Catherine Kaufman, MPA Staff Writer, Brief Policy Perspectives

Super Bowl LIV was a huge event and a historic win for the Kansas City Chiefs. About 149 million viewers tuned in to the game, and many gathered with friends and family to cheer on their favorite team. But for some Americans, the game was overshadowed by the knowledge that chronic traumatic encephalopathy (CTE), a little-understood degenerative disease, is linked to the recurring hits to the head that are common in football. Just before the game, the New York Times highlighted a 2017 article with the headline: “110 N.F.L. Brains. All But One Had C.T.E,” drawing attention to the alarming discoveries that have entered the American public understanding through movies like Concussion and Netflix’s documentary series about Aaron Hernandez. The disease, which can only be diagnosed after death, is associated with “mood swings, depression, dementia, impulse control issues, and suicidal thoughts.” 

Despite the attention given to professional-level players, 70% of all football players in the U.S. are children under the age of 14, about 2.5 million children in total. And the risk of brain damage is higher when players start younger: the Times published an article at the end of 2019 showing that for each year a player played football, their risk of developing CTE rose by 30 percent. Athletes who start playing tackle football before the age of 12 exhibit more cognitive and behavioral problems later on than those who started after the age of 12—and for every year younger that someone was exposed to tackle football, those cognitive and behavioral problems start about two and a half years earlier. A 2018 study at Wake Forest University found that white matter, which impacts learning and brain functions in the brains of boys ages eight to thirteen, changed after just one season of tackle football. 

To assuage fears about brain safety in youth tackle football and other sports, states and sports leagues have implemented policies that aim to make youth safer. These policies include both secondary (reducing effects of injury) and primary (preventing the injury) measures. 

Secondary Measures: Improving Detection and Treatment of Injury

Protecting the forty million children who play organized sports every year in the U.S. is no easy feat, but lawmakers have been trying to increase safety for young athletes. Laws aimed at early detection and treatment of the injury generally follow the outline of the state of Washington’s 2009 Zackery Lystedt Law, named after a 13-year-old who suffered a brain injury and hemorrhage after being tackled in a football game and later put back on the field. The law prohibits young athletes from returning to play without a licensed healthcare provider’s approval and requires that coaches and trainers undergo annual training on how to recognize a concussion. Implementation of the law changed the way legislators viewed sport-safety legislation: from 2009 to 2014, all 50 states and Washington, D.C. passed versions of the Lystedt Law.

A study published in the American Journal of Public Health found that concussion reporting increased significantly after the passage of the Lystedt Law (football had the highest incidence rate for concussions out of the sports studied). Two years after the law was passed, these numbers declined significantly. Researchers concluded that this initial increase in reporting, though varied among states due to legislative requirements, differences in implementation, and time of law adoption, was likely due in part to increased awareness of concussions and their health effects. Though studies demonstrated that there was an overall decrease in recurring concussions, there was not a decrease in new concussions, indicating that more primary measures are needed to avoid the concussions in the first place. 

Primary Measures: Reducing Incidence of Injury

Youth sports leagues have made several steps over the past decade to reduce the number of concussions and other brain injuries sustained by their athletes. In 2011, USA hockey banned checking in games with children under 13. The U.S. Soccer Federation banned heading for children under 10 in 2016, citing concerns over concussions and concussion awareness after a class-action lawsuit. Around the same time, the New Jersey State Interscholastic Athletic Association (NJSIAA) adopted guidelines to limit full-contact activity during high school practices in a move more limiting than any of the other seven states with similar laws. The oldest and largest national youth football league, Pop Warner, limited contact drills to one-third of practice time and banned head-on blocking and some tackling drills in 2012 over concerns about brain damage from small, repetitive blows to the head. The National Football League has also made changes. In 2010, the NFL commissioner sent letters to governors of 44 states, encouraging them to pass laws similar to the Lystedt Law. In 2012, the NFL introduced a youth program called Heads Up Football, which aims to change the strategy of tackling to keep their heads up and lead with their shoulders. 

While some see these moves as beneficial to reduce concussions and other head injuries in youth sports, others see them simply as a marketing ploy to create the perception that football can be made safe. One former player made this comparison: “you don’t let the tobacco industry regulate what’s safe in terms of smoking.” Despite the NFL’s claims to the contrary, a 2016 New York Times review of the study found that Heads Up Football did not have a demonstrable effect on concussions and that it had a significantly lesser effect on other injuries than the NFL touted. Only leagues that followed Pop Warner’s rules saw any change in injury. 

But even Pop Warner’s policies have problems. In 2016, Pop Warner settled a lawsuit alleging that a 25-year-old with CTE committed suicide because of a failure of the organization to spot the symptoms and remove him from play. The league argued that it could not be liable for a popular and commonly played sport, because, like many other states, Wisconsin law states that an activity must be extremely dangerous and uncommon to be a liability. In February 2016, Pop Warner announced further changes to make tackle football safer for youth. 

Some states are also taking primary measures to reduce the incidence of brain injury in youth sports. Six states (New York, Illinois, California, Maryland, New Jersey, and Massachusetts) have pending legislation attempting to ban tackle football for children under varying ages. Some are on second attempts after the first failed, and most view the bans as unlikely to pass. While some see them as necessary actions to prevent brain damage, others believe the bans would make it more difficult to teach kids about how to play football safely, and that the causal link between football and brain damage is not strong enough to justify the ban on a sport that is a large part of many American families’ lives.

Future Policies and Next Steps

More research is needed to definitively prove whether contact sports can be made safer, or even whether there is a causal link between youth football and brain injuries like CTE. Government funding for research and safety equipment could help to keep athletes safe and coaches informed. As long as sports are played, the concussion risk can never be completely null, but policies enacted at the federal and state level could help keep developing brains safe from unnecessary trauma.