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This study examined a larger, more representative sample of former professional American football players to assess associations between AFE before age 12 (AFE\u2009&lt;\u200912) and clinical outcomes compared with those who started at age 12 or older (AFE 12\u2009+).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Former professional American football players who completed a questionnaire were dichotomized into AFE\u2009&lt;\u200912 and AFE 12\u2009+\u2009. AFE groups were compared on outcomes including symptoms of depression and anxiety, perceived cognitive difficulties, neurobehavioral dysregulation, and self-reported health conditions (e.g., headaches, sleep apnea, hypertension, chronic pain, memory loss, dementia\/Alzheimer\u2019s disease, and others).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 4189 former professional football players (aged 52\u2009\u00b1\u200914\u00a0years, 39% self-reported as Black), univariable associations with negligible effect sizes were seen with AFE\u2009&lt;\u200912, depressive symptoms (<jats:italic>p<\/jats:italic>\u2009=\u20090.03; <jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.001), and anxiety-related symptoms (<jats:italic>p<\/jats:italic>\u2009=\u20090.02; <jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.001) only. Multivariable models adjusting for age, race, body mass index, playing position, number of professional seasons, and past concussion burden revealed no significant relationships between AFE\u2009&lt;\u200912 and any outcome. Linear and non-linear models examining AFE as a continuous variable showed similar null results.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In a large cohort of former professional American-style football players, AFE was not independently associated with adverse later life outcomes. These findings are inconsistent with smaller studies of former professional football players. Studies examining AFE in professional football players may have limited utility and generalizability regarding policy implications for youth sports.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40279-024-02062-9","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T02:01:27Z","timestamp":1719367287000},"page":"2675-2684","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Age of First Exposure Does Not Relate to Post-Career Health in Former Professional American-Style Football Players"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1707-3225","authenticated-orcid":false,"given":"Douglas P.","family":"Terry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Grashow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant L.","family":"Iverson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Atkeson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Rotem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn R.","family":"Eagle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Daneshvar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross D.","family":"Zafonte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Weisskopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Baggish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"2062_CR1","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1212\/WNL.0000000000001358","volume":"84","author":"JM Stamm","year":"2015","unstructured":"Stamm JM, Bourlas AP, Baugh CM, Fritts NG, Daneshvar DH, Martin BM, et al. 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The NFL Players Association did not contribute to the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This work received support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Douglas Terry, PhD, serves as a scientific advisor for HitIQ. He previously consulted for REACT Neuro, Inc. He receives research funding from Football Research, Inc. and Amgen Inc. He has a consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including former athletes). Dr. Grashow received grant funding from the NFL Players Association. Dr. Iverson has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including former athletes). He has received past research support or funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He receives royalties from the sales of one neuropsychological test (WCST-64). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He has received research funding from the Wounded Warrior Project\u2122. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, the National Rugby League, Boston Bolts, and the Schoen Adams Research Institute at Spaulding Rehabilitation. Scott Zuckerman, MD, MPH, is a member of the NFL Head, Neck, and Spine Committee. Dr. Zafonte reported receiving royalties from Springer\/Demos publishing for serving as coeditor of the text Brain Injury Medicine; serving on the scientific advisory board of Myomo Inc, and onecare.ai Inc; evaluating patients in the Massachusetts General Hospital Brain and Body\u2013TRUST Program, which is funded by the NFL Players Association; and receiving grants from the NIH. Dr. Baggish has received funding from the National Institute of Health\/National Heart, Lung, and Blood Institute, the National Football Players Association, and the American Heart Association and receives compensation for his role as team cardiologist from the US Olympic Committee\/US Olympic Training Centers, US Soccer, US Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. Dr. Daneshvar serves as a medical advisor and options holder for StataDx and provides expert testimony for cases involving TBI and spinal cord injury. None of the other authors had any competing interests to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"This study has been approved by the Institutional Review Board at the Harvard T.H. Chan School of Public Health, protocol number IRB18-1365.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Informed consent was provided by each participant.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Participants provided consent to publish study data.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Due to the high profile nature of the participants in this study, data are not available at this time.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Material"}},{"value":"D.P.T., R.G., S.R.E., and S.L.Z. contributed to study proposal development. R.G., P.A., and R.R. contributed to data collection and analyses. D.P.T., R.G., A.B., and G.L.I. contributed to writing the majority of the manuscript. D.H.D., R.D.Z., M.G.W., and A.B. led acquisition of funding and oversight of the larger research initiative. All authors critically reviewed the manuscript for submission.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author Contributions"}}]}}