The Failure of Youth Sports Concussion Laws and the Limits of Legislating Health Education

Sydney Diekmann, Christine Egan, Carly Rasmussen & Francis X. Shen

ABSTRACT. Legislatures have increasingly turned to education-based strategies to address significant public health challenges, despite unclear efficacy of statutory mandated education. In this Article, we examine the recent and rapid adoption of youth sports concussion laws as a lens to explore the limits of education-based legislative intervention models. In less than 10 years, all 50 states adopted a youth sports concussion statute—and each law mandates concussion education for coaches and/or student-athletes. This expansive, expensive intervention was designed to reduce concussion incidence and improve concussion care. But based on a review of 54 peer-reviewed studies, we argue that concussion education has not, and likely will not, produce the desired public health outcomes. The data largely demonstrate that, at most, concussion education can produce short-term changes in knowledge, but that these gains are unlikely to translate into measurable behavior changes that reduce the incidence and risk of concussion in sport. The Article uses public health perspectives to explore the reasons why top-down education interventions from legislatures may fail to have their intended effect. Given these limitations, the Article argues for a new type of concussion education intervention that better aligns with incentives to win, focuses on primary prevention, and promotes culture change in concussion reporting.

AUTHOR. Sydney Diekmann, B.S. Neuroscience, University of Minnesota. Christine Egan, B.S. Neuroscience, University of Minnesota. Carly Rasmussen, B.S. Neuroscience & B.A. Psychology, University of Minnesota. Francis X. Shen, Professor of Law & McKnight Presidential Fellow, University of Minnesota; Director, Shen Neurolaw Lab; Executive Director, Massachusetts General Hospital Center for Law, Brain, and Behavior; Instructor in Psychology, Harvard Medical School MGH Dept. of Psychiatry; Executive Director of Education & Outreach, MacArthur Foundation Research Network on Law and Neuroscience. Contact: Walter F. Mondale Hall, 229-19th Avenue South, Minneapolis, MN 55455, 612-625-5328, fxshen@umn.edu. Acknowledgements: Preparation of this article was supported in part by the University of Minnesota Law School, a University of Minnesota Grand Challenges Grant. For helpful feedback and advice, we thank members of the Grand Challenges Grant team and the Big Ten/Ivy League Traumatic Brain Injury Research Collaboration. For excellent research assistance, we thank Micaela Yarosh.

RECOMMENDED CITATION. Sydney Diekmann, Christine Egan, Carly Rasmussen & Francis X. Shen, The Failure of Youth Sports Concussion Laws and the Limits of Legislating Health Education, 19 Yale J. Health Pol'y L. & Ethics (2019). Available at: https://digitalcommons.law.yale.edu/yjhple/vol19/iss1/1.