States Tackle Youth Sports Concussions – New Data!

By Benjamin Hartung, JD, Joshua Waimberg, JD, and Nicolas Wilhelm, JD

While brain injuries and studies associated with professional football get the majority of media attention, student athletes, especially young football and soccer players, are also at risk for similar brain injuries. Each year, as many as 300,000 young people suffer from traumatic brain injuries (TBIs), more commonly known as concussions, from playing sports.

State governments have responded to the problem of brain injuries in youth sports by adopting laws aimed at reducing the harm that comes from injuries that occur during team practices or events. Delaware was the first state to pass a regulation relating to youth TBIs in 2008, with Washington State following shortly after in 2009. In the years since, all states have passed youth TBI laws, many modeled after the Washington law, that mandate when student athletes are to be removed from the field, how parents should be notified in the event of a concussion, what training is required of athletic coaches, when a student athlete may “return-to-play,” and who may allow this return to the field.

In 2009, four states had passed laws addressing youth sports concussions: Delaware, Kentucky, Oregon and Washington.

More recently, states have responded to new research and CDC guidelines about the dangers of returning to the classroom too soon after a concussion by enacting “return-to-learn” requirements for student athletes. Under “return-to-learn” provisions students gradually return to academic activities after suffering a concussion. The “return-to-learn” requirements can include reduced class time, modifications of the curriculum, or monitoring by teachers, coaches, and nurses.

We updated our youth TBI maps on to include these new characteristics.

In 2011, no states had “return-to-learn” provisions in their youth TBI laws, but by 2012, Hawaii, Maine, and New York had included the provisions in their law. By 2015, 10 states had “return-to-learn” requirements, and as of July 1, 2017, 13 states had enacted the requirements. Four of those 13 states — Illinois, Maine, Massachusetts, and New York — require limitations on the activities an athlete can engage in after suffering from a concussion. Five of the 13 states — Idaho, Illinois, Maine, Massachusetts, and North Carolina —require the school academic staff to monitor the student during recovery.

As of July 2017, there are 13 states with “return to learn” provisions in their laws.

Besides the “return-to-learn” provisions mentioned above, our update also captures certain types of preventive measures that have been incorporated into the state laws. These include the maximum amount of time student athletes can participate in certain activities, and the types of activities that are to be limited. Massachusetts sets limits on the types of physical activities student athletes can engage in during practice after a concussion. California sets a maximum amount of time an athlete can engage in full-contact physical activity.

Significantly, these legal changes are taking place largely without evidence or evaluation as to the impact of the laws. There have been a few studies, but not many considering the proliferation of the laws. One, published in Cureus, finds that roughly half of US coaches surveyed had heard about the CDC’s guidelines, and that hearing about the guidelines had a significant correlation with how important coaches think pediatric concussions are, as well as the likelihood that a coach calls the athlete’s parent when an injury occurs. Another study, published in 2015 in the Clinical Journal of Sports Medicine, looked at the impact of the CDC’s guidelines on pediatric emergency departments. It found that the percentage of patients who received a recommendation of cognitive rest increased from 4 percent to 12 percent after the guidelines were published in 2010.

Although the availability of information on youth sports concussions has had an impact on coaches and medical professionals, gaps in knowledge still exist. We hope that the policy surveillance data on could spur more research into the impact of these laws on young athletes’ health.

Temple University Center for Public Health Law Research

Based at the Temple University Beasley School of Law, the Center for Public Health Law Research supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. It works by developing and teaching public health law research and legal epidemiology methods (including legal mapping and policy surveillance); researching laws and policies that improve health, increase access to care, and create or remove barriers to health (e.g., laws or policies that create or remove inequity); and communicating and disseminating evidence to facilitate innovation.

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