{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:56:10Z","timestamp":1793138170109,"version":"4.5.0"},"reference-count":43,"publisher":"National Athletic Trainers' Association","issue":"11-12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>Flag football is promoted as a safer alternative to tackle football. This may be 1 reason why participation rates have risen by 39% over the past 3 years. Despite rising participation, epidemiologic research on sport-specific injuries and associated relative risk is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To prospectively document the epidemiology of injuries in youth flag football.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Descriptive epidemiology study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Regional and national youth flag football tournaments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients or Other Participants<\/jats:title><jats:p>Athletes (N = 1939; 1744 boys and 195 girls), ages 6 to 12 years. An athletic trainer prospectively monitored the athletes for sport-related injury and exposures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>Athlete risks of injury and injury rates were calculated overall and by sex. Injury characteristics were reported for the total population and by sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty-seven injuries to unique individuals were recorded in 1939 athletes with a total of 9228 athlete-exposures (AEs). The overall risk of injury was 2.4% (95% CI = 1.79%, 3.21%), with an overall injury rate of 5.1 per 1000 AEs (95% CI = 3.75, 6.77). Of the 47 injuries, 36 occurred in boys (8365 AEs), and 11 occurred in girls (863 AEs). A higher risk in girls was evidenced by both the injury risk ratio (2.73; 95% CI = 1.41, 5.30) and injury rate ratio of 2.96 (95% CI = 1.51, 5.82). The most common injury sites were the head\/face\/neck (n = 15, 31.9%), followed by the ankle\/foot (n = 9, 19.1%). The most frequent types of injury were contusion (55.3%), sprain\/subluxation (14.9%), and general trauma (10.6%); 74.5% of all injuries resulted from direct impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the competition injury rate for youth flag football was lower than the values from studies reporting comparable tackle football data, the frequencies by body part, type, and mechanism were similar. Given that most injuries were related to some form of impact and predominantly contusions, adopting minimal protective equipment or padding may reduce the numbers of these injuries.<\/jats:p><\/jats:sec>","DOI":"10.4085\/1062-6050-0427.22","type":"journal-article","created":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T16:47:50Z","timestamp":1687538870000},"page":"1004-1009","source":"Crossref","is-referenced-by-count":6,"title":["Descriptive Epidemiology of Game-Related Youth Flag Football Injuries"],"prefix":"10.4085","volume":"58","author":[{"given":"Kim Daneen Barber","family":"Foss","sequence":"first","affiliation":[{"name":"*Emory University, Flowery Branch, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane C.","family":"Khoury","sequence":"additional","affiliation":[{"name":"\u2020Cincinnati Childrens Hospital Medical Center University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey C.","family":"Eisenmann","sequence":"additional","affiliation":[{"name":"\u2021Carnegie School of Sports, Leeds Beckett University, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Cappaert","sequence":"additional","affiliation":[{"name":"\u00a7Rocky Mountain University of Health Professions, Provo, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","published-online":{"date-parts":[[2023,12,18]]},"reference":[{"key":"2023121723525415700_i1062-6050-58-11-1004-b01","unstructured":"State of play 2017: trends and developments. Aspen Institute. Published December 10, 2017. Accessed September 8, 2023. https:\/\/www.aspeninstitute.org\/publications\/state-of-play-2017-trends-and-developments\/"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b02","unstructured":"2019 SFIA topline participation report. Association SFI. Updated 2019. Accessed December 1, 2021. https:\/\/sfia.org\/"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b03","unstructured":"Drape J , BelsonK. The future of football has flags. The New York Times. Published November 20, 2018. Accessed October 21, 2019. https:\/\/www.nytimes.com\/2018\/11\/20\/sports\/football\/flag-football-nfl.html"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b04","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/bs.pmbts.2015.07.019","article-title":"Exercise as a polypill for chronic diseases","volume":"135","author":"Pareja-Galeano","year":"2015","journal-title":"Prog Molec Biol Transl Sci"},{"issue":"(5)","key":"2023121723525415700_i1062-6050-58-11-1004-b05","first-page":"330","article-title":"Exercise is the real polypill","volume":"28","author":"Fiuza-Luces","year":"2013","journal-title":"Physiology (Bethesda)"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b06","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1186\/1471-2458-13-1100","article-title":"Fit in 50 years: participation in high school sports best predicts one\u2019s physical activity after age 70","volume":"13","author":"Dohle","year":"2013","journal-title":"BMC Public Health"},{"issue":"(20)","key":"2023121723525415700_i1062-6050-58-11-1004-b07","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1136\/bjsports-2016-096833","article-title":"\u2018Don\u2019t let kids play football\u2019: a killer idea","volume":"51","author":"MacDonald","year":"2017","journal-title":"Br J Sports Med"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b08","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1249\/JSR.0b013e31825da961","article-title":"Exercise deficit disorder in youth: play now or pay later","volume":"11","author":"Faigenbaum","year":"2012","journal-title":"Curr