Michael Cusimano, a neurosurgeon at Toronto's St. Michael's Hospital, says in a study of selected news coverage over the past 25 years that there's plenty of room for improvement regarding the print media's coverage of the issue.
"The accuracy of medical information is pretty good, let's say a B-plus or A-minus," Cusimano said. "In terms of being action oriented towards making the game safer, I hold people to a higher standard and I would give a C-plus or a B-minus.
"We could do much better but I think we're moving up. In the past I'd say we were closer to an F but now we're taking baby steps forward which is encouraging."
Cusimano's study, which is published in the peer-reviewed, open-access medical journal PLOS ONE, examined the coverage of sports-related traumatic brain injuries in the Toronto Star, Vancouver Sun, New York Times and Chicago Tribune. The papers were selected to provide Canada-U.S. content and cover east and west areas while encompassing Original Six cities as well as expansion-era NHL locales.
The study examined if reporting themes changed over time and specifically looked at a total of 541 newspaper articles published between 1998-2000 and 2009-2011. The articles were retrieved using the ProQuest database, an online periodical index administered by the Cambridge Information Group.
Cusimano's study examines only what has been reported in the four newspapers, and not how or if public opinion of head injuries in hockey has changed over time. But he said newspapers can be important tools in educating the public about head trauma.
"The media can play a critically important role in this whole story that's been playing out these many years," he said. "One thing this study highlights is the important role the media and personalities in the media can play in making the sport safer and actually strengthening the sport for future generations."
The study found the Canadian papers discussed hockey aggression more in recent reports and over time the role of equipment shifted from protecting to potentially becoming a potential cause of injury.
More recently, according to the study, stories dealt more with the severity and personal impact of head injuries and violence.
By comparison, the study found that American papers spoke less frequently about aggression contributing to head injuries in hockey. But more often they address perceptions of the risks of brain injury.
"In both Canada and the United States, we see accurate reporting of the medical side of things more frequently," Cusimano said. "But there is still the sense, in both media to a certain extent, that aggression and violence are part of the sport.
"Early we saw things almost to the point where promoting aggression as a way to incite interest. You see that a little bit more in the U.S., but certainly in Canada. This recent shift towards a condemnation of needless aggression and violence like in staged fights and that kind of thing, we see that a little bit more and there's a shift there.''
Cusimano said this was particularly evident following Canada's win over the United States in the 2010 Olympic gold-medal game in Vancouver.
"After the last Olympics ... the Toronto Star said: 'Canadians were just treated to some amazing hockey at the Olympics and nowhere was fighting or head-hunting seen. The game can survive and thrive without it,'" he said. "That's pretty telling to come from Canada.
"I think there's a recognition in the Canadian media to almost preserve hockey, to keep it going and prevent it from, it might be extreme to say, becoming extinct. There's a desire to keep it in a way that preserves the excitement but also addresses the issue of keeping youth safe playing the sport."
Cusimano said studying newspaper coverage of brain injuries is important because it can help shape public attitudes and behaviour regarding health issues.
"Both American and Canadian newspapers have increasingly reported on the need for rule changes and protection of players from violence-related traumatic brain injury," he said. "Developing ways to keep players safer requires we understand how attitudes and behaviours related to brain injury and violence in that sport are preserved and how they change over time.
"Since newspapers both report and shape culture in a sport, this research provides insight into the prevention of brain injuries and violence in sports and the roles that media can play in the process."
While the study itself does not have injury prevention implications, it says future work can build on the findings by analyzing how reporting on head trauma affects public opinion and shapes programs and policies that affect public health.
"If you listen to parents and their concerns and the concerns of even kids who are getting to the 12-, 13- 14-year-old age group and they're starting to get hurt and not finding it fun and want to leave the sport, those should be loud, loud bells ringing that say we need to do more," he said. "I'm definitely encouraged that we're seeing definite changes in the right direction but there's a lot that we still need to do."
Cusimano said one example is how sports are governed.
"We can certainly look at rules but we need to have rules that are more strictly enforced," he said. "We need to have enforcement with penalties that are harsh enough not only to the (offending) player but the teams and leagues need to experience some of that.
"If there are leagues that, let's say, want to change the game to have less body checking ... they need to have equal access to things like municipal resources and ice time just as the traditional leagues.
"We need to look at having new voices in how sports are governed and that governance should change on a regular basis to allow new voices and change to come in that makes sports safer but still maintains all the positive benefits of it."