In recognition of April as National Youth Sports Safety Month, MomsTeam is again asking our friends in the medical, health, fitness, nutrition and athletic training communities to write blogs answering two questions: first, how or why did they get into their field, and second, how have they made a difference in the life of a youth athlete in the past year. 

Today, we hear from Toben Nelson, Associate Professor in the School of Public Health, Division of Epidemiology & Community Health at the University of Minnesota.

By Toben F. Nelson, ScD

How did I get into my field?

When I was growing up, my family was very involved in sports. It was important to my parents that my brothers and I get involved in lots of different activities. I played baseball, soccer, football, basketball, tennis, golf, and ran track -- really anything that was active. We felt that sports helped us to learn how to work hard, win and lose, persist in the face of adversity, and work with others as a team - all valuable life skills. And it kept us active and physically fit. In school I was interested in doing scientific research and learning about ways to improve health. Participating in sports seemed like a natural pathway to promote those goals and I looked for ways to combine those interests in my studies.

When I was a graduate student at the University of Wisconsin studying kinesiology I came across a research paper (1) that challenged my thinking about the health benefits of participating in sports.  Researchers at UCLA found that athletes in college were more likely than their peers who were not athletes to engage in a wide range of risky behaviors. Those risk behaviors included some of the largest threats to health for young people, such as excessive drinking, smokeless tobacco use, unsafe sexual activity, physical violence, and unsafe use of motor vehicles. Those behaviors are among the leading actual causes of death and long-term harms to health and well-being for youth

Does participating in sports lead to poor health? At first I was very skeptical, but to me this was a really interesting paradox and it sparked a new way of thinking about the health and social effects of sports.

How have I made a difference in a young athlete's life in the past year?

My early interest  in the link between sports and health has carried over into my work as a professor of Public Health at the University of Minnesota. In a series of studies (3-6) my colleagues and I observed the same findings of excessive alcohol use among athletes observed in the UCLA study, as well as gaining a more detailed understanding of the role sports participation plays in heavy drinking.

We found that those who were involved in sport during high school or were sports fans were much more likely to drink alcohol, drink to excess and experience problems related to alcohol in college than those who did not drink before college. In fact, those who were fans and/or former athletes reported about the same level of drinking and related harms as current athletes. These levels were considerably higher than students who were not involved in sports. Interestingly, being involved in sports does not seem to be risky during high school. The risk comes after high school. However, most of those students don't have an opportunity to play sports competitively once they reach college.

While athletes are not necessarily at greater risk during high school, they are more likely to attend parties where drinking is taking place. We think that prohibitions against drinking for students who are on a sports team have an important protective effect on drinking behavior - while they are participating on that team. Young athletes are also exposed to significant marketing of alcohol products through sports that both glamorize alcohol use and link it directly to involvement in sports. As one of our research participants once put it, "Alcohol and sports. They just go together." Drinking may help maintain the link to sports and identity as an athlete for those that simply can no longer compete. It's a link that can be very risky.

Risk assessment needed

This is not to say that sports don't still have those virtues that I experienced when I was growing up. Clearly they do, and now that I have children, my wife and I encourage them to be active in sports. I think too often people become either proponents or opponents of sports. It is more complicated than that. I think it is also very important to recognize the risks and try to understand them. Some of my work focuses on those goals, as well as trying to create experiences for youth through sports that maximize the many benefits of sport while at the same time minimizing the risks.

Parents and coaches should be aware that being involved in sports may place their children at greater risk for excessive alcohol use and the many problems that can result. The challenge is to identify what can be done to keep harmful things from happening. While athletes are at special risk for drinking, the strategies that are effective for prevention apply to everyone.

Alcohol abuse prevention strategies

My main area of research focuses on developing public policies that are effective in reducing the harms that result from excessive alcohol use. While there is no single magic solution to preventing alcohol-related harms, there are many effective strategies. (7,8) The common thread across these effective strategies is limiting access to alcohol and restricting the use of alcohol, particularly in risky settings.

One of the most effective strategies for reducing drinking among young people is the minimum legal drinking age in the United States of 21. (9) Since it was raised from age 18 in most states in the 1980s and 1990s, youth drinking (and wide range of alcohol-involved harms) has declined dramatically. Without the 21 drinking age we undoubtedly would see more drinking and harms among our youth. Continued support for this important law, and use of effective enforcement strategies to make everyone accountable to that standard, is needed.

Two common traps

Parents can play a critical role in protecting their children from the problems associated with excessive drinking. Youth who report that their parents disapprove of excessive drinking are less likely to drink excessively. Parents' behavior also influences their children's behavior. Youth who report that their parents drink and drink to excess are more likely to drink to excess themselves.

