Abstract This study examines concussion knowledge, attitudes, and behaviors among European American football athletes using an online survey. Data from 256 players (mean age 26.8years (SD 4.9); 7.4 (SD 4.5) years of experience) across some of the highest leagues (Austrian Football League, German Football League, European League of Football) revealed an average concussion knowledge index of 17.9 (SD 2.3) of 25 and an attitude index of 63 (SD 6.3) of 75. Notably, 43.1% of athletes reported they would continue to play despite experiencing concussion symptoms indicating a gap between knowledge, attitudes, and safe behavior. These findings underscore the need for targeted educational measures to improve the transfer of knowledge toward safer decision-making processes and to strengthen the prevention and management of concussions. Practical implications • Standardized concussion education can improve symptom recognition and reporting among athletes. • Coaches and medical staff play a critical role in monitoring player health and enforcing safety protocols. • Implementing regular training and mandatory educational programs may help shift attitudes and reduce the incidence of risky behavior in American football.
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