The label attached to every Schutt football helmet reads like something off of a carton of cigarettes.
It begins with "WARNING" and ends eerily: "No helmet system can protect you from serious brain and/or neck injuries, including paralysis or death. To avoid these risks, do not engage in the sport of football."
Never have the risks been more in the public eye than now, following the suicide of former All-Pro linebacker Junior Seau in the spring.
Seau's death, which occurred less than three years after his 20-year NFL career ended, is the latest in a string of highly publicized deaths of former pro football players who suffered concussions during their playing days.
High Schools: Concussion challenges
Colleges: Medical staffs, less contact are key
Equipment: Proper helmets can help reduce risks
When Seau took a shotgun to his chest on May 2, Pop Warner Little Scholars -- the largest youth football program in the world with 250,000 players -- already was preparing new rules to cut back on contact in practice and thus reduce the risk of concussions.
An annual survey of football injuries by the National Center for Catastrophic Sport Injury Research found that three of the four deaths directly related to football in the United States last year were a result of brain injuries. The University of Pittsburgh Medical Center, meanwhile, estimates that 300,000 football-related concussions occur in the nation each year.
Dalton resident Billie Henderson saw her son Sam suffer one of those last fall as a seventh-grader.
"It's pretty dangerous," Billie said. "It's been kind of brushed aside and taken lightly for a long time. People didn't understand how serious it can be. I'm glad that's becoming more apparent to people, and people are being educated about the dangers."
Entering a new football season -- practice begins next month -- most coaches in Berkshire County agree that education is the key to preventing concussions, yet mandating training classes has been a slow process.
That crawl has been especially noticeable at football's entry level.
There are no education requirements for dealing with the injury in the Berkshire Youth Football Asso ciation, an all-volunteer organization that encompasses the nine youth leagues (ages 6 to 14) across the county but which is not part of Pop Warner.
A Massachusetts state law requires high schools to train coaches and other school officials on head injuries, but that legislation doesn't extend to youth leagues.
Dr. Ellen Deibert, a neurologist who said she sees about 200 complex concussion cases at her Pittsfield practice each year, said the Massachusetts legislation has forced public schools to tackle the issue head-on.
She said the youth leagues should follow this example.
"Youth leagues, which have not had to follow the state law, they're far behind in their education -- the education of their coaches," Deibert said. "I would say it's more likely for me to have a player get accidentally put back into play who's had a concussion in the youth-league sort of scenario ... more so than our public schools right now."
Deibert has been a part of Berkshire Medical Center's neurology division since 2003 and started Berkshire Health System's Comprehensive Brain Injury program in 2007.
Pittsfield attorney Bill Martin, the Berkshire Youth Football Association (BYFA) commissioner from 2007-11, said he encouraged local leagues to seek concussion training through USA Football, an NFL-endowed organization that has provided support for youth leagues since 2003 but which has no true governing authority.
"We didn't have 100 percent participation," Martin said. "Not every coach and every program was as committed as I would've liked. One of the things I hope is continuing, we were headed in the direction of making it a requirement that at least one coach [per team] has this kind of certification."
New BYFA commissioner Dan Hogan said the organization for the past 15 years has required equipment to be inspected by sporting-goods companies such as Stadium System Inc. in Canaan, Conn., but he acknowledged there is no mandate for concussion education.
Hogan, a chief engineer at General Dynamics, said he strongly encourages coaches to take advantage of programs through Indianapolis-based USA Football and plans to emphasize concussion education in the BYFA's preseason coaches' meeting on Aug. 10.
"Getting constant exposure to that is a good thing," Hogan said. "We could be moving toward the point that [any coaches who have] registered have been exposed to that."
To this point, education -- as well as regulations regarding concussions -- has been hit and miss. Still, Hogan said there are encouraging signs among leagues in the BYFA.
"I see it in the equipment they buy," he said. "I've seen coaches go out of the way to take kids out of the game, even if there are boos from parents."
Hogan said the BYFA doesn't track concussions or other injuries. He said, however, that no concussions were reported to the league last season and that he plans to discuss injury tracking during the meeting next month.
That conversation is a first step that USA Football is trying to help leagues take. On its website alone (www.usafootball.com), the organization offers articles, videos, step-by-step guides and other training materials regarding concussion awareness and proper tackling techniques.
And while USA Football spokesman Steve Alic said his organization has seen leagues try to reduce injuries by making moves such as a gradual phasing out of the heavy-contact drills that many coaches grew up with, there is no one set of rules for volunteer coaches to follow and no required instruction on drills considered "safe."
Alic said more than 80 percent of the nation's youth leagues aren't affiliated with a national organization such as Pop Warner, which this season has started banning full-speed, head-on contact beyond 3 yards in practice and reduced the practice time used for contact to one-third of all practice time.
The rules changes come on the heels of a 2012 study by the Center for Injury Biomechanics at Virginia Tech-Wake Forest University that found that many major collisions in youth football take place in practice, not in games.
Dr. Cathy O'Connor, a general surgeon in Sanford, Maine, who used to work with the athletic teams at Amherst College, said education at lower levels, such as the Berkshire Youth Football Association, is important because there are no full-time trainers or medical personnel covering those leagues.
