By Kate Snow, Sarah Koch, Deirdre Cohen and Jessica Hopper

Rock Center

Fifteen-year-old Allison Kasacavage, once a rising soccer star in Pennsylvania, is slowly recovering after suffering debilitating concussions while playing the game she loved.

“It’s almost like I need a sign on my back saying, ‘My head is broken.’ And you can’t see it. It’s like not visible and it’s like not many people understand, “said Allison in an interview with Rock Center’s Kate Snow.

Allison, who lives with her family in Chester Springs, Pa., has had at least five concussions.  She is only able to attend school four hours a day.  Her room is lit with soft blue light to ease her headaches and her family now eats dinner by candlelight. 

She is one of hundreds of girls across America each year who suffer concussions while playing soccer. 

“People who think of concussions as only being present mostly in guys and mostly in the sport of football are just plain wrong,” said Dr. Bob Cantu, who is chairman of the surgery division and the director of sports medicine at Emerson Hospital in Concord, Mass. “Soccer is right at the top of the list for girls.” 

With the steady popularity of youth soccer, more girls are playing the game than ever before.  Girls make up 48 percent of the more than 3 million kids registered in US Youth Soccer leagues.

Cantu said that the country is in the midst of “a concussion crisis” and that studies show girls are reporting nearly twice as many concussions as boys in the sports they both play.

‘Concussion Crisis’ impacting girls’ soccer

The number of girls suffering concussions in soccer accounts for the second largest amount of all concussions reported by young athletes, according to the American Journal of Sports Medicine.  (Football tops the list.)

“What’s happening in this country is an epidemic of concussions, number one, and the realization that many of these individuals are going to go on to post-concussion syndrome, which can alter their ability to function at a high level for the rest of their lives,” Dr. Cantu said. 

Allison still remembers when she suffered her first serious concussion in October 2008.  It came when she collided with another player on the field. 

“When I like got up, my head was like pounding,” Allison said. “There was, like, a pulse in my head. It was like the strangest thing.  There was a heartbeat in my head and I had no idea what it was and why it was there.  I have never felt that before and I was just so confused,” she said.

Click here for more on concussion symptoms

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After Allison had apparently healed from the concussion, she returned to soccer.  She’d been a star player since she was six years old, working her way up to one of the top teams in Pennsylvania.  She said that her identity had been wrapped up in the game and she felt pressure to please her coaches.

Allison said that she was nervous about heading the ball, but continued to do it. 

“If you didn’t head the ball, you were like the weakest link,” Allison said.

When heading, players attempt to use their foreheads to direct the ball, often jumping with opposing players, a move that can lead to collisions between players, bumped heads and strained necks.  Dr. Cantu says that the act of heading is one of the most dangerous parts of soccer because players often collide.

Allison suffered a third concussion in her final season of soccer and another two off the field, the latter because her spatial awareness had been impacted from her previous concussions and she hit her head on a table and other furniture, her mother said.

Her parents said that they knew about the danger of concussions in sports like football, but it wasn’t until Allison had her first serious head injury that they realized what a big problem concussions can be in soccer.

“I think that we were blind to what was going on around us because, yes, it was about the team.  It was about the winning. It was about all the, it was almost like a routine of, like I said, an awful lot of practices and you just went through it and really your lives rolled by with soccer being the most important thing,” said Lex Kasacavage, Allison’s father.

Sports psychologist Richard Ginsburg says that enthusiasm for the game and the kids by parents and coaches, while well-meaning, might be making the concussion crisis worse.

“We get wrapped up,” said Ginsburg, the author of ‘Whose Game is it Anyway?’  “We want success for them and so sometimes we get, we lose perspective.  It doesn’t make us terrible people. It just makes us human. “ 

In Allison’s town of Chester Springs, about 30 miles from downtown Philadelphia, she is not alone.  She has bonded with at least five other 14 and 15-year-old girls who have suffered concussions while playing soccer.  

