Executive Summary: The Centers for Disease Control and Prevention has declared youth sports injuries an epidemic, estimating that 50% of these injuries are preventable. In partial response, every U.S. state. has a youth sports concussion law; however, no state tracks or enforces its law, leaving its effectiveness and implementation status unknown. Despite reports that the injury risk in youth sports has escalated by ten-fold in the last 25 years and that four in ten parents of children participating in youth sports will take their child for a related medical visit, injury risk prevention in youth sports, outside concussions, is not regulated. To support prevention, the CDC provides youth injury research in concussion, heat illness, overuse, emergency response, sudden cardiac arrest and misfitting equipment. State Public Health has a regulatory domain over all youth injuries, but youth sports injuries are not included with child welfare programs like water safety, bike safety, etc.
Professional and college administrations hire certified athletic trainers for injury recognition and prevention for their athletes. While every State High School Athletic Associations requires coaches to be trained using a safety course provided by the National High School Federation, only 30% of High School administrations hire certified athletic trainers to serve injury recognition and prevention. Worse, coaches for youth aged 14 and under (estimated at 7.5 million) are not required to have safety training, leaving the 42 million children participating in youth sports more vulnerable to injury. This combination of the most vulnerable athletes and the least knowledgeable coaches, compounds the risk of injury. Alabama has piloted a Public Health regulated course that has trained coaches in all 60 counties using a web-based application that registers, delivers and certifies an 8-module course in youth sports injury recognition and prevention.
Interviews: Dr. Erin Reynolds, Psy.D., Concussion specialist; Dr. James R. Andrews, MD, sports medicine pioneer, educator and researcher.
Research Reports: CoachSafely Foundation 2025 Report on Counties ; Case Studies
Executive Summary: A coach-centered approach treats the coach as the primary catalyst for wellness in every child athlete. By equipping coaches with holistic training, emphasizing emotional intelligence and mentorship skills, sports organizations prioritize long-term child development over specialization with a strict win-at-all-cost mentality. Childhood wellness is the holistic state of being where a child’s physical, mental, emotional, social, and educational needs are met. Prioritizing wellbeing allows children to fully function academically, physically, or emotionally. For children aged 14 and under, the school day is when any issues with their wellbeing manifest. Schools have consistently reported that children who are involved in youth sports have improved attendance, behavior, and performance. Youth sports can be demanding and carry risk, so it is the responsibility of the coach to emphasize wellness so that children may reap the benefits of youth sports while mitigating the risks. A certified, trained coach registered with a state occupation code will have a learning path that equips them to uphold this responsibility while also giving them more accountability and influence with parents.
Nearly half of U.S. school aged children live with at least one chronic health condition, with recent reports indicating these numbers are on the rise. In most states, Public Health regulates childhood wellness programs that include immunization, poison control, injury prevention (not in youth sports) and family safety services. When youth sports are age appropriate, positive, and focused on holistic development, they support mental and physical wellness. Accordingly, the Department of Health and Human Services has targeted increasing youth sports participation to 63% by 2030 as a public health intervention. For coaches of youth sports to support child wellbeing, coaches must be trained in health and safety, or we risk exacerbating the youth sports injury epidemic.
Interviews: Jon Solomon, Director of Research for Aspen Institute
Research Reports: Positive Coaching Alliance; U.S. SafeSport; Million Coach Challenge;
Executive Summary: Up to 80% of adolescents fail to meet recommended exercise guidelines, with teenagers exhibiting activity levels like sedentary 60-year-olds. This sets lifelong habits that increase premature mortality and chronic disease risks across subsequent generations. Sedentary behavior habits begin forming as early as age 6, primarily driven by rapid digitalization, excessive screen time, and a lack of safe outdoor active spaces. The lack of physical activity across age groups heavily taxes modern healthcare infrastructure, workforce productivity, and military readiness. HHS has responded with an objective to break the cycle by establishing a goal to increase youth sports participation to 63%. Right now, state public health departments in states that pass the Coach Safely Act have the option to participate in programs that support youth sports participation, and yet in practice, resulted in no programming. Alabama, Arkansas, and Louisiana have implemented the first direct involvement of State Public Health in youth sports with the codification of the Coach Safely Act with a mandate to affect the health and safety of our youngest athletes by training coaches. It is a coach-centered approach to changing the culture of youth to be more parent and child-friendly. Five more states will be addressing this landmark legislation in 2027.
There are 3,143 counties or equivalent in the United States, with State Public Health departments able to provide programming in each one. Since 2018, the Alabama Department of Public Health has pioneered the use of technology to train coaches in health and safety in all 60 state counties. In 2025, the state amended the legislation to have the authority to enforce the 2018 mandate. The intention is to create the first quality enforceable on-the-ground standard in youth sports focused on retention and safety. The HHS goal is achievable by simply reducing the attrition rate of 70%. Kids quit sports when they stop having fun, and we need to address the underlying causes of that problem. Focusing on why kids quit, creating standards for coaches that remedy those reasons, and training coaches to meet those standards, attrition will drop and participation with rise. F With a qualifying grant process, each state can 1) call on state leadership; 2) develop a state youth sports registry; 3) establish surveillance; and 4) promote retention.
Interview: Dr. Brian Christine, MD, Assistant Health Secretary of U.S. Depart. Of Health and Human Services
Research Reports: Aspen Institute, Project Play; Healthy 2030
