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Can legislation aimed at preventing sports-related concussions in youth succeed?
  1. Bhanu Sharma,
  2. Michael D Cusimano
  1. Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Keenan Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Michael D Cusimano, Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Keenan Research Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario M5B 1W8, Canada; injuryprevention{at}

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It is important that the health benefits of sport participation to youth1–3 are not offset by the risk of sports-related injuries, such as concussion. Unfortunately, more than half of the traumatic brain injuries sustained by youth are caused by participation in sports.4 ,5 These injuries can have lasting cognitive effects (including impaired attention and memory) in addition to behavioural consequences, such as mood disorders.6–9 Since the developing bodies of youth are prone to the long-term consequences of injury,10 it is especially important to minimise the risk of concussion in all sports youth play.

Recently, several jurisdictions have introduced initiatives aimed at preventing concussions among youth playing sports in North America. Legislation has been used to prevent injury in other, similar settings; helmet laws for cyclists reduced risk of cycling-related head and brain injury by up to 88%.11 Exploring the parallels between these two prevention efforts permits the opportunity to evaluate the strengths and weaknesses of the new sport injury prevention initiatives relative to former, successful helmet laws for cyclists. Doing so can benefit the new initiatives as we can avoid past errors and learn from prior successes.

The first legislation to prevent concussion was introduced in the USA in 2009, when Washington State drafted and enacted the Engrossed House Bill 1824, otherwise known as the Zackery Lystedt Law (ZLL).12 In 2012, the Government of Ontario, Canada, introduced Bill 39, the Education Amendment Act (Concussions), to protect young athletes from sports-related concussions by promoting awareness about concussions and implementing protocols to manage them.13 It is important to note that Bill 39 has since been prorogued due to changes in political leadership; we examine the prior Bill nonetheless to understand its potential, which may influence future discussions surrounding its reintroduction.

In this article, we …

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  • Contributors MDC developed the concept, and BS collected the data and developed the first draft of the manuscript; both authors worked on revising subsequent versions of the work and both approved the final manuscript. Both authors are responsible for the final content of the paper as guarantors. MDC holds funding from the Canadian Institutes of Health Research and the Ontario Neurotrauma Foundation and is principal investigator of the Canadian Brain Injury and Violence Research Team. The opinions expressed herein are those of the authors and not necessarily those of the funding agencies.

  • Funding This research was supported by the Canadian Institutes of Health Research Strategic Team Grant in Applied Injury Research # TIR-103946 and the Ontario Neurotrauma Foundation.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.