University of Otago Uncertainty, Precaution & Perception: Communicating the Risk of Heading in Football Alexander William Gilbert A thesis submitted in partial fulfilment of the requirements for the degree of Master of Science Communication Centre for Science Communication, University of Otago, Dunedin, New Zealand July 2020 A. Gilbert Abstract Concerns regarding the short and long-term effects of sport-related head injury have grown in recent decades. The damage incurred by mild traumatic brain injury in the context of collision sports has thus received significant attention in both the media and in scientific research. Although this field of enquiry largely concerns the neurological impact of acute head injury (including concussion), a recent proliferation of research considering more subtle mechanisms of brain damage has also taken place. General observations from the study of “subconcussion” suggest a potential link between repeated head impacts of a subclinical nature and increased risk of neurodegeneration. The act of intentionally playing the ball with one’s head, or “heading”, is an integral part of football gameplay, and has since been identified as a potential vehicle of subconcussive injury. Despite the lack of conclusive evidence for a link between the act of heading and increased risk of brain injury, both the United States and the United Kingdom have recently taken precautionary measures by introducing regulations on junior heading exposure. To date, no empirical study has investigated public perceptions of heading as a possible health risk. The present study explored attitudes of the New Zealand public towards heading in an effort to gauge how the factors of scientific uncertainty and precautionary information influence heading- related risk perceptions. A sample of domestic players and parents of junior players (n= 89) was recruited to take part in an online survey. Participants were presented with information regarding subconcussion research and the notion of a link between heading and neurodegenerative disease. Individuals presented with a disclosure of scientific uncertainty tended to report a higher level of risk attributable to heading compared to controls. Conversely, information regarding precautionary measures generally resulted in slightly lower risk perceptions than controls. Analysis revealed a medium-large interaction effect between the factors of uncertainty and precautionary information (p<.05), illustrating significantly higher risk perceptions when uncertainty was paired with a “strong” example of precaution (banning junior heading) compared to when uncertainty was associated with an example of weaker precaution (limiting junior heading exposure). The findings show that information on precautionary heading guidelines may act to attenuate concerns regarding heading as a possible health risk. Moreover, acknowledgment of the uncertainty inherent to current heading research may combine with information on strong precautionary measures to prompt a more intuitive and perhaps pessimistic assessment of risk. These findings have significant implications for the communication of current and future heading guidelines to the public, as transparent risk communication demands honest appraisals of the scientific uncertainty and value-laden precautionary judgments that underpin regulatory decisions. Considering the potential health risk posed by heading, alongside the general health benefits of physical activity; the communication of heading guidelines must take care in promoting the safety of at-risk populations while also avoiding the risk of escalating public concerns and reducing participation in football. i A. Gilbert Acknowledgments Completing this thesis has been an incredible experience. I’ve been lucky enough to meet so many great people over the last two years, and the extent to which each one has aided me is difficult to put into words. But here goes nothing. Firstly, my thanks go to Associate Professor Jesse Bering, whose expertise and guidance not only made this project achievable, but also immensely enjoyable. The lessons I’ve learnt working with Jesse have been invaluable to my completion of this thesis, but they will become no less important throughout the rest of my life. Your knowledge, patience and encouragement as a supervisor are unequalled. Thank you for helping me find my feet. I truly believe there is no department quite like the Centre for Science Communication. The friendships and memories I have gained during my time here have had a huge impact on my life, and I’m certainly a better person for it. The entirety of the Centre’s staff has aided in this journey. In particular, I would like to thank Professor Nancy Longnecker and Dr Fabien Medvecky for always showing an interest in my project and offering much-needed advice. I’m incredibly grateful for the assistance of Sue Harvey, who was always willing to go the extra mile in service of my project. I also need to thank Anna Samuel, who has so adeptly taken up the unenviable role of replacing Sue at the front desk. Your help has not gone unnoticed. My gratitude towards Dr Thomas Swan cannot be overstated. Tom’s guidance in terms of study design and statistical analysis has been nothing short of crucial. When I had no idea what I was doing, Tom pointed me in the right direction. I’m equally grateful for having met Steve Ting. There is not enough room here to list the ways in which Steve has helped me. In short, I would like to thank him for making each day I spent at the Owheo building an absolute joy. I owe special thanks to Wynton Rufer, Dr Michael Lipton and Dawn Astle, each of whom graciously offered their time and stories for the purpose of this thesis. I also wish to thank Manon Knapen and Victoria Alogna. Both were willing to take me under their wing and share their knowledge when they had no obligation to do so. The challenge of completing a thesis has a unique way of highlighting the value of good friends, hence why I want to acknowledge Matthew, Sarah, Harry and Mackenzie. Your camaraderie has been indispensable. Lastly, I want to thank my family. This year has been difficult for all of us, and I have never been more grateful to have your support. I’ll never be able to say it enough, but thank you Mum and Dad for backing me every step of the way, just as I know you always will. Robin, Campbell and Lachlan, I’m proud to call you my brothers. And to my partner and best friend Renée, thank you for putting up with me through it all. Your willingness to do so says more than I ever could. ii A. Gilbert List of Tables Table 5-1: Eight message conditions presented to participants .......................................................... 55 Table 5-2: Separate elements of message conditions .......................................................................... 56 Table 5-3: Perceived Susceptibility to Sport Injury (PSSI) scale ............................................................ 63 Table 5-4: Adaptation of PSSI scale items ............................................................................................ 64 Table 5-5: Adaptation of Sport Injury Anxiety Scale (SIAS) – Anxiety related to BPW subscale .......... 66 Table 6-1: Distribution of participants across 8 experimental message groups .................................. 69 Table 6-2: Mean risk perception scores (RPS) for each experimental message condition .................. 70 List of Figures Figure 6-1: Age and sex of participants. ............................................................................................... 69 Figure 6-2: Interaction of Uncertainty and Precaution......................................................................... 71 Figure 6-3: Importance of football to personal identity ....................................................................... 73 Figure 6-4: Frequency of heading in training ........................................................................................ 74 Figure 6-5: Frequency of heading during games .................................................................................. 74 Figure 6-6: Parents’ estimation of their child’s attitude towards heading ........................................... 75 Figure 6-7: Parents’ preference for junior heading regulation ............................................................. 75 Figure 7-1: Effect of precautionary information on EMF risk perception ........................................... 79 iii A. Gilbert Table of contents 1 INTRODUCTION .............................................................................................................. 1 1.1 Heading in football: emerging concerns .............................................................................................. 1 1.2 Heading regulation .............................................................................................................................. 3 1.2.1 Critical reception ................................................................................................................................... 4 1.3 Thesis structure ................................................................................................................................... 7 2 SUBCONCUSSION LITERATURE ........................................................................................ 9 2.1 Neurobiological findings...................................................................................................................... 9 2.1.1 Neuroimaging .......................................................................................................................................