Fundamentals of Social Sciences

Safety Decisions in High School Football

This paper focuses on one aspect of high school football safety. The study explores the issue of higher levels of injury being associated with a particular brand or brands of football helmets worn by high school athletes who play football, and the institutional decisions and actions that follow disclosure of such information. A recent study by Virginia Tech rated helmets worn by professional football players -- helmets worn by high school students have not yet been rated by the university. The study compared helmets manufactured by three companies. High ratings were given to the Riddell Speed, the Riddell Revolution, the Riddell Revolution IA, the Schutt Ion 4D, the Schutt DNA, and the Xenith X1. Medium ratings were given to the Schutt Air XP and Schutt Air Advantage. Players were warned by Virginia Tech not to wear the Riddell VSR4 and the Adams A2000. No correlation exists between safety and the price of a helmet. The Adams 2000 is the lowest rated helmet, but it costs $200. The four-star high-rated Schutt DNA costs $170.

It is important to note that the Riddell VSR4 -- the second-lowest-rated helmet -- was the most commonly worn helmet in the NFL games last season, and the helmet is also worn by college student and high school student football players. The industry and the institutions have been reluctant to issue ultimatums about which helmets their players must wear. Apparently, the NFL has been given legal advice that disclosing information about helmets without mandating a particular brand or type of helmet reduces their legal risk. Sports broadcasters enthusiastically calling attention to helmet-to-helmet contact, referees ignoring unnecessary roughness in football games, football practice -- for all practical purposes -- completely unregulated, ill-advised coaches demand nutcracker drills and other cumulatively dangerous training approaches, and pro-football players wearing the least safe brand and type of helmets, Young football athletes are exposed to cultural pressure and branding messages that can result in unsafe decisions (Gerberich, 1983; Saunders and Harbaugh, 1984).

Further, academic budgets have been reduced across the nation in response to the residual effects of the 2009 fiscal crisis and, typically, cuts to athletic programs are some of the first to be implemented. Athletics are highly popular, but they are also inordinately expensive. Educational institutions are under considerable pressure to make budget cuts in areas that are believed not to negatively impact the academic attainment of students, nor their institutional accreditation.

A diminished sports budget is bound to have some impact on sports activities at an affected institution. The condition of equipment used by student athletes can deteriorate if there is insufficient money for repair or replacement. Coaching staff may not be of high caliber if there is not money to pay for their services. Practice sessions may not be well supervised or student athletes may be encouraged to perform above their capacity or in ways that are not regarded to be safe (Pollock, 1977). Disincentives may discourage certified athletic trainers from reporting issues that are related to under-training, over-training, or pressure to perform (DiScala, 1997, "Excessive physical training," 1991).

The manner and degree to which budget cuts to high school football have on safety is of fundamental interest in this study. While the research is intended to explore the purchase and maintenance decisions regarding football helmets provided to high school football athletes following disclosure of preferred brands and types of helmets, the study is also designed to examine the degree to which cultural and traditional forces influence these decisions.

Theoretical Framework

This research is grounded in post-positivist theory in which science is perceived as a socio-cultural activity as well as a technical (empirical) endeavor. It is, in fact, the socio-cultural context that gives meaning to the scientific findings. Any scientific accounts purported to undergird findings related to the sports safety research in the literature -- as presented in this paper -- must be understood as explanations that are put forth by a specific community of scientist who are situation in a particular space at a certain time.

From the post-positivist position, the theoretical framework can be seen to be pragmatism, which is the ultimate scientific position for linking theory and practice. The approach goes beyond explanation to an application of the explanation in practice. This is fundamentally the reason for conducting research in sports safety. It is not knowledge for knowledge's sake that the researcher pursues -- rather, it is a direct application of the research to the practice that matters. The purpose of the research is to determine what "safety" in football is and looks like, and then to apply that learning to the actual practice and playing of the game of football.

