COACH: COmmunities Aligned to reduce Concussion and Head impact exposure in youth football

Project Summary Football has a high risk of concussion and incidence of subconcussive head impacts which have long-lasting negative effects on brain health. With roughly 3.5 million athletes participating in youth football each year, there is a critical need to reduce head impact exposure and concussion risk. Over an entire season, most of an athlete’s head impact exposure is attributed to practice. Coach-directed activities (e.g., practice drills) influence the frequency and severity of head impact exposure. Practices are amenable to intervention; however, youth football leagues are often community-run organizations with limited resources, making implementation and enforcement of injury prevention strategies a challenge. Thus, engaging community members is essential for successful development, implementation, and sustenance of interventions. We partnered with a community stakeholder group to co-design and implement an evidence-based intervention program: COmmunities Aligned to reduce Concussion and Head impact exposure (COACH). COACH seeks to improve knowledge and skills of youth football coaches in effective practice planning that incorporates safe drills and to change attitudes and beliefs toward contact in practice. COACH has been pilot tested in two teams and shown to be acceptable and feasible. A critical next step of this research is the pragmatic evaluation of the effectiveness of COACH on a larger scale, while identifying factors that influence implementation. This proposal addresses this critical next step by determining the capacity of youth football organizations to adopt COACH and by testing COACH’s effectiveness while monitoring the implementation process. In Aim 1, we will engage youth football organizations in a mixed methods evaluation of capacity to adopt COACH. Semi-structured focus groups with coaches and parents, and interviews with organizational leaders from a diverse sample of youth football organizations will be conducted. We will measure organizational needs, capacity, culture, and readiness to adopt COACH. Data will be used to inform ways to strategically adapt COACH prior to implementation using a community-engaged approach. In Aim 2, we will use a stepped-wedge design to test the effectiveness of COACH at reducing head impact exposure in practices and adverse neurobehavioral health outcomes. Over four years, athletes enrolled across six organizations will be recruited to participate in parallel biomechanical data collection with an instrumented mouthguard to evaluate the effectiveness of COACH at reducing head impact exposure. A sub- sample of athletes will complete pre- and post-season neurobehavioral health and cognitive assessments. Head impact exposure and changes in neurobehavioral health outcomes will be compared across the control and intervention teams. In Aim 3, we will evaluate implementation outcomes via on-field video and field notes. We will also conduct a mixed methods assessment of contextual factors that influence adaptation. Successful completion of this project will help us achieve our goal of increasing equitable access to a safe and effective practice environment and change the paradigm of safety for young athletes. 1