Wise Up Initiative! Survey

Purpose:  The Wise Up Initiative! of the Al and Sharyne Wallace Foundation is trying to learn about the public’s overall knowledge and attitudes about concussions, as well as the health of individuals who have participated in sports. Your responses to this survey will help inform the direction of our efforts in concussion awareness, education, and health promotion.

This survey should take approximately 10-15 minutes. It is anonymous, if you choose not to include your contact information at the end of the survey. If you do provide your contact information, we will use the information only to contact you about our concussion related efforts and not use it any story, and will not share your information with anyone else.

Thank you very much for your time and input. If you would like to learn more about the Wise Up Initiative! please visit our website: http://www.wiseupinitiative.org/

Instructions: Please complete the following questions about you to the best of your ability. Please try not to skip any questions.

* 1. What is your age? 

* 2. What is your gender? 

* 3. What was the highest level of education you completed in years?

* 4. What do you primarily identify as your race? (check one box):

* 5. What do you primarily identify as your ethnicity?

* 6. What is your current marital status? (check one box):

* 7. What is your current employment status? (check one box):

* 8. Zip Code:

* 9. How knowledgeable or informed do you feel you are regarding concussion symptoms?

* 10. How concerned are you that you could be at risk for CTE?

* 11. Do you think contact sports, such as football, should be banned for children younger than age 14?

* 12. If yes or no, we would like to hear your thoughts on why or why not children younger than age 14 should be banned from playing contact sports.

* 13. Do you think the media attention on concussion issues has been:

* 14. If you experienced a concussion now, what is the first thing you would immediately do after the injury? (check one box):

* 15. What is your previous level of involvement in athletic competition, if at all? (Check all that apply):

* 16. How many years did you play sports?

* 17. Have you ever had a prior concussion diagnosis?

* 18. If yes, how many concussions were you diagnosed with? 

* 19. Have you had any formal concussion training or education? 

* 20. Have you participated in contact sports (e.g., football, soccer, wrestling, boxing, etc.)?

* 21. If yes, I played contact sports in (check all that apply):

* 22. How many years did you play contact sports?

* 23. Have you ever suffered a concussion as a result of playing in a contact sport?

* 24. If yes, how many concussions resulting from contact sports did you experience? (provide your best estimate)

* 25. How many concussions resulting from contact sports were formally diagnosed? 

* 26. Does Alabama have a state law on return-to-play following a concussion?

* 27. Even after several weeks in a coma, when people wake up, most recognize and speak to others right away.

* 28. After a head injury, people can forget who they are and not recognize others but be perfect in every other way.

* 29. Sometimes a second blow to the head can help a person remember things that were forgotten.

* 30. A little brain damage does not matter because people only use a small portion of their brains anyway.

* 31. How quickly a person recovers from a head injury depends mainly on how hard they work on recovering.

* 32. A person who has recovered from a head injury is less able to withstand a second blow to the head.

* 33. Complete recovery from a severe head injury is not possible, no matter how badly the person wants to recover.

* 34. People who have had one head injury are more likely to have a second one.

* 35. After a head injury it is usually harder to learn than before the injury.

* 36. A head injury can cause brain damage even if the person is not knocked out.

* 37. Whiplash injuries to the neck can cause brain damage even if there is no direct blow to the head.

* 38. People with amnesia for events before the injury usually have trouble learning new things too.

* 39. People usually have more trouble remembering things that happen after an injury than remembering things from

* 40. When people are knocked unconscious, most wake up shortly with no lasting effects.

* 41. Most people with brain damage look and act disabled.

* 42. Concussions can sometimes lead to emotional disruptions.

* 43. After a concussion occurs, brain imaging (CAT scan, MRI, X-ray, etc.) typically shows visible physical damage.

* 44. In order to be diagnosed with a concussion, you have to be knocked out.

* 45. It is good advice to rest and remain inactive for at least a week during recovery.

* 46. Most concussion symptoms subside after 7–10 days.

* 47. The word “concussion” means the same thing as “mild traumatic brain injury”.

* 48. If you experience symptoms immediately following a concussion, you have post-concussion syndrome.

* 49. CTE can only be diagnosed after death.

* 50. Scientific evidence has shown that repeated concussions from playing contact sports, such as football, cause a brain disease called chronic traumatic encephalopathy (CTE).

* 51. After a concussion, a person is likely to experience symptoms, such as headaches, memory loss, and light sensitivity, for 6 months due to brain damage from the concussion.

* 52. Scientific evidence suggests a relationship between multiple concussions and problems with thinking skills.

* 53. Scientific evidence suggests a relationship between multiple concussions and emotional disturbances.

* 54. A concussion is harmless and never results in long-term problems or brain damage.

* 55. Once a person feels “back to normal,” the recovery process is complete.

* 56. CTE can be caused by a single event/injury.

* 57. After a concussion, a person is likely to have permanent brain damage and not function the same ever again.

* 58. Please describe how you think families can be better supported when someone in their family has a concussion/traumatic brain injury.

* 59. We are interested in learning more about how we can help the general public regarding concussion awareness, education, safety detection, management, and access to accurate information/resources.  Please share with us ways in which we can help in any or all of these areas. 

* 60. What information would you like to know more about regarding concussions?

* 61. Please list what types of information or resources you have found most helpful, if any, in strategies for helping someone with a concussion? Please briefly specify —record location/source (e.g., websites, brochure, health care facility, friend/family):

* 62. OPTIONAL: Contact Information

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