An Open Letter

Urgent Call for Awareness and Action on Repetitive Head Impacts in Sports

January 2, 2024

Mandy K. Cohen, MD, MPH
Director
Centers for Disease Control and Prevention
Atlanta, GA

Dear Dr. Cohen, 

We write to you as stakeholders in the urgent mission to raise awareness of the significant risk of brain damage and disease caused by repetitive head impacts (RHI) in sports. Together, let us strive to save lives and prevent the tragic loss of children whose head impacts in sports result in suicide, erratic behavior, severe depression, or other forms of suffering that could have been avoided. The evidence and knowledge necessary to enhance the care and quality of life for our nation’s children and to educate those responsible for their well being should be readily available.

While we are deeply appreciative of the work your agency has done to establish the Heads Up program to educate schools, coaches, parents, and others about the dangers of concussions, we believe the potential dangers of RHI are not adequately integrated into the current materials. It’s important for everyone to understand there are risks in RHI, even if they do not result in a concussion diagnosis.  

Science has evolved. Here are the facts:

• Young athletes engaged in sports during their critical developmental years are significantly more susceptible to lifelong neurological impairments if they undergo repeated head or body impacts
  *  The ages between 8 and 13 are especially vulnerable, given the significant changes and maturation occurring in young brains. Statistics reveal an elevated risk of suicide, mental health issues, addiction, irrational behavior, and learning difficulties following brain trauma. These are national issues that can, in many cases, be mitigated by safeguarding a child’s developing brain.
• Despite advances in sports safety equipment, improved playing standards, and enhanced coaching training, young players are still exposed to severe and unnecessary impacts to their developing brains.
  *   It is a scientific fact that, due to the physiological structure of the brain, there are no known means of preventing subconcussive exposure through technology or equipment.

Therefore, we request that the Centers for Disease Control and Prevention (CDC) take the following actions:

• Incorporate information about the dangers of RHI in sports into all Heads Up materials and related concussion-oriented materials for all audiences.
  *   Such a resource is vital for parents to make informed decisions about the sports their children should participate in. School officials, athletes, and coaches also need to be educated about the impact of RHI and the warning signs of excessive brain inflammation resulting from sports play. This information should be included in all concussion materials and training programs to include Public Service Announcements, videos, training material, and guidelines.
• Develop a set of best practices for use by school, athletes, and coaches to ensure not only proper communication of the most up to date science regarding RHI, but also options to mitigate these kind of injuries. Some examples could be:
  *  An updated concussion information sheet, to be signed by both the athlete and their parent or guardian (if a minor), and returned to the school or athletic organization prior to each season to educate about the risks of RHI in addition to concussions.
  *  Courses for coaches, trainers and sideline staff on the warning signs and dangers of RHI in athletes.

We are aware that Congress appropriated $1 million above the CDC’s request for the Traumatic Brain Injury line within the Center for Injury Prevention and Control in fiscal year (FY) 2023, the CDC carried that funding increase forward into the FY 2024 request, and that the current House and Senate appropriations bills both include this funding. We respectfully request that the agency dedicate a portion of this increased funding to the actions we request in this letter and that these activities are integrated into base programmatic activities for the Center in future years.

Your agency is the leader in developing and communicating ways to mitigate public health concerns and should, therefore, provide guidance to educational institutions, and medical, pediatric and psychological organizations on the necessary updates to informational and training materials. These updates should accurately encompass the latest scientific advancements in the understanding of RHI and brain development. Ensuring that medical and psychiatric curricula, as well as continuing medical education, incorporate this evolving knowledge is essential. Such integration is instrumental in driving progress in the diagnosis, treatment, and consultation for both children and adults affected by RHI exposure.

Our primary mission is to ensure that no other family experiences the profound loss that many of us have endured. It its crucial for all parents and athletes to fully comprehend the perils of RHI before participation in youth sports. We urge you to safeguard children from the risks of RHI in sports by sharing this information with the American public, most importantly, parents.

