify individual-to-policy level factors aimed at health promotion or disease prevention. The purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice. Grey literature search methods were utilized to conduct a review of publicly available documents. This included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines to identify whether the SVP practices identified in step one had associated peer-reviewed publications. Finally, we assessed various characteristics of each SVP practice including the target population, age range of intended participants, and whether the SVP had associated peer review publications. This led to the identification of 35 unique SVP practices: 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level. This review uncovered several important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature. Ultimately findings suggest that sport organizations ought to prioritize sexual violence prevention using national organizations for guidance.

A National Study on Drinking Game Behaviors and Related Consequences Among NCAA Student-Athletes: Racial/Ethnic and Sex Differences.

OBJECTIVE: Research indicates that college student-athletes report more alcohol use and negative drinking consequences than non-student-athletes. One drinking practice that has been linked to heavy alcohol use and related consequences is playing drinking games. In the present study, we investigated which segment of the student-athlete population is most at risk for frequent drinking game participation, elevated alcohol consumption while playing drinking games, and negative drinking game consequences. We examined sex and racial/ethnic differences in behaviors and consequences associated with drinking games in a national sample of White, Hispanic, Black, and Asian American/Pacific Islander (AAPI) student-athletes. METHOD: A total of 11,839 student-athletes (51.4% women) from 165 National Collegiate Athletic Association (NCAA) member institutions who endorsed lifetime participation in drinking games completed a confidential online survey. RESULTS: Hierarchical linear modeling revealed that being a White (vs. Black or Hispanic) student-athlete was associated with more frequent drinking game participation, and among AAPI and Black (but not White or Hispanic) student-athletes, men played drinking games more frequently than women. Being a Black (vs. White) student-athlete was associated with more drinking game consumption; no sex differences in drinking game consumption were found among Black student-athletes. Among White, AAPI, and Hispanic student-athletes, being a male student-athlete was associated with more drinking game consumption. Finally, female student-athletes had a higher likelihood of experiencing one or more negative consequences from drinking games than did male student-athletes. The association between drinking game participation and negative drinking game consequences was also stronger for women compared with men. CONCLUSIONS: Student-athletes are heterogeneous with regard to drinking game behaviors and related consequences. Knowing who is at greatest risk for drinking game participation and related outcomes is an important first step in developing targeted intervention approaches for student-athletes.

itMatters: Optimization of an online intervention to prevent sexually transmitted infections in college students.

ObjectiveTo describe an iterative approach to developing an online intervention targeting the intersection of alcohol use and sexual behaviors among first year college students. Methods and Participants: Using the multiphase optimization strategy (MOST), we conducted two iterative optimization trials to: (1) identify candidate intervention components (i.e., descriptive norms, injunctive norms, outcome expectancies, perceived benefits of protective behavioral strategies, and self-efficacy to use strategies); (2) revise components; and (3) identify the optimized intervention. Participants were first year college students at six geographically diverse universities (optimization trial 1 N = 5,880; optimization trial 2 N = 3,551) Results: For both optimization trials, the results indicated that only descriptive and injunctive norms produced a significant effect (p<.05). Conclusions: The iterative process of MOST allowed us to develop an optimized intervention which is an essential tool to maximize intervention effectiveness and efficiency to improve uptake, sustainability, and public health impact.

A randomized iterative approach to optimizing an online substance use intervention for collegiate athletes.

