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Readability of Online Chronic Traumatic Encephalopathy (CTE) Information: Health Literacy Implications for Parents Navigating Youth Tackle Football Decisions.

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Title: Readability of Online Chronic Traumatic Encephalopathy (CTE) Information: Health Literacy Implications for Parents Navigating Youth Tackle Football Decisions.
Authors: Ethan D; Department of Health Promotion and Nutrition Sciences, Lehman College, The City University of New York, Bronx, NY, 10468, USA. danna.ethan@lehman.cuny.edu., Basch CH; Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA., Hillyer GC; Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA.
Source: Journal of community health [J Community Health] 2026 Oct; Vol. 51 (5), pp. 813-818. Date of Electronic Publication: 2026 Jul 08.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Springer Country of Publication: Netherlands NLM ID: 7600747 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-3610 (Electronic) Linking ISSN: 00945145 NLM ISO Abbreviation: J Community Health Subsets: MEDLINE
Imprint Name(s): Publication: Amsterdam : Springer
Original Publication: New York, Human Sciences Press.
MeSH Terms: Parents*/psychology , Football*/injuries , Health Literacy* , Comprehension* , Chronic Traumatic Encephalopathy* , Internet*, Humans ; Cross-Sectional Studies ; Adolescent ; Decision Making ; Female
Abstract: Tackle football is the most participated youth sport in the U.S. with leagues beginning as early as age 5. Exposure to cumulative repetitive head impacts (RHI) over years of play is increasingly viewed as a major contributor to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease documented in contact sport athletes. Amid growing awareness of CTE, parents may turn to online information to guide decisions about youth tackle football participation. This cross‑sectional study examined the readability of online CTE information. Using the search term, 'CTE,' 68 URLs providing non‑technical information were identified after applying exclusion criteria. Online software was used to generate metrics from six widely-used readability formulas. Grade-level readability scores were categorized as ≤ Grade 8, 9-12, and ≥ 13 and summarized using descriptive statistics; distributions were compared by URL designation using chi-square tests (P < 0.05). Web page publication/revision date and presence of references were recorded. Median readability scores ranged from high school to early college with few pages meeting the recommended ≤ Grade 8 reading level for the general population. Levels were similarly high across non-commercial (.org,.gov,.edu) and commercial (.com) domains. Nearly 40% lacked clear publication or revision dates; fewer than half (47.1%) included references. Commonly accessed online CTE resources exceed recommended reading levels. This digital barrier impairs parents' functional health literacy and capacity for informed decision-making. As research on CTE and tackle football participation evolves, there is a need for plain‑language, clearly-sourced, updated online resources tailored to this decisional context.
(© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Competing Interests: Declarations. Competing Interests: The authors report no conflict of interest.
References: Neurol Educ. 2023 Sep 25;2(4):e200092. (PMID: 39359321)
Pediatrics. 2019 Nov;144(5):. (PMID: 31615955)
Internet Interv. 2022 Feb 07;27:100500. (PMID: 35242586)
Ann Neurol. 2020 Jan;87(1):116-131. (PMID: 31589352)
JAMA. 2017 Jul 25;318(4):360-370. (PMID: 28742910)
Public Health. 2018 Oct;163:137-140. (PMID: 30149263)
JAMA Neurol. 2023 Oct 1;80(10):1037-1050. (PMID: 37639244)
Front Neurol. 2022 Jul 22;13:938163. (PMID: 35937061)
Brain. 2013 Jan;136(Pt 1):43-64. (PMID: 23208308)
Mol Neurodegener. 2024 Feb 6;19(1):10. (PMID: 38317248)
Am J Mens Health. 2018 Sep;12(5):1665-1669. (PMID: 29888641)
Acta Neuropathol. 2016 Jan;131(1):75-86. (PMID: 26667418)
Am J Med Qual. 2018 Sep/Oct;33(5):487-492. (PMID: 29345143)
Nat Commun. 2023 Jun 20;14(1):3470. (PMID: 37340004)
Contributed Indexing: Keywords: CTE; Digital literacy; Health literacy; Readability; Youth tackle football
Entry Date(s): Date Created: 20260708 Date Completed: 20260926 Latest Revision: 20261008
