NFHS Voice: No HS Football Link to CTE
October 21, 2019
By Karissa Niehoff
NFHS Executive Director
When it comes to the long-term effects of concussions in sports, there is a wide range of information published – almost on a daily basis. Unfortunately, much of the media coverage as it relates to high school sports – and particularly the sport of football – is misleading.
Last week, the Concussion Legacy Foundation introduced its new public-service announcement that compared youth football dangers to smoking. As the pre-teen football players puff on cigarettes, the voiceover says, “Tackle football is like smoking, the younger I start, the longer I’m exposed to danger.”
The “Tackle Can Wait” campaign by the foundation is an attempt to steer children under the age of 14 into flag football. Although establishing a finite age may be difficult, reducing contact at youth levels is certainly a positive. USA Football is doing just that nationally through its Football Development Model. Likewise, the 51 member state associations of the National Federation of State High School Associations (NFHS) have enacted limitations on contact during preseason and practice sessions.
Our concern is the term “exposed to danger.” These types of messages continue to spread unwarranted fear to parents of high school student-athletes. The “danger” refers to reports that players who incur repeated concussions can develop chronic traumatic encephalopathy (CTE).
A 2017 study from the Journal of American Medical Association (JAMA) linked CTE in the brains of deceased National Football League players. Even if this report is accurate, these are individuals who endured repeated blows to the head for 20 to 25 years BEFORE any concussion protocols were in place.
Less publicized is a study by Dr. Munro Cullum and his colleagues at the Peter O’Donnell Jr. Brain Institute, which is a part of the University of Texas Southwestern Medical Center in Dallas. Cullum’s group studied 35 former NFL players age 50 and older who had sustained multiple concussions throughout their careers. The findings showed no significant association between the length of the individuals’ careers, the number of concussions and their cognitive function later in life.
Two studies, two different conclusions. Regardless of the outcome, however, they are not applicable to kids playing football before and during high school. There is absolutely no linkage to CTE at these levels, and the word “danger” should not be a part of the discussion.
A more applicable and significant study was also published in JAMA in 2017. In a study of about 4,000 men who graduated from Wisconsin high schools in 1957, there was no difference in cognitive function or decline between those who played football and those who did not as they reached 65 years of age. We would assume the majority of these individuals discontinued football after high school.
With more than one million boys – and girls – playing the contact sport of football each year, severe injuries do occur from time to time, but parents should know that efforts to lessen the risk of a catastrophic injury, including head injuries, have never been stronger than they are today.
In fact, new data from the National High School Sports-Related Injury Surveillance Study indicates some positive trends in concussion rates. The study, which was released in the American Academy of Pediatrics online issue of Pediatrics last week, indicated that concussion rates during football practices dropped from 5.47 to 4.44 concussions per 10,000 athletic exposures between the 2013-14 and 2017-18 seasons.
In addition, repeat concussion rates across all sports declined from 0.47 to 0.28 per 10,000 exposures during the same time period.
Concussion laws are in place in every state. All NFHS sports rules books have concussion management protocols. Helmet-to-helmet hits are not allowed in football. Limits on contact in preseason and practice in football are in place in every state.
After considering all the available research, we encourage parents to let their kids play their sport of choice in high school, but we would discourage moving away from football – or any contact sport – solely based on the fear of developing CTE later in life.
Dr. Karissa L. Niehoff is in her second year as executive director of the National Federation of State High School Associations (NFHS) in Indianapolis, Indiana. She is the first female to head the national leadership organization for high school athletics and performing arts activities and the sixth full-time executive director of the NFHS, which celebrated its 100th year of service during the 2018-19 school year. She previously was executive director of the Connecticut Association of Schools-Connecticut Interscholastic Athletic Conference for seven years.
