Concussion Poll: AZ Parents See Football as Riskier than Contact Sports

For the first time, a majority of Arizona parents say they will forbid their kids to play football because of concussion concerns, according to a survey by Barrow Neurological Institute in Phoenix.

But that attitude does not extend to contact sports in general – the percentage of parents who allow contact sports increased for the first time in three years, the survey found. And girls’ soccer participation is rising despite the relatively high concussion risks in that sport.

“Parents are clearly deciding that football has too much risk of concussion, but they don’t feel that way about contact sports,” says Dr. Javier Cárdenas, director of the Barrow Concussion and Brain Injury Center at Barrow Neurological Institute, which is part of Dignity Health St. Joseph’s Hospital and Medical Center. “It is true that football has the highest concussion rates, but they have been falling. It also may be a result of the media focus on concussion in football over the last several years.”

Football is considered a collision sport. Contact sports include soccer and basketball.

Each of the last five years, Barrow has measured the public’s awareness of concussion and how it impacts participation in high school athletics. Greater awareness of sport-related concussion has led to widespread concern over the long-term effects of brain injuries.

Football Numbers Plummet

As the public has become more educated about sport-related concussion, the percentage of Arizona parents allowing football has steadily declined, from 68 percent in 2016 to 47 percent this year.

  • 2016: 68 percent of Arizona parents allowed their children to play football
    • 2017: 65 percent
    • 2018: 59 percent
    • 2019: 54 percent
    • 2020: 47 percent

That has resulted in a decrease in participation in high school football, although the sport still attracts the most players overall.

Arizona has led the nation in working to make all sports safer, especially football, with groundbreaking rules limiting tackling in practice and helmet dislodgement rule. Despite that, participation continues to fall. “I don’t see football participation increasing any time soon, but the numbers may ebb and flow,” Cárdenas says.

The percentage of parents who allowed contact sports dropped from 82 percent in 2017 to 74 percent in 2018 and 65 percent in 2019. This year, number grew slightly, to 71 percent.

Meanwhile, girls’ high school soccer participation in Arizona has climbed at virtually the same rate that football has declined – from 5,298 in 2008-09 to 6,489 in 2018-19. The state is also home to a thriving club soccer culture, with many girls playing the sport year-round.

Javier Cárdenas, MD
Dr. Javier Cárdenas, Director, Barrow Concussion & Brain Injury Center

The participation numbers remain high despite reports that girls’ soccer concussion rates approach those of football. A 2019 Pediatrics study of head trauma in high school sports found that girls’ soccer had the second rate of concussion, eight per 10,000 practices or games, behind only football, with 10 per 10,000 practices or games.

Overall, 84 percent of Arizona parents say they would allow their children to play soccer, consistent with previous surveys.

“While concussion rates are rising in soccer, especially girls’ soccer, they are still less than football,” Cárdenas says. “The gap is closing, in part because fewer athletes are playing football and the rates are falling, but there is still a gap.”

In soccer, concussions most often occur when players collide with each other, although some are a result of falling to the ground or colliding with the goal post.

Concussion Fatigue?

Efforts to educate teens on the danger of concussions appear to be paying dividends. Nine in 10 Arizona teens agree that concussions are a serious medical condition, consistent with previous surveys. But the percentage of athletes who say they would play through a concussion if the state title were on the line rose sharply, to 36 percent from 27 percent.

Cárdenas, a member of the Arizona Interscholastic Association’s medical advisory panel, says he is troubled by that statistic.

“Concussion prevention and safety appear to have taken a back seat to competition and winning,” he says. “Trying to play through a concussion is a terrible idea, and in rare cases it could be fatal.”

Cárdenas, who treats numerous student-athletes in his Barrow clinic, cited the possibility of “concussion fatigue” among teens. “People are constantly needing reminders,” he says. “Some may be tired of hearing about concussions.”

About one in three Arizona student-athletes reported sustaining a concussion while playing sports.

Concussion prevention and safety appear to have taken a back seat to competition and winning. Trying to play through a concussion is a terrible idea, and in rare cases it could be fatal.

Dr. Javier Cárdenas, Director, Barrow Concussion & Brain Injury Center

Concussion Education Pays Dividends

Arizona has been among the national leaders in concussion education for student-athletes. Barrow Brainbook has more than 1 million users entering its 10th year. More than 300,000 ImPACT baseline concussion tests have been administered to Arizona teen athletes. Barrow Brainbook was created by Dr. Cárdenas and launched in 2011 as the most comprehensive concussion education effort in Arizona. Brainbook is a web-based learning tool developed specifically for high school student-athletes that provides information on how to prevent, recognize, and respond to concussions.

Improved understanding of concussion may be empowering teens to decide whether to play a sport. More than half of teens say that they alone made that decision, and those who called it a joint decision dropped sharply (to 28 percent from 43 percent last year).

“That was always its intent of Brainbook—it’s clear that teens are more informed when they make the choice to participate,” Cárdenas says. “We know that sports offer many health benefits. Our challenge is to make sure the public can weigh the benefits against injury risks and make informed decisions.”

The teens study was conducted in April 2020 with a sample of 301 males and females, ages 14 to 18, living in Arizona. Of these, 228 reported playing school and / or club sports. The margin of error is plus or minus 5.6 percent at 95 percent confidence for the full sample (301), and plus or minus 6.5 percent among high school athletes (228).

The parents study was conducted in April 2020 with a sample of 601 Arizona adults selected randomly.  Of these, 200 were parents of a child or children under the age of 18. The margin of error for the different sample sizes is as follows: plus or minus 4.0 percent for the full sample (601) and plus or minus 6.9 percent among parents of teens.