The Concussion Legacy Foundation’s PSA draws parallels between smoking and starting tackle football under the age of 14.

By Professor Steven Broglio
Director, Michigan Concussion Center

In October 2019, a public service announcement entitled “Tackle Can Wait” drew parallels between smoking and children under 14-years-old playing tackle football. The website Tacklecanwait.com urged parents to stop their child from playing football because “a child’s risk of developing CTE from tackle may add up faster than a smoker’s risk of developing lung cancer.” The website also claims a football player who starts playing tackle football at the age of five has 10 times the risk of developing CTE over someone starting at age 14. The PSA stems from a Boston University study published in the Annals of Neurology concluding the risk of developing chronic traumatic encephalopathy (CTE) is tied to years of tackle football exposure.

It would be imprudent to suggest football participation carries no risk for concussions or other injuries, but the PSA falls short by drawing a parallel to smoking, which carries no known health benefits. Indeed, former professional football athletes have longer life spans than the general population (NIOSH, 1994; Koning, 2014; Lehman, 2016), while smokers are the opposite. Further, a study by Caccese et al. found no difference in neurocognitive performance between nearly 3500 collegiate athletes who started football participation before or after age 12. This suggests the science surrounding the long-term effects of concussion and head impact exposure is far from settled.

The shock value of the PSA – a child lighting a cigarette – does draw attention to concussions, head impact exposure, and the need for well-conducted science that addresses one of the most pressing questions surrounding sport participation. It will take decades to fully elucidate the relationship between concussion, head impact exposure, and long-term cognitive health, but that should not prevent risk-minimizing measures from being implemented into football and other contact sports. We endorse the presence of certified athletic trainers at all games and practices to identify, remove, and manage injured athletes, but we also recognize the financial realities faced by many athletic programs. Conversely, simple, low/no-cost approaches may include ensuring coaches, parents, and athletes are up to date on concussion knowledge and their roles and responsibilities for athlete health and safety; creating a culture where reporting a concussion is supported, and enabling organizing bodies to evaluate plays and behaviors and modify rules accordingly to reduce injury risk.

We are far from resolving the concussion issue, but implementing proven concussion risk reduction measures while continuing to conduct high-quality research strikes a balance between ignoring the problem and more extreme measures.