Sports Med Rep"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b09","doi-asserted-by":"crossref","first-page":"924945","DOI":"10.4061\/2011\/924945","article-title":"Physical inactivity and mortality risk","volume":"2011","author":"Kokkinos","year":"2011","journal-title":"Cardiol Res Pract"},{"issue":"(6)","key":"2023121723525415700_i1062-6050-58-11-1004-b10","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1007\/s40279-021-01609-4","article-title":"Head games: a systematic review and meta-analysis examining concussion and head impact incidence rates, modifiable risk factors, and prevention strategies in youth tackle football","volume":"52","author":"Pankow","year":"2022","journal-title":"Sports Med"},{"issue":"(8)","key":"2023121723525415700_i1062-6050-58-11-1004-b11","doi-asserted-by":"crossref","first-page":"e1002103","DOI":"10.1371\/journal.pmed.1002103","article-title":"Long-term outcomes associated with traumatic brain injury in childhood and adolescence: a nationwide Swedish cohort study of a wide range of medical and social outcomes","volume":"13","author":"Sariaslan","year":"2016","journal-title":"PLoS Med"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1477-7525-12-26","article-title":"Physical and psychological long-term outcome after traumatic brain injury in children and adult patients","volume":"12","author":"Andruszkow","year":"2014","journal-title":"Health Qual Life Outcomes"},{"issue":"(6)","key":"2023121723525415700_i1062-6050-58-11-1004-b13","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1097\/JSM.0000000000000753","article-title":"Relative head impact exposure and brain white matter alterations after a single season of competitive football: a pilot comparison of youth versus high school football","volume":"29","author":"Barber Foss","year":"2019","journal-title":"Clin J Sport Med"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b14","first-page":"230","article-title":"Parents\u2019 intentions to allow youth football participation: perceived concussion risk and the theory of planned behavior","volume":"6","author":"Murphy","year":"2017","journal-title":"Sport Exerc Perform Psychol"},{"issue":"(24)","key":"2023121723525415700_i1062-6050-58-11-1004-b15","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1136\/bjsports-2016-096508","article-title":"Sports concussion research, chronic traumatic encephalopathy and the media: repairing the disconnect","volume":"51","author":"Kuhn","year":"2017","journal-title":"Br J Sports Med"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b16","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1542\/peds.2008-0080","article-title":"Medical conditions affecting sports participation","volume":"121","author":"Rice","year":"2008","journal-title":"Pediatrics"},{"issue":"(2)","key":"2023121723525415700_i1062-6050-58-11-1004-b17","doi-asserted-by":"crossref","first-page":"2325967116686784","DOI":"10.1177\/2325967116686784","article-title":"Youth football injuries: a prospective cohort","volume":"5","author":"Peterson","year":"2017","journal-title":"Orthop J Sports Med"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b18","unstructured":"Dean AG , SullivanKM, SoeMM. OpenEpi: open source epidemiologic statistics for public health. Updated April 6, 2013. Accessed March 1, 2022. www.OpenEpi.com"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40621-018-0152-0","article-title":"Characteristics of sports and recreation-related emergency department visits among school-age children and youth in North Carolina, 2010\u20132014","volume":"5","author":"Harmon","year":"2018","journal-title":"Inj Epidemiol"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b20","doi-asserted-by":"crossref","first-page":"2325967120975402","DOI":"10.1177\/2325967120975402","article-title":"Emergency department visits from 2014 to 2018 for head injuries in youth non-tackle football compared with other sports","volume":"9","author":"Zendler","year":"2021","journal-title":"Orthop J Sports Med"},{"issue":"(6)","key":"2023121723525415700_i1062-6050-58-11-1004-b21","doi-asserted-by":"crossref","first-page":"645","DOI":"10.4085\/1062-6050-44.6.645","article-title":"A comparison of high school sports injury surveillance data reporting by certified athletic trainers and coaches","volume":"44","author":"Yard","year":"2009","journal-title":"J Athl Train"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b22","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1542\/peds.110.3.e28","article-title":"Survey of the injury rate for children in community sports","volume":"110","author":"Radelet","year":"2002","journal-title":"Pediatrics"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b23","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1177\/0363546518825361","article-title":"The epidemiology of injuries in middle school football, 2015\u20132017: the Advancing Healthcare Initiatives for Underserved Students Project","volume":"47","author":"Kerr","year":"2019","journal-title":"Am J Sports Med"},{"issue":"(8)","key":"2023121723525415700_i1062-6050-58-11-1004-b24","doi-asserted-by":"crossref","first-page":"2325967116662251","DOI":"10.1177\/2325967116662251","article-title":"Anthropometrics, physical performance, and injury characteristics of youth American football","volume":"4","author":"Caswell","year":"2016","journal-title":"Orthop J Sports Med"},{"issue":"(2)","key":"2023121723525415700_i1062-6050-58-11-1004-b25","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1177\/03635465030310022001","article-title":"Risk factors for injury in middle school football players","volume":"31","author":"Turbeville","year":"2003","journal-title":"Am J Sports Med"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b26","first-page":"395","article-title":"Time-loss and non-time-loss injuries in youth football