Dissertation
The epidemiology of mild traumatic brain injury among United States youth: prevalence, academic outcomes, and return-to-learn policy
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2026
DOI: 10.25820/etd.008468
Abstract
Concussions and other traumatic brain injuries (TBIs) are common among children and represent a significant public health concern in the United States (U.S.). These injuries can impact a child’s brain development and limit their ability to participate in everyday activities, such as school and sports. This research focuses on childhood TBIs and return-to-learn (RTL) provisions in the United States and Iowa. Data from the 2024 National Health Interview Survey, the 2023 Youth Risk Behavior Survey, and a statewide survey of Iowa school personnel were used to address three aims: 1) estimate the 12-month prevalence of TBIs among U.S. children, 2) examine academic outcomes among high school students reporting concussions in states with and without RTL provisions, and 3) examine Iowa’s RTL legislation and the barriers and facilitators to its implementation.
Using the 2024 National Health Interview Survey, 2.3% of children ages 0–17 years reported a TBI in the past year, with 68.1% medically evaluated and 66.0% occurring during sports and recreational activities. Prevalence varied by age, sex, race/ethnicity, and household region, indicating demographic differences in TBI occurrence and medical evaluation.
Analysis of 2023 Youth Risk Behavior Survey data and state concussion law data from 20 states found no evidence that the RTL provisions modified the association between self-reported concussion and academic performance.
Finally, a cross-sectional survey of Iowa school personnel yielded 120 responses, 87 of which were included in the analysis. Among the schools included, 73.6% reported having a RTL plan; 62.5% of these plans were written, and 82.8% applied to all students, with the plan presence the highest in public and rural schools. Key barriers included reliance on external medical guidance and underreporting of concussions by students, while key facilitators included dedicated staff and parental advocacy.
Overall, these studies demonstrate that TBIs effect a substantial proportion of children in the U.S., RTL provisions did not modify the relationship between concussion and academic performance, and implementation of RTL policies in Iowa schools varies. The findings highlight the scope of childhood TBI, the potential benefits and limitations of RTL laws, and identified ways to strengthen school-based support for students recovering from concussion.
Details
- Title: Subtitle
- The epidemiology of mild traumatic brain injury among United States youth: prevalence, academic outcomes, and return-to-learn policy
- Creators
- Emily Louise Acers Carlson
- Contributors
- Cara J. Hamann (Advisor)James Torner (Committee Member)Carri Casteel (Committee Member)Kari Harland (Committee Member)Joseph Cavanaugh (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Spring 2026
- DOI
- 10.25820/etd.008468
- Publisher
- University of Iowa
- Number of pages
- xi, 126 pages
- Copyright
- Copyright 2026 Emily Louise Acers Carlson
- Language
- English
- Date submitted
- 04/10/2026
- Description illustrations
- Illustrations, graphs, charts, tables, map
- Description bibliographic
- Includes bibliographical references (pages 106-117).
- Public Abstract (ETD)
Concussions and other brain injuries are common among children in the United States. These injuries can make it harder for children to learn, play sports, and do everyday activities. We do not fully know how frequently these injuries happen, how state laws affect students returning to school, or how well schools in Iowa use these laws. This research looked at these questions in three studies.
First, a national survey found that about 2 in 100 children had a brain injury in 2024. Nearly one-third of these children did not see a doctor, and 66% of these injuries happened during sports. Second, we looked at whether state return-to-learn (RTL) laws affected grades for students who had a concussion. We did not find that students in states with RTL laws had different grades than those in states without these laws. Third, we surveyed schools in Iowa about their RTL plans. Most schools had a plan, especially public and rural schools. Schools said the hardest parts of carrying out these plans were relying on doctors outside the school and students not reporting concussions. Support from school staff and parents helped schools carry out the plans.
These studies show that some children with brain injuries do not get medical care, and that schools and states help students recover from concussions in different ways. Understanding how often injuries happen, how schools respond, and the challenges they face can help teachers, doctors, families, and policymakers give children the support they need to succeed after a concussion.
- Academic Unit
- Epidemiology
- Record Identifier
- 9985177274102771
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