Statement of purpose The potential impact of traumatic brain injury (TBI) in youth sports on child/adolescent health is significant and nationwide. Participation in high school sports exceeded an estimated 7.7 million in 2012–2013. Sports are the leading cause of TBI in young people. Since 2009, all 50 states and D. C. passed legislation addressing youth sports TBIs. Legislatures are now revisiting and revising them in response to evolving knowledge and experience. This presentation explores the current legislative landscape related to youth sports TBI, amendments to state laws since initial passage, recent litigation, and implications for implementation of youth sports TBI laws and future policymaking.

Methods/Approach I performed the legislative and legal analyses that form the basis of this discussion using established legal research methodologies. I developed a Boolean search string and used a commercial legal database to capture all relevant state statutes, administrative regulations, enacted bills, and adopted rules related to youth sports TBI effective as of December 31, 2014. I recorded legal citation, specific provisions, and enactment and effective date. (An earlier version of this research is available on the Network for Public Health Law Web site at https://www.networkforphl.org/_asset/n7bm5m/Sports-Concussion-Table.pdf.)

Results Initially, the laws contained similar provisions with little policy experimentation, modelled after Washington’s Lystedt Law: parent/student athlete education, mandatory removal from play, and medical clearance to return to play. All of the laws focus on secondary prevention to mitigate the downstream effects of concussions. Twenty states have made substantive changes to their original laws – six more than once – and more states are likely to follow suit. These changes have centred around three major themes: expansion of applicability (7 states); streamlining/new provisions based on lessons learned from implementation, best practices, or evolving knowledge (19 states); and primary prevention/early detection (3 states).

Conclusions TBI policymaking will likely continue along this trajectory, with increasing efforts in primary prevention (e.g., full-contact limits), better/earlier detection (e.g., baseline testing or helmet sensors), and addressing needs of concussed student-athletes (e.g., “return-to-learn” protocols). Bukal v. IHSA, the first lawsuit brought by a class of former athletes against a state high school association for allegedly inadequate concussion protocols, raises interesting legal questions and implications for implementers. Does existence of statutory provisions protect high school associations from liability? Does a comprehensive law become impracticable and, therefore, less effective (e.g., requiring medical personnel on the sidelines of all high school football games)?

Significance and contribution to the field Youth sports TBI has emerged as a major public health issue in the U.S. All 50 states and D.C. have passed legislation to address the problem. While others have described TBI legislation as initially passed, the laws are still evolving as new research, lessons from implementation, and best practices emerge. Monitoring changes and developments in youth sports TBI statutes, regulations, and case law will: provide crucial information to injury policy researchers and evaluators for identifying which provisions are having the desired impact; inform future policymaking; and guide the increasing state government oversight of youth sports.