“My main friends are actually people that have head injuries,” said one of the teens, Kimmie Zeffert, 14.  “I’ve become so close with them because I can relate to them.  They understand what I’m going through.”

Kimmie had her first concussion when she was 12.

“I took another head ball and then I don’t even remember,” she said. “The next thing is I got, apparently, got elbowed in the back of the head. But (when) the coach asked me if I wanted to come out, I was like, ‘No, I’m going, I’m going to stick it through.”

Those hits -- heading the ball and being elbowed by a player in the head -- ended her soccer career.

Kimmie’s teammate Jenna Rohr made the same choice to continue playing in her game after getting hit in the head.

“I didn’t want to quit,” she said. “I didn’t want to let my team down because, like, so many people already had concussions on the team.”

Both Jenna and Kimmie have been unable to make it through a full day of school for almost two years.  They still suffer from intense headaches, dizziness, nausea and vision problems. 

Along with their physical ailments, several of the girls NBC News spoke to have struggled with depression since leaving soccer. Some have taken anti-depressants. One teen soccer player, who is returning to the sport after suffering a concussion, said that she felt so terrible at one point that she even thought about suicide.

Despite their experiences, the teens still love soccer and say they don’t discourage their former teammates from the sport.

“I think like speaking for all of us, like we would do anything to just be able to play one more game,” Jenna said.

Should heading be banned from girls’ soccer?

Dr. Cantu has made the bold proposal that heading be eliminated from youth soccer under the age of 14.  He said girls, because of their anatomy, may be especially vulnerable to concussions.

“Girls as a group have far weaker necks,” Cantu said.  “The same force delivered to a girl’s head spins the head much more because of the weak neck than it does the guys.”

New research suggests some body types may be more at risk than others.

“We believe that individuals with very long, thin necks may be at greater risk,” Cantu said.

With this evidence, Cantu said, “I would hope it would not only make parents look at their daughters, but make every one of those parents insist their daughters are on a neck strengthening program if they’re playing a collision sport.”

Brandi Chastain, the Olympian who helped the United States win a World Cup, strongly disagrees with Cantu’s proposal to eliminate heading from girls’ soccer.

“It’s a part of the game and I think it’s an important part and I think it’s a beautiful part of the game, to be honest with you,” she said.  “I would never want to see that go away, but there’s a right way to do it. There’s a protective way to do it.”

Chastain said that girls need to be taught to create protective space around their bodies.  She says heading isn’t dangerous if it’s done correctly.

“I circle back to education and preparation and I put that on parents and coaches because the kids don’t know any better,” Chastain added. “You know, they just want to go out there and play, but if we can educate them in a fun environment that’s safe, that teaches them the skill and gives them the confidence to try it and then they can put it into practice in the game.”

Back in Pennsylvania, the girls and their families are trying to educate people based on their own experiences.  Despite their concussions, though, they say they don’t want to discourage girls from playing soccer.

“Please don’t go and not play soccer because it’s such a great opportunity for the girls to just prove themselves and challenge themselves and make friends and travel,” said Wendy Zeffert, mother of Kimmie.  “But be aware.”

Editor's Note: Click here to watch Kate Snow's full report, 'Contact Sport,' that aired on NBC's Rock Center with Brian Williams on May 9.

A majority of doctors in a United Kingdom survey supported measures to deny non-emergency medical services to smokers and the obese, The Observer newspaper reported Sunday.

Although the survey by the networking website doctors.net.uk was a self-selecting poll, the site's chief executive called the response "a tectonic shift" for the profession.

The results feed into a British debate about "lifestyle rationing" by the National Health Service, the Observer reported.

The survey by doctors.net.uk, which claims nearly 192,000 members, found that 593, or 54 percent, of the 1,096 doctors who participated answered yes to this question: "Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?"

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Doctors who approved gave a few examples, The Observer said:

• Denying in-vitro fertilization to childless women who smoke was justified because the procedure was only half as successful for them as for non-smokers.
• Obese or alcoholic patients should be expected to change their behaviors before undergoing liver transplant surgery.

