April 8, 2020 ~ Violence Prevention

Today’s theme for National Public Health Week 2020 is Violence Prevention—Violence Prevention focuses on reducing personal and community violence to improve health. We’re excited to get insight on the topic of concussion prevention from Emily Acers.

Emily is a current graduate student in the University of Minnesota’s School of Public Health, an intern with the Minnesota Public Health Association and #NOTINVISIBLE Campaign and teaches water aerobics for New Brighton Parks and Recreation.

How did you get involved in this area of public health? Was it something you knew you always wanted to do?

The short answer is yes, I’ve always known public health was something I wanted to do. However, I give all the credit to my younger brother for my initial interest in this type of violence prevention.


In my small hometown in Northern Minnesota, ice hockey was the thing to do. I spent many weeknights and weekends watching my younger brother play. I remember sitting at these games hoping that my brother wouldn’t get hurt. More specifically, I recall hoping that he wouldn’t get a concussion. From then on, I knew I needed to do something with concussion prevention.

Why are you passionate about public health? 

Public health is so broad, but it really comes down to helping make people and populations as physically, spiritually, emotionally, etc. healthy as possible. When it comes to concussion prevention, to me that is about keeping people’s health safe. By preventing a concussion, you are helping to protect the health of an individual in a sense.

How do you see your area of public health evolving or changing in the future?

The concussion field has evolved and changed dramatically in the last few years and I believe that it will continue. The evolution that has already happened thus far is just scratching the surface. I believe there is so much more to learn and implement when it comes to the concussion field.


Which sports have the most concussions? Is it the same in Minnesota as on the national level? 

Through my research, the sports with the highest number of reported concussions include football, wrestling, ice hockey, and soccer. When it comes to the number of concussions in a sport per state, I would expect the concussion rates to vary by sport. For example, I expect to see more concussions in ice hockey in Minnesota than in Alabama because Minnesota has more ice hockey. Additionally, I expect to see a higher number of concussions for football in states like Alabama, Louisiana, Georgia etc. where football is played more.

In 2016, there was a really great data brief done by the Minnesota Department of Health focusing on sports-related concussions in our Minnesota High School Athletes. The brief breaks down the number of concussion per sport, gender, and age group.

What are some of the local and national efforts to educate kids, coaches, and parents on symptoms to be on the look-out for with concussions?

At the national level, the biggest concussion education effort that I know of is the CDC’s HEADS UP program. This program is designed to provide concussion education for all stakeholders involved such as parents, healthcare providers, coaches, and school professionals. Overall, I find the HEADS UP program to be a very helpful and useful tool when it comes to concussion education. It provides easy to understand materials for each stakeholder group and focuses on all aspects of a concussion: the recognition, how to respond, and how to minimize the risks.

At the local level, I believe that athletic trainers are the main educators for coaches, parents, and athletes. I have worked with many athletic trainers and have found all of them to be so knowledgeable, caring, and helpful in making sure that their athletic communities truly understand concussion education.

For example, my hometown athletic trainer is incredible and goes above and beyond when it comes to concussion education for her athletic community. She holds pre-season meetings for the athletes, parents, and coaches where she touches briefly about the importance of concussions, the signs and symptoms, and the purpose and importance of baseline testing. Additionally, she provides concussion fact sheets—the HEADS UP ones—to all parents at the pre-season meetings, carries them with her on the sidelines for parents/players, and puts them into every sports team’s medical kit. She goes above and beyond to make sure that her sports community is educated about concussions, which I think every school should be doing.

Does Minnesota have any laws or rules designed to prevent concussions in youth sports? Do other states?

To my knowledge, Minnesota doesn’t have any specific laws designed to prevent concussions. However, we do have  Minnesota Statute 121A.38 which focuses on removing athletes from sporting events if they are showing signs or symptoms of concussion or if a concussion is suspected. Additionally, this statute states that when an athlete is removed from a sporting event due to a concussion, they may not return to play until they are no longer showing signs or symptoms of concussion and they must be evaluated by a health care provider trained and experienced in evaluating and managing concussions, and the provider gives the athlete written permission to resume participation.

At the national level, every state and the District of Columbia has enacted some form of “When In Doubt, Sit Them Out” concussion in sports law. The first concussion in sports law was created and implemented in 2009 by the state of Washington and was called the Zackery Lystedt Law.

However, because each state creates and defines their own concussion in sports laws, some states have more comprehensive concussion laws than others. For example, Rhode Island not only has a return to play protocol, coach training, and athlete and parent education but their law encourages the use of baseline testing and the attendance of medical trainers at all athletic events.

My hope is to one day see all these requirements—as well as a section that addresses concussion prevention—in every state’s concussion in sports laws.  

Do you think that education efforts are enough? Or does there need to be changes in how the sports are played (like making heading a soccer ball illegal) or requiring certain types of equipment (like safer football helmets)?

I think education efforts are a really good start to addressing the issue of concussions. However, more needs to be done. When it comes to how better to address this issue, I personally think that whatever we do can’t hurt. For example, I think that soccer players shouldn’t be taught to head the ball until they are at the U10 or U12 level. Additionally, safer equipment could potentially help address this issue, but I think ultimately it would cause unintended consequences. For instance, if safer equipment is developed and the athlete believes that this new equipment would “protect” them no matter what, it could cause them to play riskier and more aggressive, which could result in more concussions occurring.

There are two main athletic programs can do to help address concussions. First, every school or school district should have an athletic trainer. Currently a majority of schools around the nation do not have athletic trainers. As I talked about earlier, my hometown athletic trainer has been phenomenal in all concussion steps: the prevention, detection, diagnosis, treatment, and recovery. Therefore, I believe athletic trainers could help protect our athletes.

Second, I think concussion spotters should be integrated into high school sports. A concussion spotter has the primary role of identifying a possible concussion, not treating a concussion. If they suspect an individual to have a concussion, they call down to the athletic trainer to pull the player out of the game. Overall, I believe concussion spotters to be helpful in addressing the issue of the underreporting of concussions.

Tell us a little about your master’s project.

The underreporting of concussions is a big public health problem. About 55% of concussion occurring in high school athletes go unreported, which is a huge number. I wanted to focus my master’s project addressing this issue, so I designed an implementation plan that focuses on implementing concussion spotters into Minnesota high school sports. There are four major outcomes I address in this proposal—the acceptability, valubility, effectiveness, and financial feasibility of concussion spotters—by doing a systematic literature review and multiple stakeholder interviews. My goal for this implementation plan is to provide it to the Minnesota State High School League so that they can best address the underreporting of concussions in high school sports with the help of concussion spotters.


Is this an area of research that you’re interested in continuing to pursue after you graduate from Minnesota?

Oh yes! Concussion prevention is my passion in life. My goal is to continue to work on this topic in any and all capacity I can. There are a few really great organizations out there doing incredible concussion work that I would love to be involved with after I graduate. I believe that we need to help protect our athletes from concussions because they have long and healthy lives to live.

This interview is by the Minnesota Public Health Association for National Public Health Week (NPHW) 2020.

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