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5 questions: Are the health risks of youth football being addressed?

Children are more vulnerable because they are still growing, and they can’t have informed consent the way an adult can. They are unable to fully consent to the potential short- and long-term risks.

Kathleen Bachynski is an assistant professor of public health at Muhlenberg College in Allentown.
Kathleen Bachynski is an assistant professor of public health at Muhlenberg College in Allentown.Read moreCourtesy of NYU

In 1956, children in King of Prussia had a new opportunity: youth football.

It started with 22 kids practicing in a cow pasture and led within three years to a championship game in Cape Canaveral, Fla. (They lost, but just getting there was a point of pride.)

The growth of the league – the players, aged 6 to 13, and the girls who were their cheerleaders – provides a case study of how tackle football grew among youths in the new book, No Game for Boys to Play: The History of Youth Football and the Origins of a Public Health Crisis. It was written by Kathleen Bachynski, an assistant professor of public health at Muhlenberg College in Allentown.

She spoke with us recently about the book.

What prompted your interest in this topic?

I played soccer in high school and ripped my ACL, which is a knee ligament. I had had a number of teammates with injuries, as well. When I went on to get my master’s and, later, a doctorate in public health, I was really interested in sports injuries.

But I became more interested in brain injuries than knee injuries. A knee injury is terrible, and you might need a knee replacement, but there is no such thing as a brain replacement. Brain injuries are so much harder to treat than bone or joint injuries. So that led to my interest in football.

Why is youth football more of a concern than college or pro football?

It is more of a concern from a public health perspective for two reasons. First, there are way more children who play football than adults who play college or professional football. It is estimated there are approximately two million kids in the U.S. between ages 6 and 14 who play the sport. And then there are another estimated one million high school players. So three million kids up to age 18. But there are only about 100,000 at the college level and a couple thousand at the professional level. The overwhelming majority of players are children.

Second, children are more vulnerable because they are still growing, and they can’t have informed consent the way an adult can. They are unable to fully consent to the potential short- and long-term risks.

Some say kids don’t hit as hard as adults, so they aren’t as much at risk for injuries. But my concern with kids, as opposed to adults, is that they are smaller, their necks are weaker, and their heads are bigger in proportion to their bodies. So you can get a bobblehead effect. You can still have significant enough force to cause trauma to the brain.

Also, kids’ brains are still developing, which is another vulnerability. And many brain injury symptoms are things like dizziness and headaches. It’s tough enough for an adult to notice these, but it’s even tougher for kids. And they don’t have as much access to trainers or other medical personnel on the sidelines looking out for them.

Finally, there aren’t helmet standards specific to kids; helmets aren’t tested specifically for children. And, as with adults, although helmets are designed to prevent skull fractures, they’re not very good at preventing concussions. That’s because your brain sits inside fluid. It’s not directly attached to the skull. So even when you’re wearing a helmet, it doesn’t necessarily stop the movement of the brain inside the skull when you get hit.

You say that “a wide range of cultural priorities other than child health" have shaped the youth football safety debate. What are they?

Kids younger than high school age started to play football a lot more after World War II for several reasons.

One was that we were in the middle of the Cold War. And President Eisenhower became concerned about the fitness of American youths. He and, later, President Kennedy supported a presidential fitness program. Were our kids tough enough, were they strong enough, to keep up with the Soviet kids? One of the things Eisenhower and other administrators and educators started to promote was competitive sports, including football. There was more interest in exposing boys to a tough sport like football than there were concerns about what the health implications might be.

One of my favorite quotes was from Bonnie Prudden, director of the Institute for Physical Fitness at White Plains, N.Y., and co-author of a 1954 study that American children were not as fit as their European counterparts. Prudden, invited to a White House luncheon, reportedly lamented, “This is a Band-Aid Society. … The catastrophe is that so few opportunities for adventure remain to children, and the few that do remain are often curtailed by overanxious parents.” The idea was that parents were too protective. During my research, I found all kinds of quotes from players and administrators showing that they considered “getting your bell rung,” as they called it, a minor injury. And maybe it was a good thing to experience because it toughened you up.

You also say that race plays a significant part in the debate.

Race has been an important part of how Americans have thought about football. The sport started in colleges, especially the more elite and Ivy League colleges like Harvard and Yale. These were predominantly white, Anglo-Saxon, Protestant young men. Football was promoted as a way to represent the superiority of young white men. In 1900, the football coach at Harvard said, “Football is the expression of the strength of the Anglo-Saxon.” The idea was that it would show off the strengths of the men who were expected to be the business and military leaders of the U.S.

What ended up happening is that as football got more and more associated with schools, and as college scholarships become more and more valuable, football also became promoted as a way to have access to higher education. So people who were historically denied access, or who have less resource, which in this country historically has often been African Americans, were drawn to the sport. You might consider the health risks worthwhile if that’s the only way you can access a college education. Since the ‘60s and ‘70s, after the integration of schools, and with the increase in the value of college scholarships, football has become ever more important to those who need scholarships.

Are we making any progress in addressing the health risks of youth football? As a public health professional, what gives you hope?

The way I think about it is, are there other ways to get the same benefits — physical fitness, teamwork, discipline — with lower risks to players’ brains and bodies? For kids, the answer is yes. Those are either non-contact sports or lower-contact sports — flag football, basketball, baseball, tennis. The way I would think of it is, we want kids to enjoy sports, but not have repeated collisions be part of that.

There is definitely huge power and money involved in football. But I am cautiously optimistic. The progress I see is, first, a greater awareness that “seeing stars” or “getting your bell rung” is something you cannot just brush off. To me, that’s a huge victory in itself.

Also, we’re starting to see more flag football options for the youngest kids. I don’t expect football to go away entirely. But having lower-collision options for the younger kids, and making sure that younger children are not having injuries or brain trauma at that young age, we’re starting to move in that direction. With that, it’s my hope we’ll be trying to do a better job of protecting our youngest players.