{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T15:43:49Z","timestamp":1784907829259,"version":"3.55.0"},"reference-count":33,"publisher":"National Athletic Trainers' Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n<jats:title>Context<\/jats:title>\n<jats:p>High school football remains a popular, physically demanding sport despite the known risks for acute brain and neck injury. Impacts to the head also raise concerns regarding their cumulative effects and long-term health consequences.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To examine the effectiveness of a helmetless-tackling training program to reduce head-impact exposure in high school football participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>A 3-year, quasi-experimental, prospective cohort study.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Setting<\/jats:title>\n<jats:p>Public and private secondary schools with varsity and junior varsity football in the Honolulu, Hawaii, (Oahu, Hawaii) area.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Patients or Other Participants<\/jats:title>\n<jats:p>A total of 496 football participants aged 14 to 18 years.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Intervention(s)<\/jats:title>\n<jats:p>Participants wore new football helmets furnished with head-impact sensor technology. Teams used a season-long (12-week) helmetless-tackling and -blocking intervention (Helmetless Tackling Training program) in years 2 and 3 consisting of a 3-phase systematic progression of 10 instructional drills.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Main Outcome Measure(s)<\/jats:title>\n<jats:p>Head impacts per athlete-exposure (ImpAEs), location of impacts, and head-impact burden per participant intervention adherence level (60% and 80%) and time (weeks).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>An overall regression analysis revealed a negative association between ImpAE and adherence (<jats:italic>P<\/jats:italic> = .003, \u03b2 = \u22121.21, SE = 0.41). In year 3, a longitudinal analysis of weekly ImpAE data showed an overall difference between the adherent and nonadherent groups (<jats:italic>P<\/jats:italic> = .04 at 80%, <jats:italic>P<\/jats:italic> = .004 at 60%), mainly due to decreases in top and side impacts. Mean cumulative impact burden was less for the adherent (n = 131; 2105.84<jats:italic>g<\/jats:italic> \u00b1 219.76<jats:italic>g<\/jats:italic>) than the nonadherent (n = 90; 3158.25<jats:italic>g<\/jats:italic> \u00b1 434.80<jats:italic>g<\/jats:italic>; <jats:italic>P<\/jats:italic> = .02) group at the 60% adherence level.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Participants adhering to the intervention on at least a 60% level experienced a 34% to 37% reduction in the number of head impacts (per exposure) through the season. These results provide additional evidence that a helmetless-tackling and -blocking training intervention (using the Helmetless Tackling Training program) reduces head-impact exposure in high school football players. Adherence to an intervention is crucial for achieving intended outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.4085\/1062-6050-0014.24","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T05:08:23Z","timestamp":1713416903000},"page":"458-467","source":"Crossref","is-referenced-by-count":1,"title":["Influence of Adherence to a Helmetless-Tackling and -Blocking Training Intervention on Head-Impact Exposure Rates in Hawaiian High School Football"],"prefix":"10.4085","volume":"60","author":[{"given":"Erik E.","family":"Swartz","sequence":"first","affiliation":[{"name":"Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay L.","family":"Myers","sequence":"additional","affiliation":[{"name":"Department of Biology, Southern New Hampshire University, Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JongSoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics, University of Massachusetts, Lowell"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Broglio","sequence":"additional","affiliation":[{"name":"School of Kinesiology, University of Michigan Concussion Center, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Furutani","sequence":"additional","affiliation":[{"name":"Hawaii Concussion Awareness and Management Program, Department of Kinesiology and Rehabilitation Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Oshiro","sequence":"additional","affiliation":[{"name":"Hawaii Concussion Awareness and Management Program, Department of Kinesiology and Rehabilitation Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard A.","family":"Gioia","sequence":"additional","affiliation":[{"name":"SCORE Program, Children\u2019s National Hospital, Departments of Pediatrics and Psychiatry, George Washington University School of Medicine, Washington, DC. Ms Meyer is now at the College of San Mateo, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darian","family":"Brothers","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, University of Hawai\u2018i, Manoa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiera D.","family":"Glodowski","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, University of Hawai\u2018i, Manoa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivet Lloansi","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, University of Hawai\u2018i, Manoa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Rehabilitation Science, University of Hawai\u2018i, Manoa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Murata","sequence":"additional","affiliation":[{"name":"College of Education, University of Hawai\u2018i, Manoa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"key":"i1938-162X-60-6-458-b01","article-title":"2021\u201322 high school athletics participation survey","author":"The National Federation of State High School Associations","unstructured":"The National Federation of State High School Associations. 2021\u201322 high school athletics participation survey. 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