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Five international consensus statements on concussion in sports have been published. This commentary argues that there is a strong need for a new approach to them that foregrounds public health expertise and patient-centered guidance. Doing so will help players, parents and practitioners keep perspective about these potentially life-altering injuries especially when they recur.

After World War II, organized tackle football programs for boys younger than high school age grew enormously in popularity in the United States, prompting concerns from pediatricians and educators about the sport's physical and emotional health effects. At the same time, sports medicine was emerging as a sub-specialty. Examining how American sports medicine doctors and football coaches established their professional authority on youth football safety in the 1950s and 1960s reveals how their justifications for this collision sport were connected to broader cultural trends. Doctors and coaches, who were virtually all men, emphasized their firsthand knowledge of an all-male sport that was widely promoted as a means of teaching boys to become men. They insisted that proper supervision and equipment were sufficient to protect young athletes. Their arguments for youth football's benefits were based on the belief that men best knew how to impart desired values such as loyalty, patriotism and discipline to boys. In framing football's health risks as manageable with adult supervision, coaches and sports medicine doctors played a crucial role in promoting the vision of American manhood associated with tackle football., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Competing Interests: Competing interests: None declared.

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates., (© 2014 American Society of Law, Medicine & Ethics, Inc.)

Campaigns to limit tobacco use started in the 1970s and have led to bans on public smoking, which have been extended to parks and beaches. A review of state and local statutes shows that during 1993-2011, smoking was banned in 843 parks and on 150 beaches across the United States. Three justifications for these restrictions have been invoked: the risk of passive smoke to nonsmokers, the pollution caused by cigarette butts, and the long-term risks to children from seeing smoking in public. Our analysis of the evidence for these claims found it far from definitive and in some cases weak. What, then, accounts for the efforts to impose such bans? We conclude that the impetus is the imperative to denormalize smoking as part of a broader public health campaign to reduce tobacco-related illness and death. Although invoking limited evidence may prove effective in the short run, it is hazardous for public health policy makers, for whom public trust is essential.

Introduction: The purpose of this research is to describe the leading circumstances of military vehicle crashes to guide prioritization and implementation of crash avoidance and/or warning technologies., Methods: A descriptive study using narrative text analysis on 3,944 military vehicle crash narratives. Crash data on drivers, from 2001 to 2006, were assembled from the U.S. Army Combat Readiness/Safety Center. Reviewers collected information on the circumstances of crashes and determined if vehicle technology could have prevented the crash., Results: Nearly 98% of the crashes were nonfatal; 63% occurred in the U.S. and 24% in Iraq. Among crash events where the direction of the impact was recorded, 32% were to the front of the vehicle and 16% involved a vehicle being rear-ended. Rollovers were mentioned in 20% of the narratives. Technology was determined to have the potential to prevent 26% of the crashes, with the forward collision warning system, rear end collision avoidance, emergency brake assistance, and rollover stability control system likely to have the greatest impacts., Conclusions: Some technologies available for civilian vehicles may prevent certain military crash circumstances., Impact on Industry: The results of this research are significant in light of ongoing global military operations that rely on military vehicles. Improving the preventive technology featured on military vehicles may be an effective strategy to reduce the occurrence of military crashes., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Ice hockey and motorcycle riding are increasingly popular activities in the United States that are associated with high risks of head and facial injuries. In both, effective head and facial protective equipment are available. Yet the debates about safety policies regarding the use of head protection in these activities have taken different forms, in terms of the influence of epidemiological data as well as of the ethical concerns raised. I examine these debates over injury prevention in the context of leisure activities, in which the public health duty to prevent avoidable harm must be balanced with the freedom to assume voluntary risks.

Objective: Suicides among active duty US Army personnel have been increasing since 2004, surpassing comparable civilian rates in 2008. This analysis uses US military data to assess suicide rates for the 2-year period 2007--8, and examines relative risks (RR) of suicide associated with mental health disorders., Methods: Historical trends of US Army suicides were assessed using 1977--2008 data from Army G-1 (Personnel). Suicide rates, RR and the 2000--8 trends of mental health disorders were calculated using data from the Defense Casualty Information Processing System and Defense Medical Surveillance System., Results: A total of 255 soldiers committed suicide in 2007--8 (2008 rate 20.2 per 100 000). Factors associated with higher suicide risk included male gender, lower enlisted rank and mental health disorders treated on an outpatient basis (RR 3.9), as well as a number of mental health disorders (mood disorders, anxiety disorders, post-traumatic stress disorder, personality/psychotic disorders, substance-related disorders and adjustment disorder; RR range 4.7--24.5). Analysis of historical trends suggested that 25--50% of the suicides that occurred in 2008 might have been related to the major commitment of troops to combat beginning in 2003., Conclusions: The recent increase in suicides parallels an increase in the prevalence of mental disorders across the army. This finding suggests that increasing rates of clinically treated psychopathology are associated with increasing rates of suicides; these rates probably serve as sentinels for suicide risk in this population. Soldiers seeking treatment for mental disorders and substance abuse should be a focus for suicide prevention.