Trends of public interest in chronic traumatic encephalopathy (CTE) from 2004 to 2022

Statistical analysis

To analyze the change of RSI in CTE over time, we constructed linear regression models for each of the terms queried. Additionally, we compared the mean RSI in ‘CTE’ and ‘concussion’ during the NFL season from September to February each year to the offseason months – because Brain Injury Awareness Month is in March. Finally, we utilized an autoregressive integrated moving average (ARIMA) model to forecast RSI immediately following the first publicized incident involving an NFL player with CTE (2012) – and then compared the highest actual peak in RSI to the forecasted value and determined the coinciding event. This study does meet the requirements for human subjects research as defined by 45 CFR 46.102(d) and (f) of the Department of Health and Human Services’ Code of Federal Regulations and was not submitted to an Institutional Review Board for review.

Implications and recommendations

The increased search interest in CTE surrounding these traumatic events may have influenced the parents’ decision to allow child participation in the sport as the number of athletes aged 6–18 has dropped from 8.4 million in 2006 to 5.2 million in 2021 [19]. Further, in addition to ongoing research regarding TBI, both the NFL and National Collegiate Athletic Association (NCAA) in 2018 implemented rules to discourage helmet-to-helmet contact when players tackle [20]. The following year, the NFL announced that the number of reported concussions was down 29 % [21].

Our main recommendation is that as osteopathic physicians, we develop partnerships with newscasters and media journalists to deliver accurate information regarding brain injuries when broadcasting sports in which traumatic head injuries may occur. Further, by creating media partnerships, we may be able to provide a more holistic context of circumstances surrounding the tragic events that peaked public interest when they are being presented in the media. Many contact sports can result in a wide range of head injuries, in addition to TBI, and all can result in long-term behavior, mood, and memory changes, which can lead the public to quickly make speculations about CTE. As such, is also important that information shared with the general public is evidence-based, and that it balances information about the possible risks of sports with accurate information concerning recovery from a single concussion or other less threatening events. For instance, the nocebo effect is a well-known contributor that can negatively affect recovery post-TBI [22]. The nocebo effect focuses on when a patient experiences worsening symptoms as a result of increased negative information on a topic [22]. While it is clear that repeated concussive and nonconcussive blows are a risk for CTE pathology, the linkage to the syndrome and specific behaviors remains under investigation, thus the public must be properly informed about the progression of head injuries for which creating partnerships between the media and physicians could be a great avenue. Given that our findings show increased search interest in TBI-related terms occurring during the NFL season – specifically ‘concussion’ – an additional recommendation is to consider changing both Brain Injury Awareness Month, currently in March, and Concussion Awareness Day, currently in September, to November. This would coincide with not only the NFL season but also the National Hockey League season – two sports in which players experience an increase in reported head injuries. By changing the timing of these brain injury awareness initiatives to November, public awareness and access to research will coincide with several different in-season sports with players who are known to experience head injuries and may provide an opportunity for a more scientific discussion of CTE.

Strengths, limitations, and future research

In the United States, Google accounts for 61.4 % of all searches; however, despite being a widely utilized search engine, Google Trends research is limited to those who have internet access [23]. Additionally, because we focused on the NFL, which is predominantly played within the United States, we limited our searches to those that occurred within the United States for this study. Future research should focus on the full extent of media coverage for CTE, which could include social media outlets such as X (formerly known as Twitter). This could better assess the public’s interest and discussions around CTE and other head injury–related topics that are occurring on these platforms. Additional research could also focus on CTE and concussions in other sports such as hockey, soccer, and rugby – including assessing prevalences in and differences between men’s and women’s leagues.