BACKGROUND: Rates of drug use among collegiate athletes are high, yet there are few evidence-based interventions for this population. myPlaybook, an online intervention for collegiate athletes, targets multiple predictors of drug use (i.e., norms, positive and negative expectancies about use, and harm prevention intentions). PURPOSE: We aimed to optimize modules from myPlaybook. METHOD: We evaluated modules through three sequential randomized factorial trials, using the Multiphase Optimization Strategy framework. We recruited and randomized 54 (Trial 1), 47 (Trial 2), and 42 (Trial 3) schools and invited all first-year and transfer collegiate athletes to participate. Athletes completed a baseline survey, their randomly assigned modules, and immediate posttest and 30-day follow-up surveys. Across trials, 3,244 (48.8% female), 2,837 (51.9% female), and 2,193 (51.4% female) athletes participated. In Trial 1, we evaluated and revised less effective modules (defined as d < 0.3-0.4 for targeted outcomes). In Trial 2, we re-evaluated and revised less effective modules. In Trial 3, we re-evaluated the revised modules. RESULTS: Trial 1: All effects were d < 0.15, so we revised modules to target proximal outcomes (i.e., the hypothesized mediating variables in our conceptual model), rather than specific drug use behaviors. Trial 2: Most effects were d < 0.3, so we revised all modules. Trial 3: The norms module improved descriptive and injunctive norms (all d >0.35). The expectancies module improved alcohol positive expectancies (d = 0.3). The other modules were not effective. CONCLUSIONS: After three trials, two myPlaybook modules substantially improved proximal outcomes, increasing the likelihood that the combined intervention will have a meaningful clinical impact on collegiate athletes' drug use.

Rates of drug use among collegiate athletes are high, yet there are few evidence-based interventions for this population, and the few existing interventions only address alcohol use. In addition, alcohol and drug use interventions targeting college students are not always as effective or efficient as they could be. Our goal was to strengthen modules from myPlaybook, an online drug use intervention for collegiate athletes as a way to optimize the full intervention package. We conducted three intervention trials. Each trial occurred in separate academic years and included 2,000­3,000 athletes from 40 to 50 colleges and universities. We randomly assigned athletes to receive one or more intervention modules that target known risk factors for drug use (i.e., social norms, expectancies about the effects of drug use, harm prevention strategies, and life skills). We used the results about the effects of each module to improve the module prior to the next trial. After these trials, the revised modules targeting social norms and expectancies about drug use had meaningful effects, increasing the likelihood that the full myPlaybook intervention will lead to clinical reductions in drug use among collegiate athletes.

Dimensions of Athletic Identity and their Associations with Drinking Behaviors among a National Sample of University Athletes in the United States.

Although prior studies have indicated athletic identity plays a role in alcohol use among college athletes, this research has largely drawn on a unidimensional conceptualization. Addressing this gap, the current study utilized a sample of 8,550 university athletes (Mage = 19.70 years, SD = 1.33, 50.8% men) from 203 U.S. post-secondary institutions to examine the associations between athletic identity dimensions (i.e., social identification, negative affectivity, and exclusivity) and alcohol use for athletes across gender, sport type, and division. The results indicated that negative affectivity and social identification were associated with higher levels of alcohol use, whereas exclusivity was associated with lower levels of alcohol use. Further, the association between dimensions of athletic identity and alcohol use varied across competitive level (i.e., Division I, II, and III). The findings implicate the need for (a) future research to approach athletic identity as a multidimensional concept when examining its association with alcohol use outcomes, and (b) post-secondary alcohol prevention professionals to integrate dimensions of athletic identity in alcohol prevention approaches.

A Hybrid Evaluation-Optimization Trial to Evaluate an Intervention Targeting the Intersection of Alcohol and Sex in College Students and Simultaneously Test an Additional Component Aimed at Preventing Sexual Violence.