From these definitions of the theoretical framework of the study, the reader is encouraged to review the various official agencies and research bodies charged with constructing the corpus of knowledge regarding safety in sport, as presented in the following subsection.

Sports safety record-keeping and research. Football injuries can cause debilitating injuries and are costly to individual players, football teams, and the institutions that host football games. Considerable research has been dedicated to sports safety and the incidence of sports injuries, but coordination of the many efforts has been difficult. Unlike the record-keeping that occurs for pandemic health issues or the sophisticated tracking carried out by the Center for Disease Control and Prevention, information about football injuries at the level of educational institutions tends to be somewhat isolated.

"Not surprisingly, the rising prevalence and expense of sport and exercise injuries have increased the public's attention toward sports injuries. For example, the Centers for Disease Control (CDC) included sports injuries as an area of focus in its most recent Injury Research Agenda" ("Datalys Center," 2011).

Epidemiology and biostatistics. The advent of digital medical record-keeping has made it possible to collect and analyze information that would once have lain dormant and forgotten in obscure medical files. At sports medicine clinics associated with universities engaged in medical research and having established teaching hospitals, medical records scrubbed of individual information are being added to immense databases for analysis. The ability to use electronic record-keeping for tracking the causes of injuries and the outcomes of patients is beginning to reach local levels. Physicians are investing in the infrastructure for electronic medical and health care record-keeping.

Data mining and data integration. As the digital infrastructure expands and electronic record-keeping becomes more common place, the possibility of integrating databases becomes a feasible option. Institutions of higher education and of secondary education generally have well-developed technology infrastructures. Through data mining techniques, it has become possible to collect and analyze information from disparate databases. A number of organizations now exist to keep records and conduct research on sports safety. These organizations are discussed below.

National Operating Committee on Standards for Athletic Equipment. The mission of the National Operating Committee on Standards for Athletic Equipment (NOCSAE) is to commission research that informs the establishment of standards for athletic equipment, and where possible, to establish those standards. The Committee promotes dissemination of information on research finding related to athletic equipment, data on injuries, and other associated areas of inquiry. To this end, the Committee collaborates with organizations that are represented on the NOCSAE Board of Directors and with other entities in the disciplines of sports medicine and athletic medicine.

National High School Sports-Related Injury Surveillance Study. The High School RIO is an internet-based data collection system used in the National High School Sports-Related Injury Surveillance Study, which follows a national sample of U.S. high school athletes, and it is currently the only surveillance study of all time-loss injuries within the sample. The study began in the 2005-2006 academic year and has been maintained ever since. The study is a spin-off -- a high school version -- of the National Collegiate Athletic Association (NCAA) Injury Surveillance System. Refinements have been made to the National High School Sports-Related Injury Surveillance Study over the years with input from the high school sports community, which includes the student athletes, their parents, high school athletic directors, local and state high school athletic associations and administrators, the National Federation of State High School Associations (NFHS), and pediatric sports medicine clinicians.

National Collegiate Athlete Association Injury Surveillance System. The National Collegiate Athlete Association Injury Surveillance System offers a program of free participation, training, and system support. The program creates permanent electronic athletic training records, maintains coach's records, creates individual and team injury reports for insurance purposes, maintains team injury and participation records, and serves as a resource for decision-making at the school, conference, and Association levels. The database permits customized reports, such that, a researcher could compare injury trends across academic years to examine, say, changes in coaching staff, or to compare school data to divisional and national trends. Further, reports can quantify the treatment plans and treatment modalities across different sports programs or across schools by sport.

Datalys Center for Sports Injury Research and Prevention. Researchers, sports associations, and the sports medicine community require complete, reliable information about the incidence and outcomes of sports injuries in order to develop ways to more effectively prevent and treat them. In fact, complete and reliable data is a programs, rules, education, and policies. The goal is to prevent, mitigate, and treat exercise and sports injuries. The Datalys Center for Sports Injury Research and Prevention is to translate that information into better prevention, and public health and sports medicine outcomes.

