Promoting and inhibiting factors in implementing state youth sports concussion laws: Results of a survey of state implementers

As of 12/31/2012, youth sports concussion legislation was effective in 42 states and the District of Columbia, all passed since 2009. While the laws contain very similar provisions aimed at secondary prevention (e.g., secondary impact syndrome, early-onset dementia, suicide), little is known about how they are being implemented or what factors promote or inhibit implementation. We conducted a qualitative interview study to explore states' experiences with implementing concussion laws, conducting key-informant interviews over 5 months with individuals from state agencies/organizations charged with implementation. As of 2/1/2013, with a response rate of 74% (32 interviews, 31 of 43 states represented), findings suggest considerable heterogeneity. Respondents report that factors facilitating implementation include involvement of the implementing agency/organization in the lawmaking process, prior state-level activity, preexisting resources and partnerships, and “lead time” before the law's effective date. Factors impeding implementation include vague/imprecise statutory terminology, geographic access to trained medical professionals, and decentralized nature of recreational sports. Respondents reported a desire for requirements not included in their state laws, including “return to learn” guidance and training for additional groups. Enforcement mechanisms are minimal-to-nonexistent, and we identified almost universal belief that education and awareness resulting from the law will have the greatest impact on reducing negative outcomes. States' ability to collect data for policy evaluation seems to be tied to existing partnerships (e.g., with academic medical centers). Our research provides an important first step in evaluating the effectiveness of youth sports concussion laws, as well as information to guide lawmakers in drafting public health legislation.