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Study: Barriers to Implementing State Concussion Laws

Brock Fritz

It’s been a decade since harsher concussion laws started being introduced across United States high schools.

Researchers at the Center for Injury Research and Policy in the Abigail Wexner Research Institute at Nationwide Children’s Hospital in Columbus, Ohio recently released a study investigating the barriers high schools have faced since implementing concussion laws.

"Our hope is that school administrators, athletic directors, and athletic trainers can use these findings to identify implementation barriers in their own schools," said Ginger Yang, PhD, MPH, the senior author of the study. "These findings can help high schools structure their school's policies to maximize the safety of student-athletes and shed light on necessary updates and revisions to current state-level concussion laws."

While all 50 states adopted concussion laws between 2009-2014, they aren’t universal. However, each state has laws that address three main tenants: concussion education, removal from play after a suspected concussion, and return-to-play requirements.

The study, titled Barriers to the Implementation of State Concussion Laws Within High Schools, found that many high schools have difficulties implementing and enforcing the laws. The study, which was published Nov. 19 in the Journal of Adolescent Health, collected data by interviewing 64 high school athletic trainers – 90.6% of which worked at public schools – from 26 states between 2014 and 2016.

The study found that, “Implementation barriers to the concussion education tenet were (1) lack of quality education, (2) lack of buy-in to educational requirements, and (3) lack of time for and attendance at educational meetings. Implementation barriers to the removal from play tenet included (1) athletes underreporting concussion symptoms, (2) lack of communication, (3) resistance from parents and coaches, and (4) sport culture and “old school” mentality. Finally, (1) cost of and access to medical care, (2) resistance from stakeholders, and (3) lack of understanding of concussion were identified as implementation barriers to the return-to-play tenet.”

The concussion issue impacts a significant number of adolescents. A 2017 study titled Self-Reporting Concussions from Playing a Sport or Being Physically Active Among High School Students found that 15.1% of students – 2.5 million – reported having at least one concussion related to physical activity in the previous year, while 6.0%  – 1.0 million – reported having two or more. The University of Pittsburgh Medical Center Sports Medicine Concussion Program finds that five in 10 concussions go unreported. 

There are several reasons a concussion can go unreported, but the Abigail Wexner Research Institute’s study found that education and self-reporting of concussions has been difficult to enact due to the long-standing mentality that athletes play through injury.

"It is imperative that parents, athletes and coaches understand and follow their school's concussion policy. It's better to sit out for a game than to get injured worse and miss the rest of the season," said Sean Rose, MD, pediatric sports neurologist and co-director of the Complex Concussion Clinic at Nationwide Children's. "Athletic directors, school administrators and athletic trainers can help create an environment that focuses on the safety of the kids and encourages the disclosure of concussion symptoms and immediate removal from play following an actual or suspected concussion."

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