IDEAS home Printed from https://ideas.repec.org/p/hae/wpaper/2026-1.html

Concussions and the Classroom: The Effect of an Acute Health Shock on Student Academic and Behavioral Outcomes

Author

Listed:
  • Joseph Eshun

    (University of Hawai‘i at Mānoa)

  • Timothy J. Halliday

    (University of Hawai‘i at Mānoa, University of Hawai‘i Economic Research Organization, IZA)

  • Rachel Inafuku

    (University of Hawai‘i Economic Research Organization)

  • Jamie C. Higa

    (University of Hawai‘i at Mānoa, HCAMP)

  • Troy M. Furutani

    (University of Hawai‘i at Mānoa, HCAMP)

  • Nathan M. Murata

    (University of Hawai‘i at Mānoa, HCAMP)

  • Erik E. Swartz

    (University of Hawai‘i at Mānoa, HCAMP)

Abstract

Concussions are among the most common acute health shocks experienced by adolescents, yet little is known about their causal effects on educational outcomes. We study the impact of diagnosed sports-related concussions on academic performance and behavioral incidents using a unique administrative dataset linking the Hawai‘i Department of Education to a statewide concussion surveillance system. Leveraging the longitudinal structure of the data, we implement a staggered difference-in-differences design that compares students who sustain concussions at different points in time. We find that a first concussion leads to a 0.14-point decline in science GPA but has little effect on other academic or behavioral outcomes. We further examine the consequences of repeated concussions and find that students who sustain multiple concussions experience a 0.359-point decline in mathematics GPA and a 0.276 increase in behavioral offenses following their second injury. These findings suggest that the persistent educational consequences of an isolated concussion are relatively modest, whereas repeated concussion exposure leads to larger and broader disruptions in students’ academic performance and behavior.

Suggested Citation

  • Joseph Eshun & Timothy J. Halliday & Rachel Inafuku & Jamie C. Higa & Troy M. Furutani & Nathan M. Murata & Erik E. Swartz, 2026. "Concussions and the Classroom: The Effect of an Acute Health Shock on Student Academic and Behavioral Outcomes," Working Papers 2026-1, University of Hawaii Economic Research Organization, University of Hawaii at Manoa.
  • Handle: RePEc:hae:wpaper:2026-1
    as

