Yes, this is another NFL post (after yesterday's post). And before we get to the post: Yes, I will be cheering for the Atlanta Falcons tomorrow, since a Falcons win is the only way for my Panthers to make the playoffs, after they lost to the Buccaneers today. With that out of the way, onto business: player safety in the NFL.
Concussions have become big news in contact sports over the last decade or so. Long-time fans will be sure to have noticed that more players are being substituted out of games, or missing games entirely, due to concussions, than was the case in the past. The concern about concussions is due to their implication in Chronic Traumatic Encephalopathy (CTE), which is linked to behavioural problems, mood swings, and cognitive issues, which all look very similar to dementia.
The NFL has been the target of a lot of attention, and has taken action. One change that was implemented was to introduce 'unaffiliated neurotrauma consultants' to make in-game decisions about whether players should be kept out of a game after an on-field concussion (although that change has not been without controversy). Another change was the introduction of the Guardian Cap, which is a soft shell that attaches over an existing helmet and is supposed to reduce the force of impacts to the head. Do Guardian Caps work though? Guardian, the makers of the cap, is itself cautious on that point:
Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests. Guardian has always stood by the fact that Guardian Caps reduce the impact of hits and that its use should be one piece of the puzzle to an overall safety strategy.
That shouldn't dissuade researchers from looking into the impact on concussions, and it hasn't. This new article by Kerianne Lawson Rubenstein (Syracuse University) and Todd Nesbit (Ball State University), published in the Southern Economic Journal (open access), looks into whether the introduction of the Guardian Caps was associated with a reduction in concussions in the NFL.
Before you conclude that it is self-evident that a padded helmet that reduces head impacts must reduce concussions, we need to discuss the 'Peltzman effect'. In a famous paper in the 1970s, Sam Peltzman (University of Chicago) showed that mandatory safety devices on cars, such as seat belts, do not reduce traffic deaths, and actually increase the number of non-fatal car accidents. This 'Peltzman effect' is otherwise known as 'offsetting behaviour', where a policy makes an activity less risky, but results in more of the now-less-risky behaviour. One example of this in sports was that when new driver safety devices were installed in race cars in NASCAR, drivers responded by driving more recklessly, increasing the number of crashes.
Rubenstein and Nesbit test for a Peltzman effect of the Guardian Caps. They hypothesise that:
...wearing the Guardian Caps incentivizes riskier tackling due to the perceived safety from wearing the Cap. Players may not accurately calculate the risk of a helmet-to-helmet hit if they place a lot of faith in the Cap's ability to absorb the shock. And if the players only wear the Caps in practice and not during games, they may actually end up hitting harder and protecting themselves less when falling to the ground in games without the Caps because of their practiced behavior.
In other words, even if the Guardian Caps work as intended and make each impact less dangerous, players may respond by taking more risks, leading to more hits, harder hits, or less care in avoiding hits. This would be the unintended consequence of using the Guardian Caps.
The NFL mandated the use of the Guardian Cap in contact practice sessions through to the second preseason game in 2022, for all linemen, linebackers, and tight ends. This was extended to all contact practice through the entire season in 2023, as well as including running backs and fullbacks. In 2024, this was extended again, by including wide receivers and defensive backs, and by allowing (but not mandating) players to wear the Guardian Cap during games (although, from my viewing, very few players play while wearing a Guardian Cap).
Rubenstein and Nesbit use data from the 2021/22 to 2023/24 NFL seasons, and a difference-in-differences research design. This basically involves calculating: (1) the difference in concussion prevalence between players in positions with the mandate and players in positions without the mandate before it was introduced; and (2) the same difference after the mandate was introduced; and then testing whether the difference in those two differences is statistically significant. Rubenstein and Nesbit rely on data from weekly injury reports, and their unit of observation is the injured player. Essentially this analysis answers the question whether, for a given injured player, were they more likely to be injured by a concussion when the Guardian Cap was mandated for their position than when it was not?
In their main analysis, Rubenstein and Nesbit find:
... a consistently positive and significant relationship between players that were mandated to wear Guardian Caps after the mandate took place and concussions. This suggests that relative to before the mandate, concussions after the mandate were more likely for players in the position groups affected by the mandate when looking at the total number of injuries across the NFL.
The size of the effect is small but nevertheless meaningful - a given injured player is about 2.6 percentage points more likely to have been injured by a concussion with the Guardian Cap mandate in place, than without it. However, there is a problem here. The question they are answering isn't the question we really want to answer. An injury report might be more likely to be a concussion if there are more concussions, or if there are fewer injuries of other types. In other words, the share of injuries that are concussions can go up either because concussions are more common, or because other injuries are less common, even if concussions themselves haven't changed much. Rubenstein and Nesbit partially allay this concern by showing that there are no effects on either knee injuries or ankle injuries. However, despite being statistically insignificant, the point estimate on knee injuries is negative and of the same magnitude as the positive effect on concussion injuries. So, the effect they observe with their main analysis could be driven by there being fewer knee injuries, and not more concussions.
Fortunately, Rubenstein and Nesbit then go on to look at the count of concussions in each game, comparing players in positions mandated to wear the Guardian Cap and players in positions who were not mandated. In this analysis, they find that:
The coefficient on our variable of interest is consistently positive and statistically significant, suggesting that the prevalence of concussions among players that were mandated to wear the Guardian Caps increased compared to other players after the mandate went into effect. The magnitude of our coefficients suggests about 0.07 more concussions per game for the treated group of positions on a team relative to the untreated group of positions on the team. This may seem small, but considering the observation is per team and per week, our estimates suggest there were about 36 more concussions per NFL season across all linemen, linebackers, tight ends, full backs, and running backs required to wear Guardian Caps than in the season before the mandate.
So, it does appear from the analyses that there was an unintended consequence of mandating the Guardian Caps. The number of reported concussion injuries increased. But not so fast! Remember that the mandate was introduced during a period of increasing scrutiny of head injuries in the NFL. The introduction of the Guardian Caps was not the only change during this period. The NFL changed its concussion protocols during the 2022 season (see also this note by the NFL Players Association). So, an increase in concussions noted on injury reports might be because of a genuine increase in concussion injuries, or it might be because of an increase in the reporting of concussions. Because the concussion protocols changed during the same period, it’s hard to know what concussion reports would have looked like in the absence of the Guardian Cap mandate. Overall, that means that it's very hard to separate a true increase in concussions from increased reporting.
So, we can't conclude from this research that there was a Peltzman effect of mandating the Guardian Caps. It remains a possibility, but we would need better research in order to identify any such effect.
[HT: Marginal Revolution]
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