Ayana Ray OMS-II, Haelyn Lahens MPH OMS-II, Jackson Carter OMS-II, Jake Engelbrecht OMS-II, Sydney Rymes OMS-II, Michael Hamper MS OMS-II
Roughly 1.1 million U.S. high schoolers play tackle football each year, and repetitive head impacts in the sport have been linked to cognitive decline later in life. Greater exposure is associated with worse executive function. This review examined whether participation in high school tackle football specifically, distinct from higher levels of play, is associated with adverse mental health and cognitive outcomes in adulthood.
This review synthesized published studies of U.S. adult males exposed to high school tackle football, drawn from nationally representative samples, regional cohorts, and clinic- or registry-based samples of former athletes. Where possible, we limited inclusion to participants whose exposure ended at the high school level. Studies that also included play beyond high school, or that examined age of first exposure, were retained because they address hypotheses relevant to youth exposure, but they are flagged as differing samples rather than treated as equivalent evidence.
Across the included studies, no statistically significant association was found between adolescent football participation and later cognitive performance, depression scores, or anxiety symptoms. Age of first exposure was likewise not significantly related to neurocognitive measures. In contrast, studies of collegiate and professional players show a dose-response relationship, with more cumulative years of exposure and higher levels of play linked to greater cognitive impairment and psychological symptoms.
These findings suggest that high school football alone is not clearly associated with later depression, anxiety, or cognitive decline, even though greater cumulative exposure at higher levels is. Because the evidence is observational and may be underpowered to detect small effects, a causal relationship cannot be established, and the absence of significant findings should not be read as proof of no risk. Future research should use longitudinal designs, draw samples from multiple states, and include both players and non-players to control for confounders such as position, demographics, and body size. Such work could help identify young athletes at higher risk and guide appropriate healthcare access.