By Cameron Miller (Stanford University ’16) Guest Contributor
The dangers of football and other contact sports associated with head injuries are not only well known, but are starting to be addressed more directly than ever before. A wide swathe of research has documented the connection between concussions and numerous neurocognitive issues, including the early onset of dementia and the debilitating brain disease Chronic Traumatic Encephalopathy (CTE). Former National Football League (NFL) players who have participated in the ongoing NFL Concussion Settlement are routinely diagnosed with serious neurocognitive and neuromuscular conditions in their 30s and 40s—decades before other, non-football playing individuals develop such diseases. Though none of this implies cause-and-effect, the evidence correlating declines in brain health with football are strong and growing (and make intuitive sense: hits to the head cause brain injury). Yet despite the sobering findings, football remains ingrained in American culture and economy, though dips in nationwide participation numbers and NFL television ratings indicate some momentary slippage.
But the days of tackle football may be numbered for American youth, as four states (New York, Illinois, California, and New Jersey) are actively considering legislation that would prohibit organized tackle football participation for children under the age of 12.
Is this nanny state overreach or good public health policy?
This note discusses the science, ethics, and potential impact of this pending legislation.
Four state legislatures are currently considering laws that would prohibit children under 12 from participating in organized, tackle football. Illinois’s proposed law—HB 4341, or the CTE Prevention Actwould prevent children under the age of 12 from participating in tackle football organized by a “youth sport program,” which the bill defines as “any organized intramural athletic activity program, interscholastic athletic activity program, or physical education program developed and offered to children or students in this State through an organized entity, including, but not limited to, a public or private elementary or secondary school, charter school, park district, athletic association, or other for-profit or nonprofit entity.” HB 4341 justifies the proposed ban by referencing research showing“a greater risk of neurological impairment” for athletes who began tackle football participation under the age of 12. On March 1, HB 4341 narrowly passed through the Illinois House Mental Health Committee, but subsequently lost support and is now unlikely to be passed in the current legislative session. . Like Illinois’s proposed law, the California, New York, and New Jersey versions of the legislation would also prohibit tackle football participation for those under 12.
A Maryland bill that would have prohibited tackle football and other “physical sports” (e.g., “soccer in which head butting of the ball is allowed”) until high school, when children are approximately 14, was introduced in February but defeated soon thereafter. The sponsoring legislator said “the conversation [about the dangers of head injuries in sports] is [not] over,” perhaps indicating that similar legislation will be presented in the future.
Should any of these proposed bills become law, it will likely trigger legal action challenging its Constitutionality; the law favors the states in these disputes.
Brain Injury Research
As referenced in Illinois’s HB 4341, exposure to tackle football under the age of 12 has been linked to increased susceptibility to future neurocognitive impairments. Researchers at Boston University recently found that, of 213 former football players assessed (including 68 former professional players), those who participated in tackle football before turning 12 were twice as likely to experience issues with “behavioral regulation, apathy and executive functioning” and three times as likely to have “clinically elevated depression scores”. Another study published in 2015 examining 42 former NFL players revealed that players who were first exposed to tackle football before the age of 12 “performed significantly worse” on a variety of cognitive tests, “indicating executive dysfunction, memory impairment, and lower estimated verbal IQ.” The same researchers also found less-developed brain tissue in retired NFL players whose participation in tackle football started under the age of 12 compared with those who began when they were 12 or older. A project studying cumulative head impacts concluded that subjects exposed to football before age 12 “showed some increase in the risk for impairment,” but not significantly so. Finally, a study examining concussion injuries for children aged 8-12 found that concussion rates for this population were similar to those reported for high school and college players.
12 was selected as the cutoff age in these studies because, according to the Boston University researchers, the male brain “undergoes a key period of development and maturation between the years 10-12.” The 7-11 age range has been described as “critical phase of brain growth where…the details of brain circuity are being fine-tuned to support the operations of the adult brain.”
As this literature indicates, there are significant links between participation in tackle football before the age of 12 and future neurocognitive impairment. Developmental science also finds that brain development during this phase is critical and that brain injuries—including those suffered in tackle football—can disrupt normal brain growth. These dangers have already and will continue to stoke a once latent but now emerging public health crisis driven by neurological diseases manifesting at far earlier ages than would be anticipated. This data provides strong support for the proposed bans on youth tackle football.
And yet there are a number of competing interests that complicate the ethics of the pending legislation. Chief among these are the legal arguments that could be made against the bans and their restriction on the children’s freedom of association—a theory undermined by the fact that the bills would allow other forms of football, like touch and flag, and the state’s interest in protecting the health of its citizens. The legality of these bans is analyzed elsewhere and suggests the bans enjoy would enjoy strong advantages in the courts.
Individual freedom and liberty interests are also implicated here. The reaction from many opposed to the legislation is united by a “Who is the state to tell me and my family what sport(s) my child can participate in?” theme. Indeed, the state interfering with what are normally family decisions is seemingly antithetical to the radical notion of freedom undergirding America’s founding. Opponents of the laws also cite the camaraderie and life skills football provides to its participants and decry the “bubble wrap” mentality embodied in the proposed restrictions.
The debate is further complicated when considering the economics of the bans. Youth sports in the U.S. is a $15.5 billion dollar enterprise, and well over a million children aged 6-12 participated in tackle football as recently as 2015. Any restriction on tackle football—which is embedded in American communities across the country—may have negative economic impacts and offend the culture of those cities and towns where football is a religion. Indeed, strong community outcries played key roles in the legislative failures in Illinois and Maryland.
Ultimately, the ethics of tackle football bans revolve around whether the public health benefits derived outweigh the political, economic, and social disruptions they may cause.
In the context of the current legislation, one textual caveat is key: the bills do not ban all football for children under 12, only a particular type of football—that which involves tackling. This distinction is important not only from a legal perspective (the laws do not infringe on an individual’s right of association so much that they prohibit all forms of participation), but also with respect to the concerns raised by opponents. There is no evidence that flag or touch football generate any less camaraderie than does the tackle version, and there’s nothing to support the notion that tackle football somehow provides enhanced benefits—greater perseverance, stronger resolve, better attention to detail, etc.—relative to the non-tackling versions. Said differently, no evidence has yet been brought forth suggesting it is the tackling itself responsible for the purported interpersonal growth derived from football participation. And even if the aspect of tackling is so fundamental to youth football that it cannot be adequately replaced, children will have plenty of opportunity to participate in that style of football (from age 12 up).
For those concerned the bans will ill-prepare players for the physical demands of higher level competition, a prohibition until age 12 will still give players two years during which to be taught safer tackling techniques (no tackling technique is truly safe in an inherently dangerous sport). Football—the game wherein two teams attempt to advance the ball down the field and score touchdowns—can still exist as a central part of a child’s development and the social structure of families and communities without the violence of tackling. These paternalistic prescriptions, however, are nothing more than a rationalization of expanding state control,demonstrating the powerful tensions underlying this debate.
Football is, by some margin, the most lucrative American sport and a unique part its culture and identity. The pending legislation that would restrict tackle football participation for those under 12 does not seek to excise football from the American ethos or economy, nor can it. Rather, it seeks to protect children from an inherently violent game during a time when their developing brains can ill-afford injury and thereby stem a rising tide of football-related neurocognitive deficits. Yet despite these well-placed intentions, youth football bans face political, legal, economic, and social challenges casting doubt on their potential passage and ultimate impact. Tracking the legislative process and the reactions elicited from both opponents and supporters of the bills will provide revealing insight on the uncertain future of football in America.