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

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.