NFHS Hall of Famers: Multi-Sport Experience Makes Major Difference
By
The NFHS Voice
National Federation of State High School Associations
July 28, 2026
The theory that athletes in high school need to specialize in one sport in an out-of-school program to progress to the next level was not the theme from the five athletes inducted into the National High School Hall of Fame last month in Salt Lake City, Utah.
At a press conference preceding the 43rd Hall of Fame induction ceremony, five former extraordinary high school athletes – all of whom later excelled at the college, professional and for a few Olympic levels – delivered resounding messages about the importance of playing multiple sports within school-based programs.
Joe Carter, who was a four-sport standout in football, basketball, baseball and track at Millwood High School in Oklahoma City, Oklahoma, long before his stellar pro baseball career, said he might never have been a successful pro baseball player without his multiple sport career at Millwood.
“If I had played baseball all year long, I wouldn’t have been a professional baseball player because I would have burned out,” Carter said. “Coaches will tell you that if you don’t come out for football in the spring instead of playing another sport, you will be passed up. This is not the case because if you’re good they will find you. I will take an athlete who played two or three sports over an athlete who just played one sport because those guys know how to take advantage of a situation and know how to adjust.”
Jordan Larson, a three-sport participant at Logan View High School in Hooper, Nebraska, before settling into volleyball and leading the University of Nebraska to an NCAA championship and playing in four consecutive Olympics, also pointed to multiple sports as a reason for success.
“I can’t emphasize it enough – playing multiple sports helped me personally,” Larson said. “It helped me adapt and adjust as I got older. I can’t recommend it enough from a young age.
“Playing multiple sports helped shape me health-wise from a longevity standpoint. There’s something to be said for the mind. If you’re on the grind in the same sport, burnout will come.”
Another volleyball standout in the 2026 class was Alisha Glass Childress, who also played basketball at Leland (Michigan) High School and who would later lead Penn State University to three consecutive NCAA volleyball titles and team with Larson on the U.S. squad at the 2016 Olympics in Brazil.
“Playing for your high school team is so important – it’s such a different experience,” Childress said. “Being in the same program for four years and getting to know the athletes you’re with, I felt like it was family.
“High school was a beautiful time and the beginning of a love affair with sports. I fell in love with the sport of volleyball but also tried a lot of different sports. I played basketball as well. For me, high school is when you start to have an understanding of yourself – reflecting on who you want to be or what you want to achieve.
“The life lessons you learn along the way are so important. The majority of the athletes on our team did not continue on to play past high school. The life lessons you learn as a high school athlete – being a leader, accountability, goal-setting – carry with you the rest of your life.”
Patrick Willis was one of Tennessee’s top two-way football players at Hollow Rock-Bruceton Central High School who also played basketball and baseball before his hall of fame football career with the San Francisco 49ers.
“Coming from a small town with two red lights, I would say the most fun I had growing up was playing sports,” Willis said. “Life can throw a lot of things at you, and to be able to adjust is amazing. In sports, we’re able to learn these things – the discipline, the toughness, the perseverance. I wanted to be a representative that anything is possible, and it’s not just the ones from the big cities or towns, but ones from small towns also.”
Another proponent of playing multiple sports was Krissy Wendell Pohl, the most dominant player in girls ice hockey in Minnesota history and the national record-holder in goals scored in a season who went to a stellar career at the University of Minnesota and won a silver medal at the 2002 Olympics. In addition to her excellence in ice hockey, Wendell Pohl also played tennis, baseball and softball.
“It was so special for me to be able to play multiple sports,” said Wendell Pohl. “For me, playing baseball, softball and hockey, you had different groups of friends, different roles on different teams, and all of that had an impact and you don’t realize it until later.
“High school is the purest form of sport. What you learn in high school, as you’re learning and growing and developing, those things stay with you. The people who impact you in high school – you will never forget that.”
We urge coaches today to take the message from these five outstanding athletes about playing multiple sports to heart and make that option available to athletes in their schools.
These vital programs help to shape young student-athletes into successful parents, citizens and leaders of our nation for years to come.