"We're relying on kids self-reporting, which is pretty bad, or coaches recognizing, which is tough," O'Connor said. "There is more training available for them now. [The national Centers for Disease Control and Prevention] has an excellent online training program. A lot of places are mandating that all coaches must view and sign off."
That training could make it easier to identify concussions, which are difficult to spot.
When Sam Henderson, the rising Dalton eighth-grader from Dalton, suffered a concussion last fall, it took his mother nearly a week to figure out that Sam's headaches weren't normal.
"I just feel kind of bad. It's not something that's really easily diagnosed [by parents]," Billie Henderson said. "It's serious regardless of whether it's obvious or if they have more subtle symptoms. In hindsight, I was kind of upset with myself that I didn't recognize it earlier."
But Henderson also acknowledged that implementing policy is tough because of a lack of a universal governing body in youth football. It's not like at the high school level, where the Massachusetts Interscholastic Athletic Association has the ability to implement and enforce regulations.
It's that gap that USA Football has been trying to fill with what Alic calls "a standard coaching education curriculum."
This type of training has been adopted elsewhere, such as in Derry, N.H., where Alex Umansky's 8-year-old son, Owen, plays. The Umanskys were in Western Massachusetts earlier this summer for a youth football camp at Amherst College.
Alex said he doesn't think every coach needs a special certification, but that coaches should have to pass basic concussion education in the same way that coaches undergo a background check in most youth leagues.
Coaches in the Derry Football Association are required to complete an online course regarding concussions, and the organization also held an in-person seminar with a doctor last year, according to league president Fred Gendron.
That training is part of what Alic calls "a sea change" in youth sports. He said hundreds of leagues now embrace coaching education.
"Two questions that parents should ask their children's sports leagues: How are your coaches trained to properly teach this game, and secondly, what kind of training have they undergone for concussion management?" Alic said. "Frankly, every youth sport should be able to answer those two questions."
Taconic High School football coach Vinny Barbarotta said education has become more important than ever.
Barbarotta, a longtime former youth coach, said a concussion that his son Jordan suffered during the 2011 high school season was an eye-opener for him, just as a similar injury was for the Henderson family.
Even at the high school level, where hits are that much harder, Barbarotta said concussion training isn't all he'd like it to be.
"I don't think they've schooled the coaches enough, especially in the youth [leagues]," Barbarotta said. "We have clinics for them occasionally. We do clinics for the kids. There's nothing for the [youth] coaches. The sooner you start, the better."
To reach Christopher James:
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On Twitter: @BECJ2K
A concussion is a traumatic brain injury caused by a blow to the head or body, a fall, or by another injury that jars or shakes the brain inside the skull. Most people who suffer a concussion recover quickly. However, for some, symptoms can last days, weeks or longer, according to the national Centers for Disease Control and Prevention. Concussion symptoms fall into four categories:
n Difficulty thinking clearly
n Feeling slowed down
n Difficulty concentrating
n Difficulty remembering new information
n Head ache; fuzzy or blurred vision
n Nausea or vomiting
n Sensitivity to light or noise
n Balance problems
n Tired, lack of energy
n More emotional than usual
n Nervousness or anxiety
n More than usual
n Less than usual
n Trouble falling asleep
Sources: WebMD, CDC
What they're saying
The suicide of former NFL standout linebacker Junior Seau in May -- which experts said could have resulted from football-related head injuries -- and concussion-related lawsuits filed by former pro players have raised the conversation about the safety of the game, especially concerning youths.
"We have to work together as a group along with the commissioner, the NFL, leagues all the way down to those like Pop Warner and say how can we make this game safe. How can we continue to try to eliminate those concerns, or at least minimize those for parents?"
-- Kurt Warner, retired NFL quarterback and father of seven
"We know so much more now; we know that not only is the body not physically developed to play football at 5, 6 and 7, but we know the neck and the brain aren't, either. At that time, we thought it was kind of heroic to play at a young age. Now ... it's obvious the bodies of little people are not structured to absorb the hits."
-- Tom Brady Sr., saying he might not let his son play youth football today
"Parents and players in every youth sport need to know concussion signs and symptoms and what to do if a concussion is suspected. Being a fundamentally sound player with properly fitted equipment also contributes to a better, safer football experience. Within youth football's 80-plus-year history, the game has never been safer than it is today, but more education is needed."
-- Merril Hoge, former NFL player whose career was ended by concussions
Source: Eagle news services
n Injuries associated with participation in sports and recreational activities account for 21 percent of all traumatic brain injuries among children in the United States.
n The number of children and adolescents visiting hospital emergency rooms for sports and recreation-related concussions rose from 153,375 in 2001 to 248,418 in 2009.
n Of those visits related to concussions, 71 percent of the patients were males; 70.5 percent were 10 to 19 years old. Among the males, most were injured playing football or riding bikes. Among females, traumatic brain injuries resulted from playing soccer or basketball or occured while bicycling.
Sources: Centers for Disease Control, Safe Kids USA
County football in 2012
Level First practice First game
Berkshire Youth Football Association Aug. 13 Sept. 9
High schools Aug. 20 Sept. 3
Williams College Aug. 27 Sept. 22