An institutional examination of U.S. adults’ willingness to allow teenage boys to play tackle football

Abstract

Background: Despite the well-documented mental, physical, and emotional benefits of youth sports and physical activity, participation continues to fall below recommended public health guidelines in the United States (U.S.). This complex public health challenge continues to worsen, with disparities between segments of the population, yet little is known about the institutional factors associated with sport participation. To address this knowledge gap, institutional theory was used as a guiding framework to test the association of societal-level factors such as state high school football participation rates and state concussion law comprehensiveness on adults’ willingness to allow teenage boys to play American tackle football, over and above individual-level demographic and football-specific factors. Methods: This was a cross-sectional comparative data analysis with data obtained from an internet-based survey of a nationally representative sample of U.S. adults aged 18 to 93 years (N=1,018). The dependent variable was willingness of U.S. adults to let teenage boys play tackle football. Comprehensiveness of state concussion legislation, high school football participation rates for each state, and sex, age, education, race/ethnicity, and household income were included in the analysis. We used multilevel (hierarchical) linear regression to examine the influence of institutional pressures, over and above the individuallevel factors, on adults’ willingness to allow teenagers to play tackle football, while accounting for state-level clustering effects. Results: Our analyses revealed that state high school football participation rate was significantly associated with adults’ willingness to allow tackle football participation (β Est = 2.46; SE = 0.99; p = 0.013), over and above multiple individual-level factors. There was no effect of state concussion legislation comprehensiveness (Est = -.002; SE = .009; p = .79). Conclusions: Results indicate that initiatives and interventions aimed to increase tackle football participation may be more effective in states with stronger normative support for high school football participation, rather than as a broad national public health initiative.