Research Questions

Two quantitative research questions are relevant to this research project. Although the questions focus on two different issues with regard to safety in high school sports, the questions essentially address the same construct -- inadequate funding of high school sports. The focus of the overall research study is to examine the impact that inadequate funding of high school football has on student player safety. Issues of safety would be evidenced by inadequately maintained or replaced equipment and inadequate training, inadequate preparation of student athletes, or unsafe conditions during practices. The quantitative research questions are as follows:

What percentage of reported injuries is related to inadequate maintenance or replacement of equipment as indicated by the Datalys database reports?

What percentage of reported injuries has been associated with inadequate training and preparation, or conditions of practice?

Section 2

Literature Review

The literature in this area of sports safety tends to take the form of reports of injuries (ROI) databases and associated reports from formal agencies and organizations. Interest in recreation, exercise, and sports is increasing in the United States and, accordingly, related injuries are also on the rise. Football injuries can cause debilitating injuries and are costly to individual players, football teams, and the institutions that host football games. Considerable research has been dedicated to sports safety and the incidence of sports injuries, but coordination of the many efforts has been difficult.

Children younger than 15 who participate in 29 sports are injured cost more than $49 billion each year (The Consumer Products Safety Commission).

Each year in U.S. school settings, there are about 715,000 recreation and sports injuries (The CDC Injury Research Agenda).

High school athletes account for an estimated 500,000 visits to physicians, 30,000 hospital stays, and 2 million injuries each yea (MMWR weekly).

3.65 million emergency room visits each year (1 in 5 visits) result from sports, recreation, or exercise participation (The CDC Injury Research Agenda).

Unlike the record-keeping that occurs for pandemic health issues or the sophisticated tracking carried out by the Center for Disease Control and Prevention, information about football injuries at the level of educational institutions tends to be somewhat isolated. Under the best of circumstances, sports injuries are increasing. But what happens when the overall environment in which high school sports are played deteriorates -- particularly due to a reduction in the budget of athletic programs? A diminished sports budget is bound to have some impact on sports activities at an affected institution. And high school football has one of the highest rates of injury of all sports available to secondary students.

Protective gear and equipment is essential to the safety of football players, perhaps especially that of secondary students who are young and vulnerable due to their immature brains and a sense of immortality which often leads to young people taking inordinate risks. The condition of equipment used by student athletes can deteriorate if there is insufficient money for repair or replacement. When athletic programs experience budget reductions, there is likely to be less money to recruit the highest caliber coaches and certified athletic trainers. Coaching staff may not be focused on the safety of their teams if they are part-time staff and if there is not money to pay much for their services. Unless football coaches are considered to be professionals -- and hired on that basis -- they may compromise the safety of their team in order to please the school board or the parents of student players. If a football coach feels vulnerable to outside forces, they may succumb to the pressure of too many competing objectives. If a football coach is too emphatically focused on his reputation or the standing of the team, practice sessions may not be well supervised and student athletes may be encouraged to perform above their capacity or in ways that are not regarded as safe. The coach is not only in this conundrum. Disincentives may discourage certified athletic trainers from reporting issues that are related to under-training, over-training, or pressure to perform. A certified athletic trainer may be considered a luxury by some secondary schools. In order to protect his position, the certified athletic trainer is going to want very much to proof his worth and contribute value to the high school football team with which he is affiliated. This situation may create a chilling effect that discourages any sort of damper on the gung-ho attitude of coaches, who are also hired to generate results. This sort of situation is difficult to overcome.

