{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:38:27Z","timestamp":1792798707317,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:00:00Z","timestamp":1729209600000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The NFL Players Association","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"https:\/\/ror.org\/03ftsw720","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Center for Advancing Translational Sciences, National Institutes of Health","award":["UL1 TR002541"],"award-info":[{"award-number":["UL1 TR002541"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007299","name":"Harvard Catalyst","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"accepted":{"date-parts":[[2024,9,26]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Career duration is often used as a metric of neurotrauma exposure in studies of elite athletes. However, as a proxy metric, career length may not accurately represent causal factors, and associations with health outcomes may be susceptible to selection effects. To date, relationships between professional American-style football (ASF) career length and postcareer health remain incompletely characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a survey-based cross-sectional cohort study of former professional ASF players. Flexible regression methods measured associations between self-reported career duration and four self-reported health conditions: pain, arthritis, mood and cognitive symptoms. We also measured associations between career duration and four self-reported ASF exposures: prior concussion signs and symptoms (CSS), performance enhancing drugs, intracareer surgeries and average snaps per game. Models were adjusted for age and race.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4189 former players (52\u00b114 years of age, 39% black, 34% lineman position), the average career length was 6.7\u00b13.9 professional seasons (range=1\u201320+). We observed inverted U-shaped relationships between career duration and outcomes (all p&lt;0.001), indicating that adverse health effects were more common among men with intermediate career durations than those with shorter or longer careers. Similar findings were observed for play-related exposures (eg, CSS and snaps).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Relationships between ASF career duration and subsequent health status are non-linear. Attenuation of the associations among longer career players may reflect selection effects and suggest career length may serve as a poor proxy for true causal factors. Findings highlight the need for cautious use of career duration as a proxy exposure metric in studies of former athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/oemed-2024-109571","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T13:20:22Z","timestamp":1729257622000},"page":"498-506","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Career duration and later-life health conditions among former professional American-style football players"],"prefix":"10.1136","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6961-0243","authenticated-orcid":false,"given":"Rachel","family":"Grashow","sequence":"first","affiliation":[{"name":"The Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can Ozan","family":"Tan","sequence":"additional","affiliation":[{"name":"RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius Dewayne","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Nova Southeastern University, Fort Lauderdale, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"DiGregorio","sequence":"additional","affiliation":[{"name":"The Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, 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Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn R","family":"Eagle","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant L","family":"Iverson","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA"},{"name":"Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA"},{"name":"Sports Concussion Program, Mass General for Children, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia 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