    Download full text from publisher

    File URL: https://uhero.hawaii.edu/wp-content/uploads/2026/09/UHEROwp2601.pdf
    File Function: First version, 2026
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Blaabæk, Ea Hoppe & Andersen, Lars Højsgaard & Fallesen, Peter, 2024. "From unequal injuries to unequal learning? Socioeconomic gradients in childhood concussions and the impact on children's academic performance," Social Science & Medicine, Elsevier, vol. 341(C).
    2. Lixin Cai & Kostas Mavromaras & Umut Oguzoglu, 2014. "The Effects Of Health Status And Health Shocks On Hours Worked," Health Economics, John Wiley & Sons, Ltd., vol. 23(5), pages 516-528, May.
    3. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    4. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    5. Florian Fouquet & Lisa Meehan & Gail Pacheco & Alice Theadom, 2024. "The effect of a minor health shock on labor market outcomes: The case of concussions," Health Economics, John Wiley & Sons, Ltd., vol. 33(12), pages 2838-2853, December.
    6. Florian Fouquet & Lisa Meehan & Gail Pacheco & Alice Theadom, 2024. "The effect of a minor health shock on labor market outcomes: The case of concussions," Post-Print hal-04705673, HAL.
    7. Otto Lenhart, 2019. "The effects of health shocks on labor market outcomes: evidence from UK panel data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 83-98, February.
    8. Pilar García-Gómez & Hans van Kippersluis & Owen O’Donnell & Eddy van Doorslaer, 2013. "Long-Term and Spillover Effects of Health Shocks on Employment and Income," Journal of Human Resources, University of Wisconsin Press, vol. 48(4), pages 873-909.
    9. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Di Meo, Giovanni & Eryilmaz, Onur, 2025. "The impacts of health shocks on household labor supply and domestic production," Journal of Health Economics, Elsevier, vol. 101(C).
    2. Cheung, T. Terry & Kan, Kamhon & Yang, Tzu-Ting, 2025. "Parental responses to child disability: Gender differences and relative earnings," Journal of Development Economics, Elsevier, vol. 174(C).
    3. Wen, Jiayi & Huang, Haili, 2024. "Parental health penalty on adult children’s employment: Gender differences and long-term consequences," Journal of Health Economics, Elsevier, vol. 95(C).
    4. Volha Lazuka, 2022. "Household and individual economic outcomes of different health shocks: The role of medical innovations," Papers 2206.03306, arXiv.org, revised Feb 2026.
    5. Nadja van 't Hoff & Giovanni Mellace & Seetha Menon, 2025. "Gender Differences in Healthcare Utilisation: Causal Evidence from Unexpected Adverse Health Shocks," Papers 2509.01310, arXiv.org, revised Aug 2026.
    6. Arne Henningsen & Guy Low & David Wuepper & Tobias Dalhaus & Hugo Storm & Dagim Belay & Stefan Hirsch, 2026. "Estimating Causal Effects With Observational Data: Guidelines for Agricultural and Applied Economists," Journal of Agricultural Economics, Wiley Blackwell, vol. 77(2), pages 356-382, June.
    7. Federica Alfani & Vasco Molini & Giacomo Pallante & Alessandro PalmaGran, 2024. "Job displacement and reallocation failure. Evidence from climate shocks in Morocco," European Review of Agricultural Economics, Oxford University Press and the European Agricultural and Applied Economics Publications Foundation, vol. 51(1), pages 1-31.
    8. Cocco, Valentin & Chakir, Raja & Mouysset, Lauriane, 2025. "Guilty or scapegoat? Land consolidation and hedgerow decline," Journal of Environmental Economics and Management, Elsevier, vol. 133(C).
    9. van Ours, Jan C., 2024. "No novelty effect but a honeymoon that lasts: On the attendance effects of new football stadiums," Sports Economics Review, Elsevier, vol. 5(C).
    10. Jeanet Sinding Bentzen & Alessandro Pizzigolotto & Lena Lindbjerg Sperling, 2026. "Divine Policy: The Impact of Religion in Government," American Economic Journal: Applied Economics, American Economic Association, vol. 18(1), pages 195-247, January.
    11. Davide Cipullo, 2023. "When Women Take All: Direct Election and Female Leadership," CESifo Working Paper Series 10229, CESifo.
    12. Costanigro, Marco & Dubois, Magalie & Gracia, Azucena & Cardebat, Jean-Marie, 2025. "The Information Value of Geographical Indications," Food Policy, Elsevier, vol. 130(C).
    13. Abagna, Matthew Amalitinga & Hornok, Cecília & Mulyukova, Alina, 2025. "Place-based Policies and Household Wealth in Africa," Open Access Publications from Kiel Institute for the World Economy 342327, Kiel Institute for the World Economy.
    14. Alessandro Bellocchi & Chiara Lodi & Giovanni Marin & Giuseppe Travaglini & Matteo Zavalloni, 2026. "Floods, Public Budgets and Fiscal Resilience: Evidence from Italian Municipalities," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 89(8), pages 1-76, August.
    15. David Candon, 2019. "The joint effect of health shocks and eligibility for social security on labor supply," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 969-988, September.
    16. Xu, Xinkuo & Zhang, Chenxi & Yang, Lizhengbo, 2025. "Green bonds: Catalyst or constraint for corporate green investment efficiency?," Journal of Multinational Financial Management, Elsevier, vol. 79(C).
    17. Martin Huber & Sarina Joy Oberhansli, 2026. "Difference-in-differences for mediation analysis using double machine learning," Papers 2602.23877, arXiv.org.
    18. Simone Balestra & Helge Liebert & Nicole Maestas & Tisamarie B. Sherry, 2021. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," NBER Working Papers 29596, National Bureau of Economic Research, Inc.
    19. Prem, Mounu & Purroy, Miguel E. & Vargas, Juan F., 2025. "Landmines: The local effects of demining," Journal of Public Economics, Elsevier, vol. 247(C).
    20. Philipp Barteska & Jay Euijung Lee, 2024. "Bureaucrats and the Korean export miracle," Discussion Papers 2024-11, Nottingham Interdisciplinary Centre for Economic and Political Research (NICEP).

    More about this item

    Keywords

    ;
    ;
    ;
    ;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I21 - Health, Education, and Welfare - - Education - - - Analysis of Education
    • I24 - Health, Education, and Welfare - - Education - - - Education and Inequality

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hae:wpaper:2026-1. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: UHERO (email available below). General contact details of provider: https://edirc.repec.org/data/heuhius.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.