Information about the risk of concussions in sports is everywhere. Recently, four separate events focused media attention on the issue. First, the National Institute of Health (NIH) released its findings on its inquiry into the suicide death of NFL linebacker Junior Seau, concluding that Seau’s brain showed evidence of chronic traumatic encephalopathy. Then, news outlets reported that Seau’s family was joining the ranks of former players and their families suing the NFL, accusing the organization of hiding information about the link between head hits and long-term cognitive problems. The media attention on risk to professional athletes naturally has increased concern about concussions in child and adolescent athletes. Research released in the past few months tells us that the cognitive effects in children may last for months after symptoms have disappeared, and even sub-concussive hits in children and adolescents may accelerate the brain's natural aging process. Finally, on January 7, the Institute of Medicine (IOM) announced that it will study youth sports concussions, with recommendations expected by mid-summer and a report to be published by the end of 2013. We are clearly riding a tide of increasing awareness about a largely mysterious medical problem, and perhaps state laws have played a part in that process.
In 2009, states rapidly began to pass legislation designed to educate and ensure that athletes do not return to play before a concussion has healed properly. As of December 31, 2012, youth sports concussion legislation was effective in 42 states and the District of Columbia, with more states poised to follow.
[Click here to see a table summarizing state youth sports concussion laws effective as of 12/31/2012]
Many view the widespread and rapid adoption of such laws as a major victory for public health, but the question now becomes: Will they “work”? While it is too early to evaluate the impact of the laws on long-term health outcomes, such as second impact syndrome, early-onset dementia, or suicide — or even on more immediate outcomes like incidence of post-concussive syndrome due to policy lag time — we can lay the groundwork for those studies by describing how the laws are being implemented in each state. Such information will be critical to understanding nuanced differences in outcomes that may not be due to actual statutory provisions, but to differences in how the law was put into practice.
Toward this end, the Network is close to completing an interview study to explore states' experiences with implementing youth sports concussion laws. We interviewed state officials and organizational leaders charged with implementing their states' law. Our preliminary findings suggest that states share many of the same factors that either promote or impede implementation, and that they are eager to talk about it. On January 24, 2013, the Network co-sponsored a webinar with the Children’s Safety Network entitled, "Implementation of State Youth Concussion Laws: Perspectives from the Frontlines." [Access playback for the webinar here.] The Webinar presented preliminary results of the survey and featured three of the implementers interviewed for the study, who shared their insights and experiences with putting their laws into practice. Their insights were remarkable. Carlene Pavlos, Director of the Division of Violence and Injury Prevention of the Massachusetts Department of Public Health noted that when Massachusetts opened its regulations to public comment in June 2011, the Department received more comments than any other regulations promulgated in its history. Paula Hudson Hildebrand, Chief Health and Community Relations Officer for the North Carolina Department of Public Instruction talked about her organization’s efforts to provide “return-to-learn” guidance — helping schools reintroduce students to cognitive functioning after concussion. Gary Matthews, Executive Director of the Alaska School Activities Association shared his organization’s experience with the legislative process in ensuring that the law as written was workable in Alaska, where most towns are not on a road system and the medical infrastructure would not support stringent medical clearance requirements.
An unexpected realization from our conversations with implementers of state concussion laws is that much of what they shared about what helped or hurt successful implementation can be generalized to other types of public health legislation. For example, Mr. Matthews talked about the challenge of seeking changes to popular legislation to make it “work” in his state without appearing to the public to be against child safety. While we await evaluation of youth sports concussion laws’ impact on student athletes’ health outcomes, there is clear value in states sharing experiences, challenges, and best practices with implementation of their laws. In the meantime, many states are reporting an increase in sports‑related concussion incidence in children and adolescents. But this is actually a good thing — it means that people are recognizing and treating concussions in young athletes more often than in the past.
This blog was prepared by Kerri Lowrey J.D., M.P.H.,senior staff attorney at the Network for Public Health Law – Eastern Region at the University of Maryland School Of Law.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.