Participation in youth sports is considered a rite of passage in American society.
While all youth sports involve concussion risk, numerous studies find that the
highest rates of concussion occur in youth football. Between 2007 and 2014, all
U.S. states passed concussion legislation regulating youth sports participation.
Why were some U.S. states slower than others to pass concussion laws with return
to play restrictions? When states passed laws, why did some print media identify
youth football as the justification for enacting legislation, while others did not –
what explains this variation and how did the stories differ?
What did the researchers do?
The researchers first used an event history regression model to test two competing hypotheses
regarding youth sport participation and the timing of concussion legislation: constituency
vs. resistance. Discourse around concussions has focused on youth athletes as a population
at risk, which require risk-reduction medical policies to protect them. The amount of youth
sport participation in a state identifies a key group of at-risk individuals. If a disease
only affects a few individuals, it is less likely that medically informed laws will be passed.
Constituency hypothesis: States with higher levels of youth sport participation will adopt concussion
legislation earlier. If legislation affects a large, at-risk population, organizations
are more likely to enact regulations quickly.
Resistance hypothesis: States with higher levels of youth sport participation will adopt concussion
legislation later. Sport is an important activity with entrenched interests that are unlikely
to change quickly, and states with more youth athletes could be slower to pass concussion laws.
Next, researchers collected newspaper coverage of the passage of youth sports concussion laws in each state.
The framing of these laws involved different interest groups who attempted to shape laws and public
discourse. The NFL, scientists, public health officials, youth sports organizations, and parents
attempted to shape this framing and public discourse. This type of analysis reveals sources of cultural
and organized interest group power.
Youth athletes are especially susceptible to concussions
Source: YMCA of North Carolina
The NFL and U.S. CDC Partnered to Sponsor the "Heads Up"
Campaign
NFL Commissioner Goodell repeatedly downplayed
the risk and severity of football concussions to the public.
Image source: Rotolo and Lengefeld 2020.
Image source: Lengefeld and Rotolo 2025.
Image Source: Lengefeld and Rotolo 2025.
What did the researchers find?
In the first analysis, the results support the resistance hypothesis - actors who support high school football
resisted efforts to medicalize youth concussions at the institutional level.
Social context helps determine why states pass medically informed legislation at different times.
States with more high school football participation passed concussion laws later.
States with a strong college football presence (SEC Conference membership) passed concussion laws later.
States with more gender egalitarian views passed concussion laws earlier.
In the second analysis, researchers identified seven distinct themes in the newspaper reports of youth concussion legislation.
Only ten state newspaper accounts presented a critical perspective on the risk of youth football, and the vast majority
were hospitable to the NFL’s preferred framing that “all sports carry risk.” The findings point to contested processes.
Corporations (driven by profit) attempt to influence media behavior (driven by organizational preferences and journalistic practices).
The NFL’s position was that all states needed to protect vulnerable youth athletes from concussions in every sport.
Most of the coverage emphasized a narrative that diluted the risks in youth football, directing positive attention
to the NFL’s youth sports advocacy. Simultaneously, coverage diverted focus from the scandal over the NFL’s handling of
concussions at the professional level. The NFL responded to highly publicized Congressional hearings by sending letters
to 44 states (National Football League, 2016), broadly advocating for changes that did not harm the NFL. This is a
prime example of the contested process of counterframing.
How can you use this research?
Policy makers and public health advocates can use this research to help craft public health strategies that address unique
social and cultural dynamics influencing the passage of public health law at the state level. Understanding these
unique processes can help legislators formulate more comprehensive strategies to address public health crises.
Public health organizations and health social movements can use this research to inform their strategies for targeting
public health problems in regions with greater resistance to these changes, and for identifying corporate strategies
of resistance and counterframing.
Citations
Lengefeld, M., & Rotolo, T. 2025. "‘All sports carry risks’: NFL, media, and the framing of the youth
sports concussion crisis." Sport in Society, 1–23. https://doi.org/10.1080/17430437.2025.2470159
Rotolo T, Lengefeld M. 2020. "Clearing the cobwebs: An analysis of the timing of youth concussion legislation in
U.S. states." Soc Sci Med. Nov 2:113491. doi: 10.1016/j.socscimed.2020.113491. PMID: 33162197.
