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Innovative behaviourbehavior modification strategies to reduce concussion risk in high school american football athletes
  1. Erin B Wasserman1,
  2. Jason P Mihalik1,2,
  3. Kody R Campbell1,3,
  4. Patricia Combs1,
  5. Melissa A Fraser1,3,
  6. Erin Grand1,
  7. Maryalice Nocera2,
  8. Johna K Register-Mihalik1,2,
  9. Kevin M Guskiewicz1,
  10. Stephen W Marshall2,4
  1. 1Matthew Gfeller Sport-Related Traumatic Brain Injury Research Centre, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  2. 2Injury Prevention Research Centre, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  3. 3Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  4. 4Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA


Objective To improve tackling and blocking techniques to reduce concussion in high school American football players, and to evaluate the program’s feasibility and acceptance.

Design Clustered quasi-experimental study.

Setting High schools.

Participants Varsity American high school football players on three teams (two intervention; one control).

Interventions All players wore in-helmet head impact accelerometers. “High-risk” intervention team players were selected and attended clinician-coach-player mentoring sessions designed to change playing technique. Accelerometer data were used for “high-risk” selection and during mentoring sessions to reinforce the technique-driven intervention.

Outcome measures The change in top-of-head impacts and impacts with peak linear acceleration>60 g was compared between intervention and control subjects using linear risk models. Coaches and players completed post-season exit surveys.

Main results Ninety-seven players (70 intervention; 27 control) participated. Thirteen (19%) intervention players were identified as “high risk” and received mentoring. The mentored players’ high magnitude impacts (percent>60 g) in practices dropped 1.9 percent from pre-intervention to post-intervention. There was no change in non-mentored players. In post-season surveys, mentored players “strongly agreed” (56%) or “agreed” (44%) that the study improved their playing behaviours. Among intervention team coaches, three (43%) thought the study was “very effective” in changing football player behaviours about safe play, and the remaining four (57%) thought it was “effective.”

Conclusions There is growing concern head impact frequency and severity may result in neurological issues for some athletes later in life. If head impact frequency and severity can be reduced through behavioural intervention, this can have a great public health impact.

Competing interests This study is funded by a grant from the National Centre for Injury Prevention and Control (Grant #R49CE002479).

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