Original article
Consistency and Variation in School-Level Youth Sports Traumatic Brain Injury Policy Content

https://doi.org/10.1016/j.jadohealth.2017.07.003Get rights and content

Abstract

Purpose

The purpose of the study was to examine the consistency and variation in content of high school written traumatic brain injury (TBI) policies in relation to the three key tenets of youth sports TBI laws.

Methods

A content analysis was conducted on written TBI policies retrieved from 71 high schools currently participating in High School Reporting Information Online. Each policy was independently analyzed by two trained coders. The number and percent of the policies reflecting the three key tenets of state youth sports TBI laws were described and compared on policy enforcement (i.e., strictness of language), policy description (i.e., details and definitions of the requirements), and policy implementation steps (i.e., specific steps for implementing the requirements). Direct quotes were identified to support quantitative findings.

Results

All 71 high school TBI policies contained at least two of the three main TBI law tenets, where 98.6% (n = 70) included the return to play tenet, 83.1% (n = 59) included the removal from play tenet, and 59.2% (n = 42) specified the distribution of TBI information sheets to student-athletes and their parents. Nearly half of the policies (49.3%, n = 35) required parents' signature while only 39.4% (n = 28) required students' signature on the TBI information sheet. The language exhibited wide variance across the 71 TBI policies regarding policy enforcement, policy description, and policy implementation specifications.

Conclusions

All 71 TBI policies covered at least two of the three youth sports TBI law tenets, but with considerable variation. Future research should assess variations by schools within the same state and their impact on TBI rates in school athletics.

Section snippets

Study participants and data

Electronic copies of 71 concussion policies (one per high school) were collected from certified athletic trainers (ATs) or athletic directors from schools that participated in High School Reporting Information Online (RIO). High School RIO is a prospective, longitudinal Internet-based surveillance system established in 2005 that collects sports-related injury data, including TBI data, among a nationally representative sample of high schools [14]. An invitation was first sent via the listserv to

High school demographics

Seventy-one high schools from 26 states and the DC were included in the study sample (Table 2). Of these, nine states had one school, six states had two schools, and six states had three and 4+ schools, respectively. The earliest law effective date in this sample was 2009, while the latest was 2014. Of the 71 high schools, the majority (91.5%) were public schools. Over half (54.9%) of the schools had student enrollment greater than or equal to 1000. The majority of schools (88.8%) included more

Discussion

Existing research on youth sports TBI laws primarily focuses on analyzing law implementation at the state level [9], [10], [12] or among select sports [10], [19], or the impact of TBI laws on emergency department visits for concussed youth [20], [21], [22], [23]. This study is the first to analyze implementation of state TBI laws at the school level by examining the content specificity of high school TBI policies situated against the three tenets of state-level TBI laws [6], [7], [8].

Limitations

This study has several limitations. First, despite drawing from a national sample, our study sample only included high schools with ATs, and consisted of high schools from 26 states and the DC, with over half of states having only one to two participating schools. Therefore, our sample did not convey the full range of laws existing across states nor within each state. Our results could not be generalized to all high schools in the United States or high schools without ATs. Second, this study

Acknowledgments

The authors express their appreciation to High School RIO (Reporting Information Online) and to athletic directors and athletic trainers who participated in this project.

References (39)

  • P. McCrory et al.

    Consensus statement on concussion in sport—the 4th International Conference on concussion in sport held in Zurich, November 2012

    J Sci Med Sport

    (2013)
  • E. Kroshus et al.

    Concussion reporting, sex, and conformity to traditional gender norms in young adults

    J Adolesc

    (2017 Jan)
  • M. Marar et al.

    Epidemiology of concussions among United States high school athletes in 20 sports

    Am J Sports Med

    (2012 Apr)
  • V. Bompadre et al.

    Washington state’s Lystedt Law in concussion documentation in Seattle public high schools

    J Athl Train

    (2014)
  • H.H. Harvey et al.

