Researchers analyze state youth sport concussion statutes

Concussions—traumatic injuries to the brain often caused by an impact to the head—are being increasingly seen as a significant health risk, especially in youth sports. The U.S. Centers for Disease Control and Prevention (CDC) estimates that between 1.6 and 3.8 million people receive concussions each year, and children and adolescents are at particular risk because their brain structures are still maturing. As a result, by 2015 all 50 states and the District of Columbia enacted legislation aimed at mitigating the risks of concussion in youth sports.

John Spengler, JD, PhD, professor and head of the Health Promotion and Community Health Sciences Department at the Texas A&M School of Public Health, joined colleagues from the University of Florida and University of New Mexico to analyze laws across the country related to concussion risk mitigation. In their study, published in the Journal of Legal Aspects of Sport, the research team searched legal databases and considered previous research to determine key similarities and differences in state concussion legislation and identify points where these laws could be clarified to further address the risks of concussions in youth sports.

In 2009, the state of Washington enacted the first youth sport concussion statute, and, over the next few years, other states followed suit, drafting laws with support from organizations like the National Football League (NFL), National Collegiate Athletic Association (NCAA), American College of Sports Medicine and CDC. However, concussion laws vary from state to state, and the lack of uniform language can inhibit the creation of common or standard practices for reducing the risk of concussion in youth sport.

Spengler and his colleagues searched legal databases for state statutes from around the country and reviewed them to find common themes in the statutory language. They found variations in several areas, such as the definition of youth sport programs and applicability of the law to youth sports, types of sports covered, who can remove athletes and who can clear them to return to play.

“Of the 51 statutes, 24 set defined age limits, and only eight explicitly listed activities covered by the law,” Spengler said. “Additionally, some statutes only covered school-related youth sports, meaning that in some states club and recreational sports might not be subject to concussion laws.”

Most state statutes addressed education and training requirements for coaches, athletes, parents, referees or officials and other key stakeholders. Required types of training, such as on-site meetings and online training, varied for stakeholders and between states.

Laws also varied on who could remove players from play for concussion symptoms, with 19 states requiring coaches to remove athletes, while other states authorized referees, trainers and health care providers to remove players suspected of having a concussion. Additionally, laws that covered removal of athletes also had requirements that those players needed to be medically cleared to play again, though laws varied as to whether concussion-specific training was required for health care professionals to return athletes to play.

These and other variations that Spengler and his colleagues found in the 51 concussion statutes point to the need for application to recreational sport beyond organized school athletic programs. The researchers also state that further clarification on the types of activities concussion statutes cover and standardization of education requirements and rules for both removing and returning athletes would likely help better manage concussion risks in youth sports. In addition, they cite the use of legal penalties for not complying with the statutes and the need for provisions that would protect coaches, medical professionals and school officials from lawsuits when following statutory guidelines.

The findings and recommendations Spengler and his colleagues provided in this study serve to inform policy around the management and prevention of traumatic brain injury in youth sport.

“Legislators, youth sports stakeholders and other parties, such as the NFL, who cited this study in a recent paper, can use this study to direct efforts to standardize and perfect these laws meant to make youth sports as safe as possible,” Spengler said.