NFL concussion epidemiology book to be released

A skilled epidemiologist joins forces with an up-and-coming investigative political scientist to write Pigskin Crossroads, a unique and dynamic treatise on player concussions in the National Football League (NFL). Using concussion data from the NFLís website during the last three regular seasons (2010Ė2012), incidence and risk factors of concussions are calculated and compared for a range of factors rarely or never studied before. The eye-opening results help shed light on possible ways to prevent and reduce the rate of these head injuries and the long-term risks of cognitive decline.

The existing epidemiological literature on concussions in the NFL is sparse, mainly comprised of several articles written by NFL-affiliated researchers whose work has come under intense scrutiny and challenge by the scientific community and the U.S. Congress. Pigskin Crossroads fills some of the gaps related to this subject from an independent perspective. Concussion incidence rates are computed and analyzed for team, week of season, day of week, speed versus non-speed positions, conference, field surface, home versus away games, starters versus nonstarters, and other critical variables. Rates of concussions in games worked by replacement versus regular referees are compared. The risk of repeat concussions between regular seasons is also analyzed. An exposureĖresponse analysis describes the link between the number of games played and the occurrence of concussions. Intriguingly, teams of concussed players are more likely to lose games, both overall and on the day that the concussions occur.

Rigorous statistical tests identify differences between the groups under study, and all methods are explained in a way that is accessible to a lay as well as professional audience. Key results are illustrated in graphs and figures, and for those who enjoy data, there are 27 appendices that allow readers to get in the trenches of the results.

The backdrop for this empirical research is six critical essays on the politics surrounding the key issues in the NFL concussion crisis. This includes a comprehensive description of its history along with the making and remaking of league policies, protocols, and rules related to concussions, and the significant shift in NFL public relations. Another chapter discusses helmet safety standards, and the final essay details the massive ongoing class-action lawsuit against the NFL and helmet manufacturer Riddell involving nearly 6,000 retired players and families. The litigation has brought the situation to a critical juncture that may threaten the future of the game as we currently know and love it.


Jeff and Ariana Markowitz are father and daughter, both born in New York City. Jeff obtained his Doctor of Public Health from the Columbia University School of Public Health in 1988. Ariana studied Political Science at McGill University, graduating in 2007. Jeff has authored or co-authored about 70 scholarly journal articles and book chapters. Ariana has studied in the Middle East and worked on national security in Washington, DC, entrepreneurship in Africa, and economic development in Latin America.

Pigskin Crossroads will be released through in mid-August. For more information, contact Dr. Jeff Markowitz at or (609) 468-3154.