Recently I was interviewed prior to a hearing on Massachusetts House Bill 2007 No Organized Head Impact to Schoolchildren (NO HITS), an act that would not allow tackle football in Massachusetts before 8th grade. I was interviewed in my capacity as a former football player at Harvard University, as CEO of the Concussion Legacy Foundation, and as a behavioral neuroscientist who has coauthored over two dozen CTE studies.
Fox 25 quoted me as saying, “I understand the parents are upset. They don't want to be told what to do, but this isn't about them. This is about their kids. You are a bad parent if you choose to continue to put your child in tackle football before the age of 13 -- now that we have this data."
I apologize for saying that if you choose to put your child in tackle football before 13, you are a bad parent. I did not mean to say that. To provide additional context, there was a sentence that was cut from the middle. The full statement, as I remember it, with additional words in italics, was, “I understand the parents are upset. They don't want to be told what to do, but this isn't about them. This is about their kids. We’re not saying you are a bad parent if you’ve put your child in tackle football in the past, because you didn’t have access to this new study (saying that their odds of developing CTE go up 30% per year). You are a bad parent if you choose to continue to put your child in tackle football before the age of 13 -- now that we have this data."
In addition to the context provided by the missing sentence, I also misspoke. What I meant to say is “We’re not saying you are a bad parent if you’ve put your child in tackle football in the past, because you didn’t have access to this new study. But we are asking if you can still feel good about that choice now that we have this data." As a parent myself, I know parents only want what is best for their children. But what we know is best for our children changes over time as science and cultural norms change. I grew up in a time where I was frequently exposed to second-hand smoke by my extended family, now that would never be allowed. I grew up in a time where children didn’t wear bike helmets, now it’s the law in Massachusetts until age 16. Laws change as science advances.
The science on CTE has strengthened rapidly over the last decade, but John and Jane Q. Public may not know it. In addition, we are still dealing with the negative consequences of what some have characterized as a CTE misinformation campaign orchestrated by the most powerful sports marketing entity in the country, the NFL. In 2016, the NFL was finally persuaded and now agrees there is a link between playing football and developing CTE.
But the bad arguments used to try to dismiss CTE research have taken on a life of their own, and are still repeated by a small group of people and organizations, some of whom are more concerned with the game of football than the health of the people who play it.
There is still time for you, and for your child, to make the right choice and choose flag until high school, or at least middle school. If you make the wrong choice, you cannot take it back.
However, the reason I support legislation to ban tackle football is that I also see this from your child’s perspective – they don’t understand CTE science, and they can’t provide informed consent when signing up for a game that will inevitably give some of them CTE.
I cannot pass judgement on your parenting decisions. But I strongly believe it is unethical to put a child in tackle football based on the following facts:
- CTE was first established in boxing, where it has been accepted as a possible outcome from head impacts in boxing for a century.
- The US Centers for Disease Control and Prevent (CDC) put out a fact sheet in 2018 stating, “Research to date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts.”
- In youth tackle football, many children are hit in the head more than 500 times per season. No other major team sport exposes children to that many head impacts.
- Studies show that the head acceleration for 7 year-olds in tackle football is similar to what we see in college football.
- The largest post-mortem study of CTE in history revealed your child’s odds of developing CTE go up 30% each year they play tackle football, which means the odds are 10 times higher after just 9 years of football. Therefore, a player who starts tackle at age 5 would have a 10 times greater risk than a child who starts at 14. (Mez et al., 2019)
- The study (Mez et al. 2019) also showed correlation between playing football and developing CTE is statistically stronger than smoking cigarettes and lung cancer.
- This recent study (Mez et al. 2019) on the brains of 266 football players of all ages also showed:
- A season of youth tackle football and a year of NFL play appear to equally increase the odds of developing CTE.
- Therefore, the reason CTE is more frequently found in NFL and college players than high school or youth players is not because they played in the NFL per se, but because college and NFL players play more years.
- Again, CTE is not just an NFL problem. Meet Kyle Raarup, a youth football and hockey player who never played any contact sports past 8th grade and died by suicide at age 20 with CTE.
- There is no evidence to support that a child needs to tackle young to learn how to tackle safely. In fact, experts believe a child’s brain is not developed enough to learn to tackle safely.