Update Code: 20261008
DOI: 10.1007/s10900-026-01594-7
PMID: 42418055
Database: MEDLINE
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  Data: Tackle football is the most participated youth sport in the U.S. with leagues beginning as early as age 5. Exposure to cumulative repetitive head impacts (RHI) over years of play is increasingly viewed as a major contributor to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease documented in contact sport athletes. Amid growing awareness of CTE, parents may turn to online information to guide decisions about youth tackle football participation. This cross‑sectional study examined the readability of online CTE information. Using the search term, &#39;CTE,&#39; 68 URLs providing non‑technical information were identified after applying exclusion criteria. Online software was used to generate metrics from six widely-used readability formulas. Grade-level readability scores were categorized as ≤ Grade 8, 9-12, and ≥ 13 and summarized using descriptive statistics; distributions were compared by URL designation using chi-square tests (P &amp;lt; 0.05). Web page publication/revision date and presence of references were recorded. Median readability scores ranged from high school to early college with few pages meeting the recommended ≤ Grade 8 reading level for the general population. Levels were similarly high across non-commercial (.org,.gov,.edu) and commercial (.com) domains. Nearly 40% lacked clear publication or revision dates; fewer than half (47.1%) included references. Commonly accessed online CTE resources exceed recommended reading levels. This digital barrier impairs parents&#39; functional health literacy and capacity for informed decision-making. As research on CTE and tackle football participation evolves, there is a need for plain‑language, clearly-sourced, updated online resources tailored to this decisional context.&lt;br /&gt; (&#169; 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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  Data: Declarations. Competing Interests: The authors report no conflict of interest.
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  Data: Neurol Educ. 2023 Sep 25;2(4):e200092. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239359321%22&quot;&gt;39359321)&lt;/searchLink&gt;&lt;br /&gt;Pediatrics. 2019 Nov;144(5):. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231615955%22&quot;&gt;31615955)&lt;/searchLink&gt;&lt;br /&gt;Internet Interv. 2022 Feb 07;27:100500. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235242586%22&quot;&gt;35242586)&lt;/searchLink&gt;&lt;br /&gt;Ann Neurol. 2020 Jan;87(1):116-131. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231589352%22&quot;&gt;31589352)&lt;/searchLink&gt;&lt;br /&gt;JAMA. 2017 Jul 25;318(4):360-370. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228742910%22&quot;&gt;28742910)&lt;/searchLink&gt;&lt;br /&gt;Public Health. 2018 Oct;163:137-140. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2230149263%22&quot;&gt;30149263)&lt;/searchLink&gt;&lt;br /&gt;JAMA Neurol. 2023 Oct 1;80(10):1037-1050. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237639244%22&quot;&gt;37639244)&lt;/searchLink&gt;&lt;br /&gt;Front Neurol. 2022 Jul 22;13:938163. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235937061%22&quot;&gt;35937061)&lt;/searchLink&gt;&lt;br /&gt;Brain. 2013 Jan;136(Pt 1):43-64. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2223208308%22&quot;&gt;23208308)&lt;/searchLink&gt;&lt;br /&gt;Mol Neurodegener. 2024 Feb 6;19(1):10. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238317248%22&quot;&gt;38317248)&lt;/searchLink&gt;&lt;br /&gt;Am J Mens Health. 2018 Sep;12(5):1665-1669. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2229888641%22&quot;&gt;29888641)&lt;/searchLink&gt;&lt;br /&gt;Acta Neuropathol. 2016 Jan;131(1):75-86. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2226667418%22&quot;&gt;26667418)&lt;/searchLink&gt;&lt;br /&gt;Am J Med Qual. 2018 Sep/Oct;33(5):487-492. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2229345143%22&quot;&gt;29345143)&lt;/searchLink&gt;&lt;br /&gt;Nat Commun. 2023 Jun 20;14(1):3470. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237340004%22&quot;&gt;37340004)&lt;/searchLink&gt;
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