Doctors and patients who oppose lifestyle rationing call the approach blackmail that denies the sick their human rights, The Observer said.

Dr. Tim Ringrose, doctors.net.uk's chief executive, told The Observer the findings represent a significant change in doctors' attitudes, considering that the health service must save 20 billion pounds ($32.5 billion) by 2015.

"This might appear to be only a slim majority of doctors in favor of limiting treatment to some patients who fail to look after themselves, but it represents a tectonic shift for a profession that has always sought to provide free healthcare from the cradle to the grave," Ringrose said.

Dr. Clare Gerada, chair of the Royal College of General Practitioners, told The Observer the NHS should deliver care according to need.

“Clearly, giving up smoking is a good thing,” Gerada told The Observer. “But blackmailing people by telling them that they have to give up isn't what doctors should be doing."

Clinical advice about lifestyle changes are another matter, other doctors said.

"Lifestyles contribute to risk and sometimes they may make treatments too risky to undertake,” John Saunders, chair of the Royal College of Physicians ethics committees, told The Observer. “But that's quite different to saying, 'I'm not going to give you surgery because you smoke or are overweight.'"

Some UK private care trusts already ban in-vitro fertilization, breast reconstructions and hip and knee replacements for smokers and the obese, The Observer said.

Dr. Michael Ingram, chair of Red House Clinical Commissioning Group in Hertfordshire, last month wrote in the doctors' website Pulse that "Rationing is dressed up as science."

"Where does this go next? Will we deny IVF to those who have had pelvic inflammatory disease because of its association with sexual promiscuity?" Ingram wrote.

In the United States, debates have been held on withholding liver transplants for alcoholics and coronary artery bypass surgery for smokers, although no ban is in place.

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When you think of pollution, you might picture an industrial center like Camden, N.J., or Jersey City. But new research shows that when it comes to a potent class of cancer-causing toxic chemicals, many American parking lots are a lot worse.

New studies paint an increasingly alarming picture – particularly for young children – about how these chemicals are being spread across big swaths of American cities and suburbs by what may seem an unlikely source – a type of asphalt sealer. These sealants are derived from an industrial waste, coal tar.

Four new studies (links are at the end of this article) announced this week further implicate coal tar-based asphalt sealants as likely health risks.  The creosote-like material typically is sprayed onto parking lots and driveways in an effort to preserve the asphalt. It also gives the pavement a dark black coloring that many people find attractive.

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Coal tar is a byproduct of the steelmaking industry. In 1992, the U.S. Environmental Protection Agency declared that it would not be classified as a hazardous waste, even though it met the characteristics of one, because it could be recycled for uses that include coating asphalt. That meant steel mills didn’t have to pay for costly landfilling or incineration of the waste.

 

 

 

Only in recent years have scientists discovered the ill effects of this practice.

Coal tar sealants are used most heavily in the eastern United States, but were applied in all 50 states until Washington state banned the products last year. More than a dozen local governments, including Washington, D.C., and Austin, Texas, also have banned the coal tar sealants in favor of the other major type of sealant, which is asphalt-based.

Asphalt-based sealants contain about 1/1000^th the concentration of the cancer-causing chemicals that coal tar-based products do. Home Depot and Lowe’s stores have dropped the coal tar sealants from their product lines, but still some 85 million gallons of the coal tar-based sealants are applied annually in the United States.

The new research, published in peer-reviewed science journals, focuses on a class of chemicals found in coal tar and known as “polycyclic aromatic hydrocarbons,” or PAHs. Previously, researchers believed that people’s exposure to PAHs came primarily through food, which contains trace amounts produced primarily from smoking food or cooking it at high temperatures in practices such as grilling, roasting, and frying. PAHS are produced when any organic matter burns.

