Declines in Youth Football Predate Damar Hamlin's Collapse. Will They Continue?

Experts have posited that Hamlin’s cardiac arrest could have been an instance of commotio cordis, a phenomenon in which a blunt-force impact disrupts the heart’s rhythm. Though this type of cardiac episode is rare, the injury drew into sharp focus the severity of risks associated with the most popular professional sport in the country, reigniting a debate around the merits of the sport itself, including at the youth level.

Player safety in football has been a topic of debate for years, but high school participation in 11-player tackle football was trending upward in the 21st century until the 2009-10 academic year, when enrollment began to wane, according to data from the National Federation of State High School Associations’ High School Athletics Participation Survey.

The shift corresponded with heightened public discourse in 2009 regarding head injuries among former professional football players, which included a congressional hearing featuring NFL Commissioner Roger Goodell in front of the House Judiciary Committee and ensuing adjustments to the league’s rules.

The latest survey release from the NFHS – the first since 2018-19 – shows that the 2021-22 school year was the first on record with fewer than a million players participating in 11-player high school football in America since the turn of the century. The reported total of 976,886 participants represents a 12.2% decrease from a 2008-09 peak.

High school football remains popular, and is especially so in the South and Midwest. Mississippi’s 76.6 players per 10,000 residents are the most of any state, followed by Alabama (59.2) and Texas (56.4). States on both coasts tend to have lower participation rates, including New York and its mark of 13.2 per 10,000 residents – the lowest statewide rate in the nation.

As 11-player tackle football participation has decreased, participation on smaller teams has increased. In 2021-22, around 8,500 more high schoolers played on teams of either six, eight or nine players than in 2008-09.

Yet according to the Aspen Institute’s Project Play, younger ages have seen an even steeper decline in tackle football participation than at the 11-player high school level. Based on data from the Sports & Fitness Industry Association, the institute’s State of Play report shows that from 2020 to 2021, participation in tackle football for kids ages 6 to 12 declined nearly 18%. Since 2016, the institute says, tackle football participation rates for this age group have decreased 29% while flag football rates have gone up 15%, with flag football players exceeding tackle football players by more than 300,000 youth in 2021. (Among 13- to 17-year-olds, regular tackle football participation ticked up from 6.8% to 6.9% from 2020 to 2021, but was down from 7% in 2019, according to the State of Play report.)

Though cardiac health has been of increased concern at the professional level, much of the concern over both amateur and professional football player safety surrounds head injuries. A study published in 2018 by The Journal of Pediatrics identified a concussion incidence rate of 5.1% per season among youth football participants ages 5 to 14, with half of players who suffered concussions still symptomatic three weeks later.

In 2017, a Boston University study found that 110 of 111 former NFL players – and 87% of 202 former football players across levels up to the NFL – were diagnosable for chronic traumatic encephalopathy, a condition of brain degeneration often observed in people with a history of repeated head trauma.

The decrease in full-team tackle football at the high school level appears to have fueled recent diminished involvement in high school athletics overall. The National Federation of State High School Associations reported around 7.6 million participants across various types of sports in 2021-22, down 4% from 2018-19. That drop may be tied to the continued impact of the COVID-19 pandemic, and followed a 0.5% decrease between 2017-2018 and 2018-2019 that was the first decline in participation in three decades.

School-based sports aren’t the only venue for athletic participation: Club teams, for example, can offer high-level competition and perks like travel. Notably, however, the Department of Health and Human Services identified increasing the proportion of children and adolescents who play sports as a physical activity objective in the government’s Healthy People 2030 initiative, linking physical activity to cardiovascular health, blood pressure, cholesterol and obesity. Based on a decline in pre-pandemic federal survey data, the department lists the status of the objective as “getting worse.”

The tensions between keeping kids healthy and keeping them safe while playing one of the nation's most popular sports are unlikely to be resolved anytime soon, even as the data points to dwindling youth participation on the traditional gridiron.