BACKGROUND: Using the multiphase optimization strategy (MOST), we previously developed and optimized an online behavioral intervention, itMatters, aimed at reducing the risk of sexually transmitted infections (STI) among first-year college students by targeting the intersection of alcohol use and sexual behaviors. PURPOSE: We had two goals: (a) to evaluate the optimized itMatters intervention and (b) to determine whether the candidate sexual violence prevention (SVP) component (included at the request of participating universities) had a detectable effect and therefore should be added to create a new version of itMatters. We also describe the hybrid evaluation-optimization trial we conducted to accomplish these two goals in a single experiment. METHODS: First year college students (N = 3,098) at four universities in the USA were individually randomized in a hybrid evaluation-optimization 2 × 2 factorial trial. Data were analyzed using regression models, with pre-test outcome variables included as covariates in the models. Analyses were conducted separately with (a) immediate post-test scores and (b) 60-day follow-up scores as outcome variables. RESULTS: Experimental results indicated a significant effect of itMatters on targeted proximal outcomes (norms) and on one distal behavioral outcome (binge drinking). There were no significant effects on other behavioral outcomes, including the intersection of alcohol and sexual behaviors. In addition, there were mixed results (positive short-term effect; no effect at 60-day follow-up) of the SVP component on targeted proximal outcomes (students' self-efficacy to reduce/prevent sexual violence and perceived effectiveness of protective behavioral strategies). CONCLUSIONS: The hybrid evaluation-optimization trial enabled us to evaluate the individual and combined effectiveness of the optimized itMatters intervention and the SVP component in a single experiment, conserving resources and providing greatly improved efficiency. TRIAL REGISTRATION: NCT04095065.

Design Thinking: Assessing the health needs of college students with intellectual and/or developmental disabilities.

BACKGROUND: There is a dearth of literature related to well-being of college students with IDD. The purpose of this study was to use design thinking to identify health-related innovations for college students with IDD. METHOD: Two design thinking events were conducted with participants (n = 16). Subsequent web-based surveys with a separate group of students with IDD (n = 18) assessed feasibility of each innovation. Collaborative group discussions were used to assess each innovation, and quantitate data were used to assess innovation feasibility. RESULTS: A total of 16 innovations were constructed: 4 sexual health, dating and relationships, 2 drugs and/or alcohol, 2 exercise and physical activity, 2 socializing, leisure and recreation, 2 food and nutrition and 4 mental health. CONCLUSION: Design thinking methods are a suitable strategy to use with individuals with IDD and led to the development of innovations with high relevancy and feasibility for college students with IDD.

A Latent Profile Analysis to Categorize and Describe Athletes Based on Factors Related to Concussion Disclosure.

CONTEXT: Collegiate student-athletes continue competing after experiencing symptoms of a concussion. Self-report of concussion symptoms is a critical element of the recovery process. Identifying factors related to concussion disclosure can aid in encouraging self-reporting. OBJECTIVE: To use latent profile analysis to categorize and describe athletes based on factors related to concussion disclosure. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 2 881 (52.4% female; 65.3% in-season; 40% collision sport) student-athletes from 16 National Collegiate Athletic Association member institutions. MAIN OUTCOME MEASURE(S): Student-athlete concussion expectations, attitudes, and norms were the profile variables and reporting intentions served as the distal outcome variable. We conducted latent profile analysis using select profile variables to determine the optimal number of classes. Differences in concussion-reporting intentions by profile assignment were then examined. Lastly, the extent to which a student-athlete's sex, season status, and level of contact predicted his or her intentions to report a concussion within each profile was investigated. RESULTS: Five unique student-athlete profiles emerged, including 1 profile that was most risky and another that was least risky. Females had significantly higher odds of being in the least risky profile. Those participating in collision sports had significantly higher odds of being in the top 2 most risky profiles. Contact-sport and in-season athletes were less likely to be in the least risky profile. CONCLUSIONS: With a better understanding of student-athlete profiles, athletic trainers have an opportunity to encourage concussion disclosure. Prompt disclosure would allow student-athletes to begin the return-to-play protocol in a more timely manner.

First-year college students' alcohol and hookup behaviours: sexual scripting and implications for sexual health promotion.

This study used a sexual scripting framework to analyse data from the Online College Social Life Survey to examine the role of individual, (e.g. gender, race and alcohol use), relational (partner type, condom use behaviours), and contextual factors (sex ratios and fraternity/sorority affiliation) influencing 4,292 first-year college students' hookup experiences. Results suggest that hookups are relatively "safe", with the the majority involving non-penetrative sexual behaviour, condom use, and familiar partners. However, alcohol use affected hookup behaviours and lower levels of condom use were associated with heavy alcohol use, even with less well known partners. Findings point to the importance of interventions that reinforce first-year students' positive behaviours and present them with protective behavioural strategies to use in the context of alcohol, and with repeat or well-known partners to reduce risk and have enjoyable, consensual sexual experiences.

