Socioeconomic status and concussion reporting: The distinct and mediating roles of gist processing, knowledge, and attitudes

Abstract

Improving health outcomes for concussed athletes and others requires self-reporting symptoms; not reporting risks second-impact syndrome and death. However, concussions in adolescents and young adults are often underreported. We treat reporting as a risky decision, extending predictions of fuzzy-trace theory (FTT). We hypothesize that low SES indirectly interferes with the development of cognitive skills that reduce unhealthy risky decision making. Specifically, we expect that SES may be related to intentions to report a concussion because low SES delays development of cognitive gist processing that reduces risk-taking. Adolescents in high-school and young adults in college (n = 1211) answered questions about concussion knowledge, concussion attitudes, and cognitive scales based on FTT: categorical thinking and endorsement of gist principles about risk. Overall, for each of the two age groups, and for athletes as well as nonathletes, SES was associated with reporting intentions, and this association was mediated by the three psychological predictors we tested: gist processing, concussion knowledge, and concussion attitudes. Results are consistent with lower SES reducing opportunities for normative cognitive development, the latter characterized by developmental increases in gist processing about risk. Hence, consistent with hypotheses, gist processing, concussion knowledge, and healthier attitudes about concussions were each associated with greater intentions to report concussions. Although educational initiatives currently focus on rote knowledge and healthy attitudes, future interventions to reduce concussion underreporting could benefit from explaining the gist of risk, especially to low SES youth, adapting successful FTT-based risk-reduction curricula from other domains.

Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory

“…7,59,71,72 For example, categorical thinking about concussion risk (e.g., it only takes once to get brain damage) predicted unique variance in intentions to report concussion symptoms, beyond perceived social pressure. 72,73 In other words, agreement with categorical gist statements (similar to those used previously in other risk domains) predicted whether they would report concussion symptoms to a coach. This categorical thinking increased from adolescence to adulthood.…”

To risk or not: The impact of socioeconomic status on preschoolers’ risky decision‐making for gains and losses

“…One interpretation of the framing effect relates to the use of intuitive thinking. Our finding that higher‐SES children demonstrated a stronger framing effect is not consistent with the standard dual‐process theory, which considers intuitive thinking as a precursor to errors or as less sophisticated (Guo et al., 2017; Rahimi‐Golkhandan et al., 2017); instead, it better fits the FTT, which proposes that the framing effect links to gist‐based reasoning, a more developmentally advanced cognitive functioning (Blalock & Reyna, 2016; Reyna & Farley, 2006) that tends to be less prevalent in lower‐SES individuals (Ajayi et al., 2021; Gamino et al., 2022). Future research could investigate this possibility by testing how children's verbatim versus gist processing varies with SES backgrounds, and how it is related to decision‐making development.…”

“…Early life experiences can have widespread and enduring effects on individuals’ lifelong health and well‐being (Fendinger et al., 2023; Frankenhuis & Gopnik, 2023; Repetti et al., 2002). Among these factors, early life socioeconomic status (SES) plays an important role in shaping decision‐making, influencing associated psychological behaviors and processes (Ajayi et al., 2021; Amir et al., 2018; Griskevicius, Delton, et al., 2011; Griskevicius, Tybur, et al., 2011; Hill et al., 2016; Kish‐Gephart & Campbell, 2015). Existing studies have provided inconsistent findings and differing perspectives on the association between SES and risk preferences, thus the quest for an appropriate theoretical framework remains elusive.…”

“…Specifically, simple qualitative representations of decisions, such as “gain some money for sure vs. maybe gain some money or maybe gain nothing” drive these framing effects (for a recent review, see Reyna et al., 2023). Gist‐based reasoning, which is linked to more developmentally advanced cognitive functioning and improved judgment (Blalock & Reyna, 2016; Reyna & Farley, 2006), tends to be less prevalent in lower‐SES individuals (Ajayi et al., 2021; Gamino et al., 2022), likely due to the limited cognitive stimulation and heightened stress in their environments (Blalock & Reyna, 2016; Reyna & Farley, 2006). Therefore, FTT predicts that individuals from higher‐SES backgrounds, who are prone to employ gist‐based reasoning, would demonstrate a stronger framing effect.…”

“…We consider the capacity to make decisions that align with the relative expected value of choice options, which is termed “expected‐value sensitivity,” as an indicator of advantageous decision‐making, because the relative expected value signals whether to pursue or refrain from a certain option (Weller & Fisher, 2013). Existing research suggests that children with higher SES possess more advanced cognitive abilities and gist‐based reasoning skills that aid them in distinguishing between risk‐advantageous, risk‐neutral, and risk‐disadvantageous options (Ajayi et al., 2021; Barclay et al., 2018; Geary et al., 2008; Johnson et al., 2016; Raffington et al., 2018). Thus, we hypothesized that the expected‐value sensitivity would be more pronounced in children from higher‐SES backgrounds.…”