The new research shows:

• It appears that children – especially those from 3 to 5 years old – living by coal tar-sealed parking lots and driveways are getting a bigger dose of PAHs from house dust than from their food. The kids who put their hands in their mouth most often are likely receiving 9 ½ times more exposure through house dust than through food, according to research led by E. Spencer Williams, a Baylor University human health risk assessment expert. That’s just from the house dust. When the kids are outside in the yard or playing on coal tar-sealed pavement, they likely are picking up much larger doses.
• While researchers previously theorized that airborne PAHs come mostly from power plants, factories and cars’ and trucks’ tailpipe emissions, U.S. Geological Survey researchers measured large amounts vaporizing into the air off coal tar-sealed parking lots.  The concentrations coming off parking lots in suburban Austin, where the researchers are based, were higher than in centers of heavy industry, including Jersey City and Camden, N.J.; Chicago; London and Manchester, England; and Guangzhou, China. The Austin parking lots tested were three to eight years old. Much more off-gassing occurs in the first few years after the sealants are applied, researchers said.
• Concentrations measured four feet above the coal tar-sealed lots in some cases exceeded health-protection guidelines recommended by a European Union science panel to protect against cancer. The United States has no similar guidelines.
• Extrapolating from the 85 million gallons of coal tar sealants laid down annually and the out-gassing rates measured in Austin, Geological Survey researchers calculated that nationwide, more PAHs are getting into the air from coal tar-sealed parking lots, driveways and playgrounds than from all the auto and truck exhaust.

“That’s a lot,” said Barbara Mahler, a USGS scientist involved in the research.

Researchers previously had shown that coal tar-sealed parking lots were shedding tiny bits of the material, which was washed by rain into nearby waterways – killing, sickening and maiming aquatic creatures such as salamanders, minnows and, importantly, bugs at the base of the food chain. The chemicals kill tadpoles, cause tumors on fish, stunt growth of aquatic creatures and reduce the number of species able to live in a waterway.

As a result of being washed into waterways by stormwater, these chemicals’ concentrations have been rising over the last two decades, even as levels of most contaminants are headed down, Geological Survey researchers showed.

The chemicals are getting into the house dust, researchers think, when small bits are eroded off pavement and tracked into nearby homes.

Scientists also had previously demonstrated that toxic constituents of coal tar were showing up in the dust of homes adjacent to parking lots and driveways, raising questions about health effects on children in those homes, especially toddlers who frequently put their hands in their mouths. Coal tar is known to cause cancer in humans, as well as genetic mutations in lab animals.

One of the new studies helps quantify that risk. Kids who are average in terms of how often they put their hands into their mouths are getting 2 ½ times as many PAHs from house dust as from food, while those in the 95^th percentile of hand-to-mouth behavior – they do it more than 94 percent of other kids – get 9 ½ times as much from the dust.

Researchers still would like to know how much of a toxic dose those same kids are getting when they play outside in yards next to coal tar-sealed asphalt, or on the asphalt itself. The level of cancer-causing chemicals in the dust on the asphalt itself has been measured at about 37 times the levels found in house dust.

“Those concentrations are a good bit higher and this study doesn’t include that at all,” said Williams, the Baylor researcher. “That may be important because just one little fingerful could be a relevant dose,” meaning one that worries health experts.

While researchers have known about contamination of water and dust, the findings about air pollution are new. Significant amounts of PAHs continue to vaporize off coal tar-sealed lots even years after the sealant is put down.

“When we look at a seal-coated parking lots, in any direction we look we see these really strongly elevated concentrations,” said Peter Van Metre, a U.S. Geological Survey scientist based in Austin. Of the dust on the coal tar-sealed pavement, he said: “It would just take a tiny amount of that to be a large enough dose for it to be significant.”

Companies that sell and use the coal tar sealants have previously disputed the growing body of evidence of the coal tar sealants’ danger being amassed by scientists from the Geological Survey, the University of New Hampshire, Baylor and other institutions.