I think it is important to be aware of two common traps that parents may fall into when thinking about preventing the harms that result from alcohol use among their children. Sometimes these traps lead parents to actually provide alcohol to their children and their friends in risky settings, the exact conditions that lead to drinking and problems with alcohol.

Trap #1 "... as long as they aren't driving..."

Motor vehicles crashes are a very common bad outcome from drinking, but there are many more bad outcomes that can result, including sexual risk-taking and assault, falls and other injuries, physical violence, property damage, and overdose, to name a few. This type of thinking may lead to extra steps to prevent driving but often does little to reduce drinking as the main risk for driving and other problems. The numerous other risks are still present. This approach may also inadvertently facilitate drinking opportunities that otherwise would not exist, creating greater risk overall.

Keep in mind that alcohol impairs the ability to make good decisions. In part because some important functions of the brain are not fully developed, even in late adolescence, young people tend to act impulsively, aggressively and make risky decisions.

Those conditions make it more likely that young people will use alcohol to excess, and further increases the chances for poor decision making and bad outcomes when under the influence of alcohol.

Trap #2 "They are going to drink anyway."

Youth are more likely to drink alcohol when they have the opportunity to drink and access to alcohol. Assuming that they are going to drink can lead some parents to buy alcohol and host drinking parties for their children and their friends. The thinking is that they will be supervised and in a safe environment, with less risk of potential harms. Without a hosted party, some of those youth may have found other ways to access and consume alcohol, but the fact is that most of them won't.

Parties planned by young people also have a tendency to grow to include people who were not originally invited and even people they do not know. This phenomenon is not often considered when parents decide to host a party, and it is a recipe for trouble. Parents who agree to host parties often do not notify the parents of other youth who are invited to the party that alcohol will be available. Sometimes they don't even provide the supervision of the party that was part of the rationale for hosting the party to begin with. Youth who participate in sports are often social leaders who are likely to try to host, or get invited, to these kinds of parties.

A new policy strategy that has been adopted in an increasing number of cities and states is called social host liability laws. Parents considering hosting a drinking party, or learning about plans their children may have for a drinking party on their property, should consider the significant liability exposed to when something goes wrong. Social host laws in some jurisdictions hold adult property owners responsible whether or not they were aware of the party or provided the alcohol.

Excessive alcohol use is a special concern for youth who are involved in sports. The most effective solutions are those that limit access to alcohol and opportunities to drink. Parents of youth who participate in sports need to be aware of these special risks and support proven efforts in their community to reduce excessive drinking. They also need to be wary of strategies that seem like preventive measures, but may create greater risk and expose them to significant liability. These steps can help promote the aspects of sports that are valuable and reduce the potential risks.

To learn more about alcohol and prevention click here.

Footnotes:

1. Nattiv A, Puffer JC. Lifestyles and health risks of collegiate athletes. J Fam Practice. 1991;33(6):585-590.

2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245.

3. Weitzman ER, Nelson TF, Wechsler H. Taking up binge drinking in college: the influences of person, social group, and environment. J Adolescent Health. 2003;32(1):26-35.

4. Nelson TF, Wechsler H. School spirits: alcohol and collegiate sports fans. Addict Behav. 2003;28(1):1-11.

5. Nelson TF, Wechsler H. Alcohol and college athletes. Med Sci Sports Exerc. 2001;33(1):43-47.

6. Nelson TF, Lenk KM, Xuan Z, Wechsler H. Student drinking at U.S. college sports events. Subst Use Misuse. 2010;45(12):1861-1873.

7. Nelson TF, Xuan Z, Babor TF, et al. Efficacy and the strength of evidence of U.S. alcohol control policies. Am J Prev Med. 2013;45(1):19-28.

8. Community Preventive Services Task Force. Preventing Excessive Alcohol Consumption, 2014. http://www.thecommunityguide.org/alcohol/.

9. Wechsler H, Nelson TF. Will increasing alcohol availability by lowering the minimum legal drinking age decrease drinking and related consequences among youths? Am J Public Health. 2010;100(6):986-992.

Toben F. Nelson is Associate Professor, School of Public Health, Division of Epidemiology & Community Health at the University of Minnesota. He received his BA in Psychology & Physical Education from Hamline University, his Sc.D. in public health from Harvard University, and an M.S. in kinesiology from the University of Wisconsin-Madison. His research interests are in health policy, organizational change, health behavior during developmental transitions, influence of sports participation on health, social determinants of health, program evaluation, prevention of alcohol attributable harm, physical activity promotion, obesity prevention, and motor vehicle safety.