‘How can you let your son play tackle football?” As a physician, I hear this question often, and for good reason. It seems the media is filled with one study after another focusing youth sports injuries, particularly head injuries. Football takes the brunt of the scrutiny. I read and hear these reports like every other loving parent. I also follow the medical literature on this topic. So my decision to allow my son to play is, if nothing else, thoughtful.
Without question, playing football comes with the risk of incurring injuries, including concussions. In fact, football lags only behind women’s soccer in terms of relative concussion risk among competitive youth sports. The crucial question, however, is what is the absolute risk of concussion, rather than the relative risk.
Absolute risk refers how often an event occurs per exposure. Relative risk is a ratio comparing one outcome to another. For example, a drug company may advertise that their new product can lower your heart attack risk by 50 percent compared to standard treatment (relative risk). That’s a striking improvement, but it needs to be interpreted in the context of the absolute risk. If your baseline risk of suffering a heart attack is only 1 percent, taking a drug to lower your heart attack risk to 0.5 percent may not be worthwhile. On the other hand, if your absolute risk of a heart attack is 60 percent, cutting that risk to 30 percent with the drug would be a wise decision. It’s the absolute risk that needs to be understood more so than the relative risk.
Most of what is reported in the media regarding concussions and football describes the relative risk — for example, high school football players are more than twice as likely as high school wrestlers to sustain a concussion. However, the relevant question, in my view, is what is the absolute risk for a concussion in playing football? Available data suggests that for both high school and youth football (ages 8-12) there are about 0.7 to 1.7 concussions per 1,000 athletic events, where an athletic event is defined as a practice or game. The actual occurrence rate of concussions in youth and high school football is considerably lower than the relative risk suggests.
I am also asked, “Even if the absolute risk is low, why play a sport where there is even a small increase in concussion risk?” My answer is admittedly subjective and debatable, but I think there are few, if any, team sports like football — arguably the ultimate team sport. In football, every player matters on nearly every play. Twenty-two opponents line up to compete individually and the sum outcome of these unique contests determines the success or failure of a play. An entire team (coaches included) prepares for a week, focused on implementing a complex game plan that requires all team members to execute effectively.
Also, football offers an opportunity to excel even for kids not blessed with great hand-eye coordination or speed. Strength, along with agility and quickness (which are different from speed), can always be improved upon, and these are the core elements needed to play on the line. Football fosters toughness and perseverance — not just physically, but mentally. It takes courage to line up against someone a foot away from you and compete for four quarters. Former players speak of the “brotherhood” of football, and I think it is an accurate description.
Playing football was an overwhelmingly positive influence on my life, and I hope my son will have the same experience. There are risks, but I know I cannot protect my son from everything in life. I also let him ride a bike, climb trees, swim in the ocean, and ski. I don’t think that makes me a bad parent. I credit youth football programs (which seem to be ahead of other youth sports) for their efforts to educate coaches, parents, and players regarding concussions (the WW-P Wildcats program provides preseason neurocognitive testing in effort to diagnose concussions more effectively).
I will continue to follow this topic closely — in the scientific literature, rather than the media. I will be the first to prohibit my son from football if the risks are unacceptable. At this point, the data, in my view, does not support keeping him from a game that has been a positive influence on boys and young men for decades.
Haas is a physician and West Windsor resident.
