NFHS Voice: No HS Football Link to CTE
October 21, 2019
By Karissa Niehoff
NFHS Executive Director
When it comes to the long-term effects of concussions in sports, there is a wide range of information published – almost on a daily basis. Unfortunately, much of the media coverage as it relates to high school sports – and particularly the sport of football – is misleading.
Last week, the Concussion Legacy Foundation introduced its new public-service announcement that compared youth football dangers to smoking. As the pre-teen football players puff on cigarettes, the voiceover says, “Tackle football is like smoking, the younger I start, the longer I’m exposed to danger.”
The “Tackle Can Wait” campaign by the foundation is an attempt to steer children under the age of 14 into flag football. Although establishing a finite age may be difficult, reducing contact at youth levels is certainly a positive. USA Football is doing just that nationally through its Football Development Model. Likewise, the 51 member state associations of the National Federation of State High School Associations (NFHS) have enacted limitations on contact during preseason and practice sessions.
Our concern is the term “exposed to danger.” These types of messages continue to spread unwarranted fear to parents of high school student-athletes. The “danger” refers to reports that players who incur repeated concussions can develop chronic traumatic encephalopathy (CTE).
A 2017 study from the Journal of American Medical Association (JAMA) linked CTE in the brains of deceased National Football League players. Even if this report is accurate, these are individuals who endured repeated blows to the head for 20 to 25 years BEFORE any concussion protocols were in place.
Less publicized is a study by Dr. Munro Cullum and his colleagues at the Peter O’Donnell Jr. Brain Institute, which is a part of the University of Texas Southwestern Medical Center in Dallas. Cullum’s group studied 35 former NFL players age 50 and older who had sustained multiple concussions throughout their careers. The findings showed no significant association between the length of the individuals’ careers, the number of concussions and their cognitive function later in life.
Two studies, two different conclusions. Regardless of the outcome, however, they are not applicable to kids playing football before and during high school. There is absolutely no linkage to CTE at these levels, and the word “danger” should not be a part of the discussion.
A more applicable and significant study was also published in JAMA in 2017. In a study of about 4,000 men who graduated from Wisconsin high schools in 1957, there was no difference in cognitive function or decline between those who played football and those who did not as they reached 65 years of age. We would assume the majority of these individuals discontinued football after high school.
With more than one million boys – and girls – playing the contact sport of football each year, severe injuries do occur from time to time, but parents should know that efforts to lessen the risk of a catastrophic injury, including head injuries, have never been stronger than they are today.
In fact, new data from the National High School Sports-Related Injury Surveillance Study indicates some positive trends in concussion rates. The study, which was released in the American Academy of Pediatrics online issue of Pediatrics last week, indicated that concussion rates during football practices dropped from 5.47 to 4.44 concussions per 10,000 athletic exposures between the 2013-14 and 2017-18 seasons.
In addition, repeat concussion rates across all sports declined from 0.47 to 0.28 per 10,000 exposures during the same time period.
Concussion laws are in place in every state. All NFHS sports rules books have concussion management protocols. Helmet-to-helmet hits are not allowed in football. Limits on contact in preseason and practice in football are in place in every state.
After considering all the available research, we encourage parents to let their kids play their sport of choice in high school, but we would discourage moving away from football – or any contact sport – solely based on the fear of developing CTE later in life.
Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.
NFHS Voice: Football's Promising Results
September 9, 2020
By Karissa Niehoff
NFHS Executive Director
Normally at this time of year, the NFHS releases the latest figures from its annual High School Athletics Participation Survey. One of the most important and successful endeavors in the organization’s history, the NFHS has collected participation data through its 51 member state associations annually since 1971.
Before the 2018-19 school year, the number of participants in high school sports had increased for 29 consecutive years. Despite the first decline last year since 1988, we anticipated a quick turnaround in 2019-20 because of the continued strength of education-based high school athletics programs across the country.
There were encouraging reports last fall that football participation numbers were headed in a more positive direction. Interest in other fall sports continued to be at a high level, and winter sports were experiencing tremendous success. Then came the pandemic in mid-March, which shut down all high school sports competition.
Two-thirds of the states were unable to complete state basketball tournaments, and participants in the traditional spring sports of baseball, softball, track and field, and lacrosse – in most cases – were never able to take the field.
With spring sports unable to even get off the ground, state associations could not compile comprehensive surveys of sports participation for the 2019-20 school year. As a result, for the first time in the 50-year history of the survey, the NFHS is unable to release its annual summary of high school sports participation.
However, there is a silver lining to report. Though complete statistics are unavailable, numbers from a couple of sports last fall were obtained; and the optimism surrounding a positive trend in football participation came to fruition.
After annual declines of 23,311, 20,540 and 30,829 the past three years, participation by boys in high school 11-player football in 2019 dropped by only 2,489 – from 1,006,013 to 1,003,524. These numbers suggest to us that parents are appreciative of the risk minimization efforts that have been put in place. Every state has enacted rules that limit the amount of contact before the season and during practice, and every state has established concussion protocols and laws.
Participation in 11-player football reached an all-time high of 1,112,303 in 2008-09, and except for 2013-14, has declined every year since; however, this year’s decline is the smallest in 10 years.
The continued enthusiasm for football has been evident this fall – even amid the COVID-19 pandemic. State associations have worked with government, education and health leaders to do everything possible to offer the sport at some time during the 2020-21 season.
Some of the 34 states that are conducting football this fall have started play, and there is a special sense of gratitude on the part of students, coaches, officials and fans for the opportunity. While there may be pauses with some players and teams quarantined, and while 17 other states will not play until later in the school year, the excitement and anticipation of Friday Night Lights continues.
In addition to football, girls volleyball continued its tremendous growth last fall, increasing by 9,751 participants for a total of 462,559. In the past 10 years, the sport has added 60,000 participants and has passed basketball as the No. 2 sport for girls behind track and field.
Though a complete participation report for 2019-20 will not be available due to the loss of spring sports, totals on more fall and winter sports from 2019-20 will be formulated in the coming weeks. Judging from the early returns, it appears the past year’s participation numbers would have started the NFHS on a new streak of record participation if spring sports had not been cancelled.
Most likely, next year’s participation survey will be anything but ordinary as well. Regardless of the challenges in compiling participation statistics in 2020-21, the opportunity and desire to participate in all education-based activities remain.
Dr. Karissa L. Niehoff is starting her third year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.