Mandatory Bicycle Helmet Laws in the United States: Origins, Context, and Controversies.

This article examines the origins and context of mandatory bicycle helmet laws in the United States. Localities began to enact such laws in the early 1990s, having experimented with helmet laws for motorcycles previously. As cycling became increasingly popular in the 1970s and 1980s because of a variety of historical trends, from improved cycle technology to growing environmental consciousness, cycling-related injuries also increased. Bicycle safety advocates and researchers alike were particularly troubled by head injuries. National injury surveillance systems and a growing body of medical literature on bicycle-related injuries motivated a number of physicians, cyclists, children, and other community members to advocate helmet laws, which they argued would save lives. Controversy over these laws, particularly over whether they should apply universally or only to children, raised public health ethics concerns that persist in contemporary debates over bicycle helmet policies. (Am J Public Health. 2020;110:1198-1204. doi: 10.2105/AJPH.2020.305718).

"The Duty of Their Elders" - Doctors, Coaches, and the Framing of Youth Football's Health Risks, 1950s-1960s.

After World War II, organized tackle football programs for boys younger than high school age grew enormously in popularity in the United States, prompting concerns from pediatricians and educators about the sport's physical and emotional health effects. At the same time, sports medicine was emerging as a sub-specialty. Examining how American sports medicine doctors and football coaches established their professional authority on youth football safety in the 1950s and 1960s reveals how their justifications for this collision sport were connected to broader cultural trends. Doctors and coaches, who were virtually all men, emphasized their firsthand knowledge of an all-male sport that was widely promoted as a means of teaching boys to become men. They insisted that proper supervision and equipment were sufficient to protect young athletes. Their arguments for youth football's benefits were based on the belief that men best knew how to impart desired values such as loyalty, patriotism and discipline to boys. In framing football's health risks as manageable with adult supervision, coaches and sports medicine doctors played a crucial role in promoting the vision of American manhood associated with tackle football.

A Helmet of Her Own?: A Qualitative Study of Key Stakeholder Perspectives on Headgear in Girls' Lacrosse.

Introduction: Despite the high incidence rate of concussions in women's lacrosse, there is substantial push back against the use of helmets at the secondary educational and collegiate levels in the U.S. This study examines the social factors influencing the controversy surrounding the use of protective headgear and how the recent development of headgear specific to the women's game has shaped ongoing debates. Methods: Purposeful sampling was used to recruit interviewees with research knowledge or firsthand experience with injury and protective headgear in girls' lacrosse. Semistructured interviews were conducted and subsequently coded using qualitative research software to identify key themes and patterns. Results: Sixteen respondents participated in this study; 4 players, 4 coaches, 3 researchers, and 5 administrators were represented in this sample. Overarching themes identified across these interviews included playing through pain, health consequences of concussions, concussion prevention strategies and the potential role of headgear, symbolism of headgear, gender dynamics, autonomy, and decision making. Conclusions: This qualitative study shows the importance of attention to the unique history of girls' lacrosse and current narratives surrounding headgear in the sport. There is a need for greater collaboration and consensus between all relevant groups to ensure that headgear best addresses the concerns of the people who will ultimately be using it. Future qualitative research should build on this preliminary study with a larger and more diverse sample to follow up on key themes and ultimately inform effective safety measures to protect athletes.

Playing hockey, riding motorcycles, and the ethics of protection.

Ice hockey and motorcycle riding are increasingly popular activities in the United States that are associated with high risks of head and facial injuries. In both, effective head and facial protective equipment are available. Yet the debates about safety policies regarding the use of head protection in these activities have taken different forms, in terms of the influence of epidemiological data as well as of the ethical concerns raised. I examine these debates over injury prevention in the context of leisure activities, in which the public health duty to prevent avoidable harm must be balanced with the freedom to assume voluntary risks.

Mental health risk factors for suicides in the US Army, 2007--8.

OBJECTIVE: Suicides among active duty US Army personnel have been increasing since 2004, surpassing comparable civilian rates in 2008. This analysis uses US military data to assess suicide rates for the 2-year period 2007--8, and examines relative risks (RR) of suicide associated with mental health disorders. METHODS: Historical trends of US Army suicides were assessed using 1977--2008 data from Army G-1 (Personnel). Suicide rates, RR and the 2000--8 trends of mental health disorders were calculated using data from the Defense Casualty Information Processing System and Defense Medical Surveillance System. RESULTS: A total of 255 soldiers committed suicide in 2007--8 (2008 rate 20.2 per 100 000). Factors associated with higher suicide risk included male gender, lower enlisted rank and mental health disorders treated on an outpatient basis (RR 3.9), as well as a number of mental health disorders (mood disorders, anxiety disorders, post-traumatic stress disorder, personality/psychotic disorders, substance-related disorders and adjustment disorder; RR range 4.7--24.5). Analysis of historical trends suggested that 25--50% of the suicides that occurred in 2008 might have been related to the major commitment of troops to combat beginning in 2003. CONCLUSIONS: The recent increase in suicides parallels an increase in the prevalence of mental disorders across the army. This finding suggests that increasing rates of clinically treated psychopathology are associated with increasing rates of suicides; these rates probably serve as sentinels for suicide risk in this population. Soldiers seeking treatment for mental disorders and substance abuse should be a focus for suicide prevention.

No Excuses: A Brief History of Playing Through Risk in College Football.

Celebrations of playing through risk, skepticism of athletes perceived as faking injuries, unregulated training regimens, the mythos of amateurism, and lack of accountability for preventable health harms have long characterized many college football programs. Setting policies that effectively prioritize player health will require taking this history into account.

Toward Complete, Candid, and Unbiased International Consensus Statements on Concussion in Sport.

Five international consensus statements on concussion in sports have been published. This commentary argues that there is a strong need for a new approach to them that foregrounds public health expertise and patient-centered guidance. Doing so will help players, parents and practitioners keep perspective about these potentially life-altering injuries especially when they recur.