Repeated attempts this week to reach an industry representative, Anne LeHuray, executive director of the Pavement Coatings Technology Council, for comment on the new studies were unsuccessful. In an email on Thursday, LeHuray said she was tied up at a meeting of the pavement council in Memphis.

Generally, the pavement council has attacked previous coal tar research on technical grounds.

Read previous articles on coal tar sealants:

Study sees parking lot dust as a cancer risk

State bans coal tar sealants in big win for foes

The pavement council has fought bans – sometimes successfully – when they have been proposed by local and state governments. In addition to the local governments that have forbidden use of the coal tar sealants, some governments have placed restrictions on their use, including the state of Minnesota and the California Department of Transportation. Restrictions also are in effect in more than 40 Illinois municipalities.

U.S. Rep. Lloyd Doggett, a Democratic congressman from the Austin area, has previously filed legislation calling for a nationwide ban on coal tar sealants. He plans to refile the legislation, a Doggett spokeswoman said, but is currently embroiled in a redistricting fight.

Tom Ennis, an Austin city official who helped get coal tar sealants banned there, has now launched a campaign to support a nationwide ban.

“You’re looking at a big urban air quality” problem, Ennis said. “It’s completely unacceptable and something needs to be done.”

The studies announced this week appeared in the science journals Environmental Science and Technology, Chemosphere, Atmospheric Environment,  and  Environmental Pollution.

InvestigateWest is a non-profit journalism center based in Seattle. If you value this kind of in-depth, independent news reporting, please consider making a tax-deductible donation to support further work of this kind.

McDonald's confirmed that it has eliminated the use of ammonium hydroxide — an ingredient in fertilizers, household cleaners and some roll-your-own explosives —  in its hamburger meat.

The company denied that its decision was influenced by a months-long campaign by celebrity chef Jamie Oliver to get ammonium-hydroxide-treated meats like chicken and beef out of the U.S. food supply. But it acknowledged this week that it had stopped using the unappetizing pink goo — made from treating otherwise inedible scrap meat with the chemical — several months ago.

Besides being used as a household cleaner and in fertilizers, the compound releases flammable vapors, and with the addition of certain acids, it can be turned into ammonium nitrate, a common component in homemade bombs. It's also widely used in the food industry as an anti-microbial agent in meats and as a leavener in bread and cake products. It's regulated by the U.S. Agriculture Department, which classifies it as "generally recognized as safe."

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McDonald's decision was first reported this week by the Daily Mail, a blaring British tabloid, which trumpeted it as a victory for fellow Brit Oliver against the monolithic U.S. food industry. 

Oliver's campaign began in April, when he included a segment on what he called "pink slime" on his TV show, "Jamie Oliver's Food Revolution" (warning: some readers may find this video distasteful):

The use of treated scrap meat "to me as a chef and a food lover is shocking," Oliver said. "... Basically we're taking a product that would be sold in the cheapest form for dogs and making it 'fit' for humans."

Todd Bacon, McDonald's senior supply chain officer, told the Daily Mail that the decision "was not related to any particular event, but rather to support our effort to align our global beef raw material standards." 

In a statement, McDonald's clarified that it stopped using "select lean beef trimmings" — its preferred term for scrap meat soaked in ammonium hydroxide and ground into a pink meatlike paste — at the beginning of last year.

"This product has been out of our supply chain since August of last year," it said.

Sarah Prochaska, a registered dietitian at Barnes-Jewish Hospital in St. Louis, said that ammonium hydroxide is widely used in the U.S. food industry but that consumers may not be able to know what products include it because the USDA considers it a component in a production procedure — separating scrap meat — and not an ingredient that must be listed on food labels.

"It's a process, from what I understand, called 'mechanically separated meat' or 'meat product,'" Prochaska told NBC station KSDK of St. Louis.

While the government considers it safe, it certainly "does not look anything like ground beef," she said. And since it's not on nutrition labels, the only way to avoid it "would be to choose fresher products, cook your meat at home, cook more meals at home," she said.

NBC station KSDK of St. Louis contributed to this report.

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