There is a considerable corpus of data available in the literature to substantiate that sports played under certain conditions can result in an increase in the incidence of injuries. For instance, the National Center for Catastrophic Sport Injury Research collects and disseminates data on death and permanent disability sports injuries that involve the brain and/or spinal cord. Since 1965, this research has been conducted at the University of North Carolina at Chapel Hill. Three annual reports are compiled and made available each year. While the incidence of catastrophic injuries is low on a 100,000 player basis of exposure, the rate of incomplete neurological recovery was 0.39 for every 100,000 participants. Tackling has been associated with 67.8% of the catastrophic injuries since 1977. Blocking and tackling are associated with the majority of catastrophic football injuries. In the 2010 football season, one injury was caused by tackling, two being tackled, three tackling on a kick-off, and one injury in tackling drill. The researchers at the National Center have expressed that they are not confident in the number of injuries reported with full recovery, and that data collection in 2007, 2008, and 2009 produced the highest number of catastrophic recovery injuries since the study began in 1977. A combined incomplete recovery cervical cord and cerebral injuries figure brings the total to 459, which is an average of 13.5 injuries for the past 34 years. It is important to note that the rate of incomplete neurological recovery at college level was 2.66 per 100,000 players and 0.33 per 100,000 for high school and junior high school football. Most of the catastrophic spinal cord injuries occur in games -- in the 2010 football season, two such injuries took place in practice while five catastrophic spinal cord injuries took place in games. These figures indicate that football is played more intensely during games and particularly at college games. The importance of an appropriately incentivized coach, athletic director, and certified athletic trainer takes on heightened importance under these conditions.

The National Center for Catastrophic Sport Injury Research has collected and disseminated data on death and permanent disability sports injuries that involve the brain and/or spinal cord since 1965. The report, Annual Survey of Catastrophic Football Injuries, for the period from 1977 through 2010, describes the reporting of possible catastrophic football related injuries to the national center in this way. Information about a possible catastrophic football injury serves as a catalyst for contact with a player's coach, physician, and athletic director. The contact may be made by telephone contact, a personal letter, or a questionnaire. The questionnaire provides demographic (age, height, weight) data on the athlete and background data (previous injury, accident information, immediate and post-accident treatment, and equipment information) related to the injury. During the 2010 football season, according to the report, a total of seven cervical cord injuries with incomplete neurological recovery occurred. Two of the injuries occurred at the college level and five of the injuries occurred at the high school level. In 2009, there were 14 incomplete neurological recovery injuries. In 2010, 13 additional injuries occurred that involved either neck or head injuries, but these athletes experienced full neurological recovery. In addition, three cervical vertebrae fractures, three brain injuries, and one lumbar vertebra fracture were associated with high school football athletes. The data show that a majority of the catastrophic injuries occur while athletes are playing defensive football. Since 1977, permanent cervical cord injuries were sustained by 221 players on the defensive side of the ball and 52 such injuries were on the offensive side (41 of these injuries were not associated with a side of the ball in the data). Position played was also associated with the occurrence of injuries as follows: Defensive backs (35.0%); kick-off team members (9.6%), and linebackers (9.2%).

Although a great many studies are being carried out, many of which employ longitudinal data, there does not appear to be any particular focus on budget and expenditures on equipment, gear, and coaching talent. Further, this author is not aware of any move to ensure that football coaches and athletic directors are not caught up in multiple and competing goals that can compromise their duty to the safety of their student athletes. The role of the certified athletic training could be crucial to helping to reduce the incidence of injury to student athletes. A case in point is evidenced by what the data reveal about tackling techniques. Coaches report that their players are taught to tackle with their heads up, but most seem to lower their heads before they make contact during a tackle. Of the players injured while tackling, 19.6% had their heads in a down position, which means that their chins were on their chest and contact with the other player was made with the top or the crown of the helmet. Ball carriers are also being injured when their heads are in a down position when they are tackled. Coaches must stress head-up tackling during practice and during play. Further, coaches must emphasize head-up blocking and head-up ball carrying when there is a possibility of being tackled. The data indicates that many coaches train their ball carriers to lower their heads before being tackled and to run over the tackler, but this practice is dangerous and can cause cervical spine and brain injuries with incomplete recovery. Nearly 10% of the cervical cord catastrophic injuries happen as a result of being tackled. This study is intended to sort out whether these issues are related to the financial support that a high school team receives, and if greater professional independence on the part of certified athletic trainers, coaches, or athletic administrators can reduce the tendency to put young football players at risk.

