Lori Anderson grew up with a big, traditional, football-loving family in Austin, Texas, and moved her own family to midwest Michigan. There, she did what was once unthinkable: She did not let her 13-year-old son play football.
"I feel it is my job as a parent to make those hard decisions and this was one of them," she said. "I told him that there were studies that showed that some hits injured the brain, and that I didn’t want him to possibly have problems later in life."
Most of the brains of deceased football players analyzed in a study of professional and non-professional athletes released this month found the existence of Chronic Traumatic Encephalopathy, or CTE. The disease was even found in some high school players.
While the National Football League is the professional authority on the sport, the future of American football relies on the engagement of young children. It seems revelations from CTE studies are deterring some parents from starting their children in the sport. Some, though not all, leagues say they have had declining participation rates in football. And youth organizations like Pop Warner have responded to the fears by making more concerted efforts to protect their young players with rule changes and more training for coaches.
Anderson said she sat her son down when he was 9 or 10 years old and explained to him that it wasn't going to be safe for him to play football. When he was 12, his friend was badly injured and ended up in a neck brace. That "hit home for him," Anderson said. After that, her son began looking up CTE for himself on the internet and made peace with not being allowed to play.
Over 1 million high school students played football in the 2015-16 season, according to an annual participation survey by the National Federation of State High School Associations (NFHS). But participation has steadily decreased since the 2008-09 season. The most recent report shows a 2.5 percent drop, or about 28,000 fewer players than nine years ago.
The report published July 25 by the Journal of the American Medical Association (JAMA), found that 177 of the 202 deceased football players had CTE. The disease was found in 110 of 111 brains from former NFL players; 48 of 53 college players; nine of 14 semi-professional players; seven of eight Canadian Football league players; and three of 14 high school players.
"Essentially this says it's a problem for football, it's a problem at all levels at high school and above," said the study's lead author Dr. Ann McKee, a Boston University neuroscientist. "We need to now look for ways to detect it in living people, and most importantly, to treat it in living people."
CTE is linked to repeated blows to the head, resulting in irreversible changes to the brain, including memory loss, depression and dementia. As of now, the disease has no known treatment.
Anderson's 13-year-old son is on the track team and runs for the cross country team. She said he also swims and wants to play golf next year.
"He still has the teamwork aspect, which I do feel is important to experience at his age," she said. "He is still learning about hard work and time management."
Dr. Barry Kosofsky is the chief of child neurology at Weill Cornell in New York City and director of the pediatric concussion clinic. His general rule about receiving concussions while playing sports is "three strikes, you're out." But that should not apply to children under 14, who, in his opinion, should not play tackle football in any capacity.
"Football is not safe for children to play, no," he said. "Football is bad for your brain."
While the JAMA study represents a skewed sample, Kosofsky said it still managed to make breakthroughs on CTE.
"They've shown, which no one else has shown, that you can get it at earlier ages with less football exposure," he said.
USA Football, the national governing body for amateur football, uses numbers provided in the Sports and Fitness Industry Association's Topline Participation Report for tackle and flag football, for players ages 6-17. The report’s trend since 2012 has shown a drop in enrollment by 1.7 percent, a smaller percentage decline than shown by the NFHS survey.
"The youth game is taught and played differently today than it was a few short years ago," a USA Football representative said in response to questions about the latest CTE report.
Carrie Bembry is a mother of three in Centerville, Ohio. Her youngest is 10 years old and he is passionate about football. He has played since kindergarten, she said, and she does not intend to keep her son from the sport, unless he receives another concussion.
Bembry's oldest child is 17 years old and he stopped playing football after his freshman year of high school. He was sidelined by a series of concussions that lead to noticeable cognitive difficulties. Bembry said her once-honor roll, popular son is now withdrawn, depressed and struggles in school. He has difficulty completing multi-step tasks. Doctors have correlated the recent issues to concussions.
"Of course I worry about concussions with my youngest playing football, but even with my oldest son's post-concussion problems, it is a risk that we are willing to take because he loves the game so much," Bembry said. "[But] yes, it for sure weighs heavily on my mind."
Rep. Jan Schakowsky, D-Ill., is fighting against CTE in Congress, calling for legislation to protect players. Last year, as a member of the House Committee on Energy and Commerce, she pressed a NFL spokesman to note the link between CTE and football. In a statement following Tuesday's report, she said, "The time for denying facts and looking the other way is over."
"We must now actively seek out ways to protect the health and well-being of players, from Pop Warner to the NFL and every league in between," Schakowsky said. "It is also imperative to ensure that the American people are informed about the dangers associated with playing football."
Pop Warner, a youth football program with players across the country, is one of the oldest and largest of its kind. According to spokesman Brian Heffron, enrollment has remained steady over the past five years. Their last significant drop in enrollment was from 2010-12, when "certainly the concussion issue played a role."
Heffron attributes their since-steady participation to Pop Warner's aggressive campaign for player safety, including banning kickoffs and head-on blocking, and mandating a coaching education.
"As an organization driven by player safety, we're grateful for the scientific community's focus on the issue," Heffron said. "We think there are valuable learnings in this study, but even the researchers point out that this was a narrow study."
The JAMA report is a continuation of research that began eight years ago and serves as the largest update on the study. The subjects of the study were not randomly chosen; they were submitted by players themselves or their families because of repeated concussions and/or troubling symptoms before death.
Dr. Greg Landry is a member of the American Academy of Pediatrics’ sports council, and co-authored the guidelines on concussions and return to play. The son of a football coach, Landry played from ages 11 to 22, and was a team doctor for the University of Wisconsin for 25 years.
The JAMA study, he said, leaves many questions from the "biased sample" and he believes "youth football is low risk." But "coaches and officials need to do more to help football players protect their heads," he said.
NFL spokesman Brian McCarthy said the JAMA study was "important to further advancing the science and progress related to trauma."
"As noted by the authors, there are still many unanswered questions relating to the cause, incidence and prevalence of long-term effects of head trauma such as CTE," McCarthy said. "The NFL is committed to supporting scientific research into CTE and advancing progress in the prevention and treatment of head injuries."
The NFL pledged $100 million to research on neuroscience-related topics last year, after settling a $1 billion concussion lawsuit brought forth by former players.
Christina Barrett, of Macomb, Michigan, said all the reports on CTE and the movie "Concussion" were enough to convince her that her 10-year-old son should not play football.
"No sport is worth endangering a child’s health," she said. "While sports are important, they aren’t more important than my child’s health or academics. His future successes will be dependent upon his brain, not his athletic skills."