Sincerely,

And in memory, Friends and Family of:

Signed By:

Organizations:

Brain Injury Alliance of Vermont
Chandler Kimball Foundation for CTE Awareness
Chronic Traumatic Encephalopathy News
Concussions Pain Mental Health Awareness
CTE & TBI Warrior Circle
CTE Hope
Dementia Society of America
Eric Pelly Sports Education
Evan R. Hansen Legacy Foundation
Greg Stanke Legacy
I Got You Foundation
Karel’s Legacy Foundation
Mary Seau CTE Foundation
One Last Goal
Patrick Grange Memorial Foundation
Patrick Risha CTE Awareness Foundation
Practice Like Pros
Taylor’s Tree
The Knockout Project
The Mac Parkman Foundation for Adolescent Concussive Trauma
The Nicky Green Foundation
The Brain Injury Community, Inc
Traumatic Brain Injury Mommas United
21-14 Concussion Awareness Foundation

Individuals:

Elizabeth Allardice in memory of Robert D. Allardice
Cierra Anderson in memory of Noah Green and William “Billy” Evans and honor of Ken Shaver
Barbara Arnold in memory of  Scott Arnold
Tiffany Arrington in memory of Rick Arrington
Andrea Barbera
Madelyn Bender
Carol Beuten
Bill & Anne Benedict in memory of Matthew Benedict
Kristin Blake
Jane Bond in memory of Cody Hamblin
Carla Bowles
Eleanor Burks in memory of Noah Green
Lisa Carpenter in memory of Erich Carpenter
Amy Cline
Tom Dever in memory of Taylor Dever
Lisa Downey in memory of Patrick Risha
Brenda Easter in memory of Zachary Easter
Bethany Ellard-Richmond
Lisa Faulkner
Cyndy Feasel in memory of Grant Feasel
Kim & Jordan Foraker in memory of Hunter Foraker
Jan Franklin in memory of Jason Franklin
Ruth Ann Free
Carol Fust in memory of Michael Fust
John Gaal in memory of John Gala Jr.
Debbie Gorman
Brittany Graham in memory of Cody Hamblin and Robert Wolcott
Mike & Michele Grange in memory of Patrick Grange
Brendan Green in memory of Noah Green
Brittani Green in memory of Noah Green
China Green in memory of Noah Green
Essence Green in memory of Noah Green
India Green
Isaiah Green in memory of Noah Green
Mazie Green in memory of Noah Green and William “Billy” Evans and honor of Ken Shaver
Newton Green in memory of Noah Green and William “Billy” Evans and honor of Ken Shaver
Sahara Green in memory of Noah Green
Heidi & Darren & Heather Hamblin in memory of Cody Hamblin
Malka Hanna in memory of Harry Jacob Hanna
Chuck & Mary Hansen in memory of Evan Hansen
Christine Harding in memory of Danny Ray Grayson
Susanna Haynes in memory of Noah Green and William “Billy” Evans and honor of Ken Shaver
Tisha Herndon in memory of Hunter Herndon
Annette Hodges in memory of Noah Green
Chance Holley in memory of Cody Hamblin
Nancy Hudson in memory of Mac Parkman
Kimberly Jenkins in memory of Charles Michael Jenkins
Kimberly Jones in memory of Noah Green
Angela Kalantzis in memory of Chandler Kimball
Hersh Kanner, Middlebury College
Erin Keeney
Darcy Keith
Christy & Jason Kimball in memory of Chandler Kimball
Cathy Kosik in memory of Cody Hamblin
Jacqueline Koverman
Talana Klungland
Christopher Kuralt
Megan Lay
Felice Leeds in memory of Paul Pender
Sharon Lewis
Keith Love
Matt Margulies in memory of Chandler Kimball
Suzanne Maier
Donna Marsh
Keana McMahon in memory of Justin Strzelczyk
Jason Mocca in memory of Shannon Mocca
Phyllis Milans in memory of Noah Green
Laura Mulcahy in memory of Noah Green
Emily NC in memory of Noah Green
Evelyn O’Callaghan in memory of Warren & Connor O’Callaghan
Joan Pelly in memory of Eric Pelly
Bruce & Perri Parkman in memory Mac Parkman
Rachel Pelletier in memory of Mac Parkman
Rico Petrini
Jo Ann Poe in memory of David May
Deb Ploetz in memory of Greg Ploetz
Amber Pryzbylski in memory of Patrick Risha
Jessica Roffe
Mary Romaine
Kira Soto in memory of Ryan Hoffman
Mary Seau in memory of Junior Seau
Mandy Schall in memory of Matthew Anoa’i
Lorna Smetak
Jan Spence in memory of Siobhan Cattigan
Theodore Stachulski in memory of Patrick Risha
Shannan Stanke in memory of Greg Stanke
Charles Stein
Nickolas Szpak
Daniel Teree in memory of Chandler Kimball
Diane Tucker
Smith Waller
Amanda Walton in memory of Patrick Risha
Mason Watkins in memory of Cody Hamblin
Kelly White
Lisa Wiley
Brandi Winans in memory of Jeffrey Winans