- When USA Hockey banned checking under age 13, they said it was because research proved they could not teach players to hit safely, because “The 11- and 12-year-old brain is not cognitively developed to anticipate being hit.”
- Think about it – if practice was the primary way to learn an activity safely, we’d start children driving at age 5 to get more experience. But we do not, because a child’s decision-making ability and physical coordination are not developed enough
- CTE is seen primarily in tackle football, boxing, ice hockey, soccer, rugby, and military service. You may have been told that people who didn’t play sports have developed CTE. Even if the diagnosis is correct, and the patient history is correct, it would not change that tackle football can give your child CTE. There are many ways to get lung cancer besides smoking.
- Football is not the answer to obesity. If your child is obese and you don’t want them to remain obese, football may not be the appropriate sport for exercise. If your child is obese, football may encourage your child to remain obese to be a lineman. A study of high school players found 95% of offensive lineman and 78% of defensive lineman remain obese.
- Recent changes to tackle football will not prevent your child from getting CTE. Those changes may reduce their odds, but it will not eliminate them.
- When cigarettes were proven to cause lung cancer, the cigarette industry responded by:
- Adding filters to cigarettes. (The New York Times calls filters “the deadliest fraud in the history of human civilization.”)
- Lowering the tar content in cigarettes.
- Many other changes that, in theory, reduced the damage each cigarette caused.
- The football industry has responded by:
- Making slightly better helmets, which is analogous to adding filters to cigarettes.
- Reducing hitting in practice, which is analogous to lowering tar in cigarettes.
- Talking about better tackling technique, which children can’t execute safely 100% of the time, but passes the responsibility off to the child.
- Promoting concussion management, although there is no evidence or even a reasonable hypothesis to support why concussion management would significantly affect CTE risk.
- When cigarettes were proven to cause lung cancer, the cigarette industry responded by:
- Just because you don’t expect your child to play in college doesn’t mean he won’t. You are trying to teach them to love the game and become good at the game. If your child is successful, and gets a college scholarship, your child will continue to play, and double their risk of developing CTE every 2.6 additional years.
- Your child does not have to play youth football to be great at football. Did you know that the top five NFL players of all time didn’t play tackle until high school? Meet the all-time greatest NFL team that didn’t play tackle until high school.
- Despite what you may have been told, flag football is not more dangerous for the brain than tackle football. Tackle football players receive 6 times as many head impacts as flag.
- USA Football recommends children don’t lift weights until high school because it “puts too much strain on young muscles, tendons and growth plates. By 13, a child’s nervous system and muscles typically begin to develop into maturity.” The brain is part of the nervous system – if your child shouldn’t lift weights until their brain is developed, how can you justify 500 head impacts?
- If you are trying to prevent CTE, there are many more reasons to wait until high school. Learn 12 more reasons here.
- CTE is a terrible neurodegenerative disease similar to Alzheimer’s disease. Hundreds of former football players have now been diagnosed with CTE. You can meet them, and learn their stories as told by their families, here.
If you have read this far, thank you. These are not all the reasons we support legislation, but for the sake of brevity we will keep it short. I appreciate that you care about your child and support your decision to encourage physical activity and team sports. But the science has changed. If you go back and look at the history of smoking and legislation, by the 1950’s the data was clear that smoking severely increased your risk of lung cancer.
But the smoking industry fought back, and they were aided by doctors who either didn’t pay attention, weren’t trained in understanding strength of evidence, or took too much pride in being the last skeptic. In fact, a 1960 American Cancer Society poll found that only a third of all US doctors agreed that cigarette smoking should be considered ‘a major cause of lung cancer,’ and 43% of American doctors still smoked regularly. Therefore, you should not be surprised that plenty of doctors are still willing to say that hitting children hundreds of time in the head is okay. None of them are putting on a helmet and playing tackle football on the weekends. If they are wrong, only your child will suffer.
False “debates” allow industries to continue to buy time and maintain profits while families pay the price. If we’d banned cigarettes in public spaces in the 1950’s, how many lives would have been saved? As a scientist, I believe the evidence is overwhelming that football is linked to CTE, and you should too, because there is even consensus on this fact between the CDC and NFL. For the sake of your child, please consider this evidence seriously.
Chris Nowinski, Ph.D.