title: State experiences implementing youth sports concussion laws: challenges, successes, and lessons for evaluating impact.
abstract: While provisions of youth sports concussion laws are very similar, little is known as to how they are being implemented, factors that promote or impede implementation, or the level of compliance in each jurisdiction. We aimed to describe state experiences with implementation in order to inform ongoing efforts to reduce the harm of sports-related traumatic brain injury and to guide future evaluations of the laws' impacts and the development of future public health laws. We conducted key-informant interviews in 35 states with recently enacted concussion legislation. States varied considerably in their readiness and capacity for implementation. Factors facilitating implementation included existing partnerships, procedures, and resources; centralized implementation authority; prior related efforts; and involvement in the policymaking process by those now charged with implementation. Inhibitors included ambiguous statutory language, unclear delegation of authority, and compliance difficulties. Ongoing challenges persist, including primary prevention; determining which providers are qualified to make return-to-play assessments and contents of those assessments; compliance difficulties in rural and under-served areas; and unclear responsibility for enforcement. Despite the similarity of youth sports concussion laws, early evidence suggests there is considerable variation in their implementation. These findings are critical for ongoing empirical investigations to accurately evaluate the laws' provisions and to identify successful legal approaches to protecting young athletes.
authors.affiliation: Deputy Director, Eastern Region, Network for Public Health Law. She received her J.D. from the University of Maryland Francis King Carey School of Law in Baltimore, MD, M.P.H. from the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and A.B. from Brown University in Providence, RI.
authors.forename: Kerri McGowan
authors.initials: KM
authors.lastname: Lowrey
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Morain
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis / Q000517:prevention & control*; D001924:Brain Concussion / Q000175:diagnosis / Q000517:prevention & control*; D002648:Child; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D000068958:Return to Sport / Q000331:legislation & jurisprudence; D012449:Safety / Q000331:legislation & jurisprudence*; D013178:Sports Medicine / Q000331:legislation & jurisprudence; D013219:State Government; D014481:United States