    The four stages of youth sports TBI policymaking: Engagement, enactment, research, and reform

    J L Med Ethics

    (2015)
  • Zackery Lystedt Law—House Bill 1824

  • H.H. Harvey

    Reducing traumatic brain injuries in youth sports: Youth sports traumatic brain injury state laws, January 2009—December 2012

    Am J Public Health

    (2013)
  • K.G. Harmon et al.

    American Medical Society for sports Medicine Position Statement: Concussion in sport

    Clin J Sport Med

    (2013)
  • C.C. Giza et al.

    Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the guideline Development Subcommittee of the American Academy of Neurology

    Neurology

    (2013)
  • K. Lowrey et al.

    State experiences implementing youth sports concussion laws: Challenges, successes, and lessons for evaluating impact

    J L Med Ethics

    (2014)
  • Implementing return to play: Learning from the experiences of early implementers

  • C.M. Baugh et al.

    Requiring athletes to acknowledge receipt of concussion-related information and responsibility to report symptoms: A study of the prevalence, variation, and possible improvements

    J L Med Ethics

    (2014)
  • K.L. Tomei et al.

    Comparative analysis of state-level concussion legislation and review of current practices in concussion

    Neurosurg Focus

    (2012)
  • T.B. Gibson et al.

    Analyzing the effect of state legislation on health care utilization for children with concussion

    JAMA Pediatr

    (2014)
  • Education & Research (PIPER). High School RIO: Reporting Information Online

  • Codebook for youth sports traumatic brain injury laws

  • S.P. Chrisman et al.

    Implementation of concussion legislation and extent of concussion education for athletes, parents, and coaches in Washington State

    Am J Sports Med

    (2014)
  • The best complete streets policies of 2014

  • N. Zhang et al.

    Electronic word of mouth on Twitter about physical activity in the United States: Exploratory infodemiology study

    J Med Internet Res

    (2013)
  • Cited by (21)

    • Do state supports for persons with brain injury affect outcomes in the 5 Years following acute rehabilitation?

      2021, Health and Place
      Citation Excerpt :

      Family functioning and supports, which are factors external to the individual, have received some attention (Livingston et al., 2010; Ponsford, 2013; Vangel et al., 2011; Wade et al., 2006; Wallace et al., 1998; Yeates et al., 2002). Hosea has studied the effect of public policy on Return-to-Play legislation addressing concussions in youth sports (Coxe et al., 2018; Harvey, 2013) but not recovery from these injuries. Thus, there has been minimal focus on factors such as community characteristics, social supports, and public policy (Corrigan and Bogner, 2008; Corrigan et al., 2012).

    • Balancing safety on the road with risk from COVID-19: A content analysis of policy adaptations by Divisions of Motor Vehicles

      2021, Accident Analysis and Prevention
      Citation Excerpt :

      The three categories were 1) Stay-at-home order: states had a stay-at-home order in place as of June 1, 2020; 2) Increased restrictions: states did not have a stay-at-home order in place as of June 1, 2020, but increased restrictions (i.e., closed business, paused/froze reopening plans, reversed to a previous reopening phase) during this time, and 3) No restrictions/eased restrictions: states never enacted a stay-at-home order or states eased some or all of their restrictions during this time. The authors developed a codebook using existing methodologies for policy content analysis (Coxe et al., 2018) and assigned a numerical value to each theme identified. Teen driving safety experts outside the research team reviewed the initial codebook and provided recommendations that were used to finalize the codebook (Table 2).

    • Barriers to the Implementation of State Concussion Laws Within High Schools

      2020, Journal of Adolescent Health
      Citation Excerpt :

      Study participants were 64 high school ATs from schools active in High School Reporting Information Online (RIO) during the 2014–2015 or 2015–2016 academic years [13].

    • Are Concussion Laws Making Youth Athletes Safer?

      2018, Journal of Adolescent Health
    • Simulation of Sports Damage Assessment Model Based on Big Data Analysis

      2023, Learning and Analytics in Intelligent Systems
    View all citing articles on Scopus

    Conflicts of Interest: The authors have no conflicts of interest to disclose.

    Pursuant to the IRB and RIO agreements, schools were not named throughout this manuscript to provide anonymity to study participants.

    View full text