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TBI laws effective in reducing concussions among high school athletes

A new study using data collected in a national sports injury surveillance system by researchers at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus has found that state-level TBI laws are, in fact, beneficial in reducing the rates of new and recurrent concussions among U.S. high school athletes. Between 2009 and 2014, all 50 states and the District of Columbia enacted one or more traumatic brain injury (TBI) laws, more commonly known as concussion laws. These laws often include mandates to remove athletes from play following an actual or suspected concussion, a medical clearance before they can return to play, and annual education of coaches, parents, and athletes regarding concussion signs or symptoms.

The study, led by Dr. Ginger Yang at the Center for Injury Research and Policy at Nationwide Children’s Hospital with researchers from the Colorado School of Public Health and Temple University, is published in the November 2017 edition of the American Journal of Public Health. The study found that rates of new and recurrent concussions initially increase after a law goes into effect due to mandated reporting, but this is also likely due to greater awareness of the signs and symptoms of concussion itself. The authors also indicated that approximately 2 ½ years after a TBI law is in place, the data indicated that rates of recurrent concussions resulted in a significant decline.

“These concussion laws follow in a long-line of successful legislation efforts in public health injury prevention,” said Dawn Comstock, PhD, principal investigator of High School RIOTM  (Reporting Information Online), the national surveillance database that tracks high school sport injuries at the Colorado School of Public Health. “These laws in particular were passed quickly and are truly effective as found in the data and this study. What is even more interesting is even though there isn’t an enforcement of these laws—people wouldn’t be ticketed like they might be with speeding or not using their seatbelt, these laws did make a difference. It is a great example of how legislative efforts can actually drive public health and injury prevention.”

This study looked at TBIs in high school athletes who competed in at least one of nine sports between 2005 and 2016. The high school sports included boys football, boys wrestling, girls volleyball, boys and girls soccer, boys and girls basketball, boys baseball, and girls softball. Over 11 years, there were an estimated 2.7 million reported concussions in high school athletes engaged in these sports, which translates to an average of 671 concussions per day, or about one concussion in a high school athlete every two minutes. Of the reported concussions, approximately 89 percent were new while 11 percent were recurrent (a repeat concussion in an athlete that has already had at least one other concussion).

The data also showed that concussions were more frequent among male athletes, particularly in football, and during competitions. Football had the highest average annual concussion rate, followed by girls’ soccer and boys’ wrestling. Overall, males have a higher average annual concussion rate than females, but when comparing the rates in gender comparable/available sports (basketball, soccer, baseball/softball), females had almost double the annual rate of concussions as males.

This study was funded by a grant from the Robert Wood Johnson Foundation’s Public Health Law Research program. State-level concussion law data was obtained from LawAtlas. Concussion data was collected from High School RIOTM  (Reporting Information Online), a prospective, longitudinal internet-based surveillance system housed in the Program for Injury Prevention, Education and Research at the Colorado School of Public Health that collects sport-related injuries and exposures among athletes from athletic trainers at a nationally representative sample of U.S. high schools.

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Doping in sports: official tests fail to pick up majority of cases

Doping is remarkably widespread among elite athletes and remains largely unchecked despite the use of sophisticated biological testing methods. This is according to Rolf Ulrich of the University of Tübingen in Germany and Dawn Comstock of the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. They are lead authors of a study in Springer’s journal Sports Medicine.

The researchers conducted anonymous surveys among athletes competing at two major sports events in 2011. At least 30-45% of athletes at these events acknowledged that they had used banned doping substances or methods in the previous year. This is a serious concern because doping not only compromises fair play, but it is potentially detrimental to the health of athletes.

Biological tests of blood and urine typically detect doping in only 1-3% of competitors at elite international competitions. However, the new study suggests that the true rate of doping is far greater, because cutting-edge doping schemes seem to make it possible for many athletes to beat the biological tests currently in place to detect prohibited doping.

“Given the numerous recent highly publicized doping scandals in major sports, one might guess that the proportion of such undetected cheats is high,” write Ulrich and his coauthors. In their paper, the authors cite several recent commentaries suggesting that technical, human, political and financial factors are all contributing to flawed results from current biological testing techniques.

The research team conducted anonymous tablet-based surveys of the prevalence of doping at two major sports events in 2011. These were the 13th International Association of Athletics Federations World Championships in Athletics (WCA) in South Korea and the 12th Quadrennial Pan-Arab Games (PAG) in Qatar. The surveys used a randomized response technique, a method that visibly guaranteed the anonymity of the respondent, thus permitting the athletes to answer honestly about their doping without fear of exposure. Surveys were completed by 2167 athletes at the two events.

Even after assessing statistically for various possible forms of bias in the results, the authors estimated that at least 30% of athletes at WCA and 45% of athletes at PAG had engaged in doping during the previous year. The statistical analyses suggested that, if anything, these figures may well have underestimated the true prevalence of doping at the two events. By contrast, on biological testing at WCA, only two (0.5%) of the 440 athletes tested positive for illegal substances. At PAG, 24 (3.6%) of the 670 athletes tested showed positive results.

“These findings suggest that biological testing greatly underestimates the true prevalence of doping in elite athletics,” Dawn Comstock, professor of epidemiology at the Colorado School of Public Health at CU Anschutz, said. “It indicates the need for future studies of the prevalence of doping in athletics using randomized response techniques to protect the anonymity of the athletes.”

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