Association Between Community Socioeconomic Characteristics and Access to Youth Flag Football

Inj Prev. 2019 Aug;25(4):278-282. doi: 10.1136/injuryprev-2017-042677. Epub 2018 Jan 12.


Background: The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents.

Methods: In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics.

Results: In both states, communities with more educated residents were more likely to offer flag football for youth aged 6-12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001).

Conclusion: These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.

Keywords: concussion; health disparities; public health; recreation / sports; socioeconomic status; sports / leisure facility.

MeSH terms

  • Access to Information
  • Adolescent
  • Athletic Injuries / epidemiology
  • Athletic Injuries / prevention & control*
  • Brain Concussion / epidemiology
  • Brain Concussion / prevention & control*
  • Brain Injuries, Traumatic / epidemiology
  • Brain Injuries, Traumatic / prevention & control*
  • Child
  • Female
  • Football / classification*
  • Football / injuries
  • Health Knowledge, Attitudes, Practice
  • Health Status Disparities
  • Humans
  • Male
  • Socioeconomic Factors
  • United States / epidemiology
  • Youth Sports / classification*
  • Youth Sports / injuries