A New Study on Adult-Education Mandates In State Concussion Laws
By Doug Abrams
Between 2009 and 2014, amid heightened public awareness about the serious consequences of concussions suffered in youth sports, every state and the District of Columbia enacted laws designed to promote prevention and treatment of these traumatic brain injuries. Such legislative unison is rare in today’s partisan times that divide blue states and red states, but this flurry demonstrates public support for effective measures designed to make life better for the nation’s youngest athletes.
Legislatures enact standards to govern events and circumstances as they occur in the future. Recognizing that legislation is inherently predictive, prudent legislators monitor operation of their enactments to help assure that standards will work as anticipated, and to consider amendments in light of experience. In prominent matters such as youth sports concussions, laws once enacted remain works in progress.
In the December issue of the American Journal of Public Health (AJPH), researchers published a study indicating that the recent state concussion laws are already fulfilling one of their primary missions — educating adults and players about prevention and treatment. After surveying these laws, this column discusses the early signs of the positive effects of this education. The column concludes by discussing the role of concussion education in guiding parents toward an informed decision about a matter not directly raised in the AJPH study, whether to permit their child to play a particular contact or collision sport at all.
State Concussion Laws
Between 2009 and 2014, every state and the District of Columbia enacted statutes concerning traumatic brain injury in youth competition. By that time, leading voices were calling youth sports concussions “a true health crisis” and a “matter of public health.” Time reported the emerging medical consensus: “Concussions are an alarmingly commonplace injury, particularly among kids and most particularly among active, athletic ones.” With the stakes so high, said CNN chief medical correspondent, neurosurgeon Sanjay Gupta, “we owe it to our . . . kids . . . to make them as safe as we know how to do, and we can do a lot better than we have been doing.”
The various state concussion laws show differences at the outer edges, but the laws share three common directives. First, nearly all these laws require that before each season, state education departments or local boards of education provide parents, coaches, administrators, and players with information and education about the nature and dangers of concussions, about how to recognize symptoms of potential brain trauma, and about how to help insure healthy recovery. Some of the statutes contemplate provision of written educational materials, and others specify face-to-face group presentations.
Second, most of the laws require that coaches immediately remove from a practice session or game any player who is suspected to have suffered a concussion. Third, most of the laws require that the player may not return to action until a physician or other licensed medical professional clears the player and affirms that return is medically appropriate.
The Beneficial Effect of Concussion Education
The new AJPH study found a significant nationwide increase in reports of new and recurrent youth sports concussions for the first two and a half years or so after the state laws went into effect. The research team concluded that the immediate increase “may be attributable to greater recognition and reporting of concussions by athletic trainers or athletes following implementation of concussion education requirements of these laws, rather than increased number of injuries.” The research team reasoned that mandatory education has “improved coaches’, athletic trainers’, parents’, and students’ knowledge of concussion signs and symptoms.”
Concussion Education and Parental Prerogatives
The AJPH study focused on the evident effects of parent education in preventing and treating concussions among youth leaguers. But this education may also play a central role in a parent’s decision whether to permit a child to enroll in a particular contact or collision sport in the first place. For example, youth football enrollment rates have fallen noticeably in many localities, while other parents educated about the risks and rewards of participation decide to enroll their children. Either way, parental choice here is a parent’s prerogative.
Quoted in Sports Illustrated this summer, Dr. Bennett Omalu said that no child should play football. “Someday,” he predicted, “there will be a district attorney who will prosecute for child abuse, and it will succeed.” He called youth football “the definition of child abuse.”
Dr. Omalu is trailblazer in raising public awareness and concern about concussions in football and other sports, but I believe he is wrong about child abuse. There is no room for prosecuting parents for allowing their child to enroll in youth-league or school football. The Constitution guarantees parents broad discretion to raise their children, so the law requires a strong showing to defeat parental decision making. Football safety concerns are real and medical experts and safety advocates should continue to speak out to educate parents and players. Parents commit no crime, however, when they decide to allow their child to play the nation’s most popular professional and amateur sport.
A child endangerment prosecution might be appropriate if, for example, parents expose their football player to specific health or safety consequences during play, such as by coaxing him to play with a concussion or other serious injury. But the initial enrollment decision depends on the parents’ informed judgment, backed by the sort of educational outreach mandated by the states’ new concussion laws and by educational commentary and reports widely available in the broadcast and print media.
Sources: Jingzhen Yang et al., New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016, American Journal of Public Health, vol. 107 (Dec. 2017); Douglas E. Abrams, Confronting the Youth Sports Concussions Crisis: A Central Role for Responsible Local Enforcement of Playing Rules, Mississippi Sports Law Review, vol. 2, p. 75 (2013); Lyle J. Micheli, Foreword, in William Paul Meehan III, Kids, Sports, and Concussion: A Guide for Coaches and Parents xi (2011) (“[a] true health crisis”); Alan Schwartz, High School Players Shrug Off Concussions, Raising Risks, N.Y. Times, Sept. 15, 2007, at A1 (quoting Dr. Robert Sallis, president of the American College of Sports Medicine); Jeffrey Kluger, Headbanger Nation, Time (Feb. 3, 2011); Tackling the Dangers of Concussions, Daily News of L.A., Jan. 26, 2012, at L1 (quoting Dr. Gupta); Scooby Axson, “Concussion” Doctor: Letting Kids Play Football is “Definition of Child Abuse,” Sports Illustrated, https://www.si.com/nfl/2017/08/08/bennet-omalu-cte-football (Aug. 8, 2017); Brooke de Lench, Letting Kids Play Football is Not Child Abuse, http://www.momsteam.com/blog/brooke-de-lench/letting-kids-play-football-not-child-abuse (Aug. 14, 2017).