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Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study



Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes.


The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes.


We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history.


Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction.


Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted.

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Contributing CARE Consortium Investigators include: April Marie (Reed) Hoy, MS, ATC (Azusa Pacific University); Joseph B. Hazzard Jr, EdD, ATC (Bloomsburg University); Louise A. Kelly, PhD (California Lutheran University); Justus D. Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian MD (Princeton University); T. Dianne Langford, PhD (Temple University); Holly J. Benjamin MD (University of Chicago); James R. Clugston, MD, MS (University of Florida); Julianne D. Schmidt, PhD, ATC (University of Georgia); Luis A. Feigenbaum, DPT, ATC (University of Miami); James T. Eckner, MD, MS (University of Michigan); Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica Dysart Miles, PhD, ATC (University of North Georgia); Scott Anderson, ATC (University of Oklahoma); Christina L. Master, MD (University of Pennsylvania); Micky Collins, PhD, and Anthony P. Kontos, PhD (University of Pittsburgh Medical Center); Sara P.O. Chrisman, MD, MPH (University of Washington); Alison Brooks, MD, MPH (University of Wisconsin-Madison); Jonathan Jackson, MD, and Gerald McGinty, DPT (United States Air Force Academy); Kenneth Cameron, PhD, MPH, ATC (United States Military Academy); Adam Susmarski, MD (United States Naval Academy); Stefan Duma, PhD and Steve Rowson, PhD (Virginia Tech); Christopher M. Miles, MD (Wake Forest University); Brian H. Dykhuizen, MS, ATC (Wilmington College); Laura Lintner DO (Winston-Salem University). The authors also thank the research and medical staff at each of the participating sites.

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Corresponding author

Correspondence to Thomas A. Buckley.

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This publication was made possible, in part, with support from the Grand Alliance CARE Consortium, funded by the National Collegiate Athletic Association and the Department of Defence. The United States Army Medical Research Acquisition Activity, Ford Detrick, MD, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).

Conflict of interest

Beyond the research grant received, in part for this work (described under funding), Jaclyn B. Caccese, Ryan M. DeWolf, Thomas W. Kaminski, Steven P. Broglio, Thomas W. McAllister, Michael McCrea, and Thomas A. Buckley have no conflicts of interest that are directly relevant to the content of this study.

Ethics approval

The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. All study procedures were reviewed by the University of Michigan Institutional Review Board, the US Army Medical Research and Materiel Command Human Research Protection Office, as well as the local institutional review board at each of the performance sites.

Consent to participate

Participants provided written informed consent prior to participation.

Data availability

The CARE Consortium datasets generated and analyzed during the current study will be available in the Federal Interagency Traumatic Brain Injury Research repository ( by the end of 2019.

Additional information

This article is part of a Topical Collection on The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium.

The members of the ‘CARE Consortium Investigators’ are listed in the Acknowledgements section.

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Caccese, J.B., DeWolf, R.M., Kaminski, T.W. et al. Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study. Sports Med 49, 477–487 (2019).

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