Sexual sensation seeking, hookups, and alcohol consumption among first-year college students.

OBJECTIVE: To explore sexual sensation seeking (SSS) among an ethnically-diverse sample of first-year college students and their hookup behaviors. PARTICIPANTS: 1,480 first-year college students who hooked up in the last 30 days were recruited from four universities in 2016. METHODS: Students completed an online survey before completing an online STI and alcohol prevention intervention. RESULTS: Male and sexual minority students had significantly higher SSS scores compared to female and heterosexual students respectively. Students with higher SSS scores were less likely to report condom use at last vaginal and anal hookup, more likely to hookup under the influence of alcohol and participate in a wide range of sexual behaviors. There were no significant mean differences in SSS scores by level of intoxication during their last hookup. CONCLUSION: These findings highlight the role of SSS in predicting sexual risk behaviors of first-year college students and the overall low SSS scores among this sample.

Black First-Year College Students' Alcohol Outcome Expectancies.

BACKGROUND: Alcohol outcome expectancies (AOEs) are associated with college students' varied alcohol consumption. Existing research on AOEs focuses primarily on heterosexual White students. Thus, it is important to explore how the intersection of multiple identities such as race, gender, and sexual orientation influence the endorsement of specific AOEs. PURPOSE: This paper examines AOEs among Black first-year college students, with specific attention to the influence of gender and sexual orientation. METHODS: Participants were 307 Black students from four universities in the United States. We conducted bivariate analyses using the 2-factor and 4-factor B-CEOA scale. RESULTS: Most students did not hold positive AOEs such as tension reduction and sexual enhancement. They were more likely to endorse negative AOEs such as behavioral and cognitive impairment and social risk. DISCUSSION: Black first-year college students reported more negative expectations associated with alcohol use, including those related to negative social risks and consequences. Thus, AOEs may serve as a protective factor against alcohol use among Black college students. TRANSLATION TO HEALTH EDUCATION PRACTICE: Alcohol interventions should be tailored to focus on the intersection of race, gender, and sexual orientation. Culturally relevant alcohol interventions have the potential to reduce the immediate and long-term consequences of alcohol use.

Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes.

PURPOSE: A significant proportion of sport-related concussions goes unreported among adolescents, which can result in irreversible brain damage. It is critical to identify and intervene on factors that significantly impact concussion reporting. METHODS: This study tests factors associated with collegiate athletes' intentions to (1) self-report concussion symptoms; (2) report another athlete's concussion symptoms; and (3) encourage others to report. Drawing on the Integrated Behavioral Model, predictors at the athlete level included perceived norms (bystander descriptive norms, injunctive norms, and subjective norms), attitudes (positive and negative expectancies about reporting and playing through a concussion and concussion reporting attitudes), personal agency (self-efficacy to recognize symptoms and communicate), and perceived coach communication. At the team level, coaches' self-reported communication was also included. Athletes (N = 1,858) and coaches (N = 254) at 16 colleges and universities completed Web-based surveys in 2016. Multilevel modeling accounted for the nesting of athletes within athletic team. RESULTS: Bystander descriptive norms, positive reporting expectancies, concussion reporting attitudes, self-efficacy to communicate about a concussion, and athletes' perceptions of their coach's communication were positively associated with all three outcomes. By contrast, subjective norms were only positively associated with intentions to self-report and bystander reporting intentions, negative reporting expectancies were only associated with intentions to self-report, and positive and negative expectancies for playing through a concussion were only associated with intentions to self-report and bystander encouragement. CONCLUSIONS: In sum, multiple factors within the Integrated Behavioral Model predict reporting intentions and underscore the complexity of athletes' concussion reporting behaviors and offer guidance for the development of prevention strategies.