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American football is the most popular high school sport and is among theleading cause of injury among adolescents. While there has been considerablerecent attention on the link between football and cognitive decline, there isalso evidence of higher than expected rates of pain, obesity, and lower qualityof life among former professional players, either as a result of repetitivehead injury or through different mechanisms. Previously hidden downstreameffects of playing football may have far-reaching public health implicationsfor participants in youth and high school football programs.  Our proposed study is a retrospective observational study that compares 1,153high school males who played varsity football with 2,751 male students who didnot. 1,951 of the control subjects did not play any sport and the remaining 800controls played a non-contact sport. Our primary outcome is self-rated healthmeasured at age 65. To control for potential confounders, we adjust forpre-exposure covariates with matching and model-based covariance adjustment. Wewill conduct an ordered testing procedure designed to use the full pool of2,751 controls while also controlling for possible unmeasured differencesbetween students who played sports and those who did not. We willquantitatively assess the sensitivity of the results to potential unmeasuredconfounding. The study will also assess secondary outcomes of pain, difficultywith activities of daily living, and obesity, as these are both important toindividual well-being and have public health relevance.

Protocol for an Observational Study of the Association of High School Football Participation on Health in Late Adulthood