players","volume":"42","author":"Dompier","year":"2007","journal-title":"J Athl Train"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b27","doi-asserted-by":"crossref","first-page":"317","DOI":"10.4065\/77.4.317","article-title":"Injuries in youth football: a prospective observational cohort analysis among players aged 9 to 13 years","volume":"77","author":"Stuart","year":"2002","journal-title":"Mayo Clin Proc"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b28","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1001\/archpediatrics.2007.1","article-title":"Injuries sustained by high school rugby players in the United States, 2005\u20132006","volume":"162","author":"Collins","year":"2008","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b29","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/00913847.2017.1355209","article-title":"Epidemiology of injuries in men\u2019s lacrosse: injury prevention implications for competition level, type of play, and player position","volume":"45","author":"Barber Foss","year":"2017","journal-title":"Phys Sportsmed"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b30","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/JSM.0000000000000458","article-title":"Epidemiology of injuries in women\u2019s lacrosse: implications for sport-, level-, and sex-specific injury prevention strategies","volume":"28","author":"Barber Foss","year":"2018","journal-title":"Clin J Sport Med"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b31","first-page":"277","article-title":"Injury patterns in selected high school sports: a review of the 1995\u20131997 seasons","volume":"34","author":"Powell","year":"1999","journal-title":"J Athl Train"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b32","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/03635465000280031801","article-title":"Sex-related injury patterns among selected high school sports","volume":"28","author":"Powell","year":"2000","journal-title":"Am J Sports Med"},{"issue":"(4)","key":"2023121723525415700_i1062-6050-58-11-1004-b33","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1080\/00913847.2021.1931980","article-title":"Epidemiology of youth and high school American football-related injuries presenting to United States emergency departments: 2010\u20132019","volume":"50","author":"Hoge","year":"2022","journal-title":"Phys Sportsmed"},{"issue":"(9)","key":"2023121723525415700_i1062-6050-58-11-1004-b34","first-page":"2325967115603979","article-title":"Injury rates in age-only versus age-and-weight playing standard conditions in American youth football","volume":"3","author":"Kerr","year":"2015"},{"issue":"(6)","key":"2023121723525415700_i1062-6050-58-11-1004-b35","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1007\/s00167-014-3266-0","article-title":"Injuries can be prevented in contact flag football!","volume":"24","author":"Kaplan","year":"2016","journal-title":"Sports Traumatol Arthrosc"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s00167-012-2335-5","article-title":"The prevention of injuries in contact flag football","volume":"22","author":"Kaplan","year":"2014","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b37","unstructured":"Flag football equipment. NFL FLAG. Accessed April 4, 2022. https:\/\/nflflag.com\/flag-football-rules\/flag-football-equipment"},{"issue":"(1)","key":"2023121723525415700_i1062-6050-58-11-1004-b38","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/JSM.0b013e3182694870","article-title":"The epidemiology of injuries in contact flag football","volume":"23","author":"Kaplan","year":"2013","journal-title":"Clin J Sport Med"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b39","unstructured":"USA Football tackling systems. USA Football website. Accessed May 2, 2022. https:\/\/usafootball.com\/development-training\/tackling-systems\/"},{"key":"2023121723525415700_i1062-6050-58-11-1004-b40","unstructured":"NFL Way To Play. NFL Football operations. Accessed May 2, 2022. https:\/\/operations.nfl.com\/inside-football-ops\/nfl-way-to-play\/nfl-way-to-play\/"},{"issue":"(5)","key":"2023121723525415700_i1062-6050-58-11-1004-b41","doi-asserted-by":"crossref","first-page":"2325967116648441","DOI":"10.1177\/2325967116648441","article-title":"Comparison of Indiana high school football injury rates by inclusion of the USA Football \u201cHeads Up Football\u201d player safety coach","volume":"4","author":"Kerr","year":"2016","journal-title":"Orthop J Sports Med"},{"issue":"(7)","key":"2023121723525415700_i1062-6050-58-11-1004-b42","doi-asserted-by":"crossref","first-page":"2325967115594578","DOI":"10.1177\/2325967115594578","article-title":"Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football","volume":"3","author":"Kerr","year":"2015","journal-title":"Orthop J Sports Med"},{"issue":"(3)","key":"2023121723525415700_i1062-6050-58-11-1004-b43","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/00042752-200605000-00005","article-title":"Incidence and player risk factors for injury in youth football","volume":"16","author":"Malina","year":"2006","journal-title":"Clin J Sport Med"}],"container-title":["Journal of Athletic Training"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/58\/11-12\/1004\/3301179\/i1062-6050-58-11-1004.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/58\/11-12\/1004\/3301179\/i1062-6050-58-11-1004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T19:01:40Z","timestamp":1749668500000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/58\/11-12\/article-p1004.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":43,"journal-issue":{"issue":"11-12","published-online":{"date-parts":[[2023,12,18]]},"published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-0427.22","relation":{},"ISSN":["1938-162X","1062-6050"],"issn-type":[{"value":"1938-162X","type":"electronic"},{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}