Section 3

Methodology

Unit of analysis. The unit of analysis for this research study is individual student athletes. The data that will be analyzed has been collected and data points are focused on injuries occurring to individual students during football practice or football games. This is an unalterable aspect of the study design.

Dependent and independent variables.

The dependent variable in this research is incidents of student injuries during football practice and games while wearing Adams, Riddell, Schutt, and Xenith football helmets. The independent variables include: (a) Conditions of the field during practice or games; (b) condition of equipment; (c) age of equipment; (d) player position; (e) game action (receiving, tackling, blocking; passing); (f) coaching messages and training techniques; (g) training content; (h) corrective actions taken by institution, and (i) helmet type and brand.

Experimental design. The research design is quasi-experimental, in that, subjects are not randomly selected. Two groups of high school student athletes who play football will be studied. The first group includes high schools that responded to the helmet ratings in the first wave in the early 2000s. Data will be collected on the rate of head, neck, and spine injuries at these high schools before and after making deliberate and systematic changes in the football helmets they provide for and require of student football players.

The second group of high school student athletes is football players at schools that will respond to the newest helmet ratings report released by Virginia Tech. Schools will be contacted via their high school coaching associations regarding planned or accomplished change-over to recommended football helmets.

It is understood that this quasi-experimental design is not a classic experimental design as might be seen in an ABAB repeated multiple measures empirical design. But the fact of the matter is that the study uses extant and emergent data, and the "treatment" is a condition to which study "participants" are not uniformly exposed. Regardless, to use argument to support the internal validity of the study, substantive and significant data has demonstrated the relationship between helmet brand and type with injury incidence rates.

Injury data reported to the will be analyzed for one to three years prior to the systematic change over to recommended helmets, and one to three years after. The number of years of data collected and analyzed is dependent on whether the high school was an early adopter, a middle adopter, or a late adopter, in terms of being responsive to the data released on helmet ratings. The research design includes pre-program data and post-program data for multiple groups. Figure 1 is a diagram of the experimental design for this study.

The data set is large as it is collected nationwide by the High School RIO at the Center for Injury Research and Policy for all high school athletes, including high school football players. In addition, if helmet retailers are willing to cooperate, data from national, regional, and local levels for high-rated football helmets can be collected and analyzed in order to further triangulate the data.

While it is not possible to establish causality, it is certainly possible to express the research in terms of probability. The enormity of the data set helps to determine if there is a correlation between the brand of helmet, the preponderance of helmet types, and injuries to the spine, neck, and head, including concussions. Even with excellent head protection, differences in individual athletes can increase risks because of prior injuries or genetic differences, or the rotational force caused by player-to-player contact that occurs is believed to cause a great many concussions.

Sampling procedures. The data collected for the quantitative component of the research will acquired through extant sources and will not entail interaction with individual participants. Information retrieved through data mining procedures will have previously been scrubbed of identifiers -- other than those numerical identifiers assigned to the data sources for purposes of tracking back to the source or for prospective data manipulation.

The Datalys website includes a section on NCAA's Injury Surveillance Program that reflects the recent transition of the program to the Datalys Center. The portion of the Datalys website that has been dedicated to NCAA's Injury Surveillance Program is of particular interest to collegiate athletic trainers. In addition to the website, Datalys produces a newsletter, which will permit a textual analysis of documents to facilitate triangulation of data. Data triangulation can contributes to the content and construct validity of both the qualitative (emerging themes) and quantitative (hypotheses and theories) data.

The historical and on-going activities of the NCAA Injury Surveillance Program can be accessed on via these two portals. The new approach is two-pronged and includes both the Injury Surveillance Tool and the Export Engine.