North Carolina’s New Four-Year Brain Injury Plan and Statewide Screening Tool

Diagram of OBISSS online brain injury screening and support system with five steps

North Carolina has launched a new statewide strategy to help residents living with traumatic brain injury. The North Carolina Department of Health and Human Services announced its 2026–2029 Traumatic Brain Injury State Action Plan on July 22, 2026; the plan officially took effect July 1. Developed by the Division of Mental Health, Developmental Disabilities and Substance Use Services alongside NC Medicaid, the Division of Public Health, and the Brain Injury Advisory Council, it centers on four priorities: expanding access to services, strengthening provider support, bolstering resources for people with TBI and their caregivers, and equipping communities to prevent injuries.

“Really listening to those most impacted by TBI was essential to developing strategies that will improve their quality of life,” said Kelly Crosbie, assistant secretary for mental health, developmental disabilities and substance use services.

The need is significant. In 2024, roughly 8,260 North Carolinians were hospitalized for TBI, more than 32,000 visited emergency departments, and 2,668 died from TBI-related causes, with falls the leading cause.

One of the plan’s first initiatives, the Online Brain Injury Screening & Support System (OBISSS), goes live August 1. Created by the National Association of State Head Injury Administrators, this free and confidential tool identifies an individual’s exposure to brain injury.

Protecting & Rejuvenating Brains at the Pool This Summer

Three children playing and splashing in ocean waves at the beach
Swimmer diving into outdoor pool lane 4 with splash

On June 24, 2026, the U.S. Consumer Product Safety Commission released new data on child drowning. An average of 376 children under 15 died in pool and spa incidents each year from 2021 to 2023. Of these fatalities, nearly 80% of the victims are under age five, and more than 70% of incidents at residential homes.

Less visible are the roughly 8,000 nonfatal drownings annually, as both adult and youth survivors of such incidents can sustain lasting brain damage. Diving adds a second summer hazard, particularly head-first impact in shallow water drives force straight through the neck.

While these numbers may cause worry, time in the water can safely stay one of the best parts of the summer by following some rules, including:

  1. Assign a sober “water watcher”
  2. Install four-sided fencing with self-latching gates
  3. Enroll children in swimming lessons
  4. Learn CPR
  5. Enter unfamiliar water feet-first
Woman performing water exercise with therapist assistance in swimming pool

On the other side of the spectrum, for those in recovery from a brain injury, aquatic therapy (AT) is a highly recognized form of treatment. A 2020 PubMed-available study found that “the use of AT during post-acute phase to improve motor functions and quality of life in patients with s[evere]TBI.” In March 2026, a new in-depth review of this subject was published on PubMed: Aquatic Therapy as a Programmable Multisensory Environment for Arousal and Postural Control After Severe Acquired Brain Injury.

Senate’s College Sports Overhaul Includes Safety

On June 2, the Protect College Sports Act, S.4668, was introduced June 2 by Senate Commerce Committee Chairman Ted Cruz (TX) alongside Ranking Member Maria Cantwell (WA), Senator Eric Schmitt (MO) and Senator Chris Coons (DE). Chiefly an overhaul of name, image and likeness rules, “It [also] establishes strong health and safety protections,” stated Cruz on June 3, a day that was headlined by a hearing with the former Alabama coach Nick Saban. The legislation would require concussion and brain-injury safety standards enforced by independent officers and create a $60 million annual trust fund for long-term conditions such as CTE.

Infographic showing four pillars of college sports safety: injury prevention, facility safety, medical support, and education preparedness.

The committee voted 19-9 on June 18 to advance it, and it now sits on the Senate calendar awaiting a floor vote. Last week, on July 13, 2026, the bipartisan Protect College Sports Act picked up two new backers, as Senators Shelley Moore Capito (WV) and Peter Welch (VT) signed on as cosponsors. Days later, Senator Eric Schmitt told the Associated Press Sports Editors that they “probably have 60 votes,” meeting the threshold the measure needs to clear the full Senate.

The bill is backed by the NCAA but is opposed by the SEC and Big Ten. However, this opposition appears to be against financial aspects of the bill and about over government overreach, and not about new safety standards. Additionally, a House companion bill, H.R. 9137, remains in committee. President Trump has urged passage “this summer”.

Hawaii’s New Strick E-Bike Law to Prevent Brain Injury

Dr. Josh Green in white coat with stethoscope in office and Hawaiian flag

Governor Josh Green signed Act 259 (HB 2021) on July 15, 2026, giving Hawaii its first comprehensive statewide e-bike framework. The law requires helmets for all riders under 18, bars anyone under 15 from operating an e-bike, and prohibits riders under 16 from using Class 2 or Class 3 models without adult supervision.

The measure grew out of an alarming rise in head trauma. Hawaii Department of Health data reported that e-bike injuries more than doubled between 2022 and 2025, from 106 to 244. Honolulu EMS also found that 81 percent of the e-bike patients that were treated wore no head protection. Honolulu-based Kapi’olani Medical Center’s trauma team reported that e-bike crashes recently became the leading cause of injury among the children it treated.

Man riding a bicycle on the sandy beach during sunset

Green, previously an emergency physician, has been blunt about the stakes. “If they have a head trauma, they’re probably going to have long-standing disability from the traumatic head injury,” he said in a September 2025 interview.

The law also reclassifies machines exceeding 28 mph as e-motorcycles, subject to licensing, registration, and insurance. California imposes comparable rules, while New Jersey now goes further, requiring helmets for e-bike riders of every age.

See also: E-Bikes and Brain Injury: The Risks, the Recovery, and the Law

Widely Used Birth Control Comes With Brain-shaped Asterisk

Vial of Depo-Provera and syringe on medical tray

Per the CDC, roughly 1 in 4 sexually active American women have used the form of birth control Depo-Provera. Studies, though, found that the effects of this injectable go beyond contraception. The government paper trail also keeps growing, regarding the risks it may cause.  A JAMA Neurology study found a 2.43-fold higher risk for developing a brain tumor among users. Just this month, on July 2, 2026, another JAMA study flagged the injection as having the strongest risk of brain tumor development of any contraceptive. (This study also reported reassuring news: risk fades within roughly five years of stopping. Additionally, absolute risk stays low, as less than 5 in 10,000 women have this extremely negative effect.)

According to the Mayo Clinic, “Depo-Provera is a birth control shot that has the hormone progestin.” In actuality, it injects medroxyprogesterone acetate, a synthetic version of the natural hormone progesterone.  Long-term use of this injection can result in meningiomas, which are usually benign brain tumors. Meningiomas, though, can crowd the brain, triggering headaches, vision loss, and seizures. In December 2025, the U.S. Food and Drug Administration ordered a warning on the Depo-Provera label.

Meanwhile, Pfizer reached a June 2026 settlement covering over 5,500 federal lawsuits alleging it downplayed the danger. Though this number may seem large, the percent of Depo-Provera users it represents is small. So, users shouldn’t panic but should talk to their doctor about duration of use.

The Post-TBI Weight Gain No Diet Could Stop Until Now

For some survivors, uncontrollable gain weight can be a consequence of a brain injury. The condition, known as acquired hypothalamic obesity, strikes when there is damage to the hypothalamus, the brain region that regulates hunger and energy balance. Once that control center is disrupted, patients are left with relentless hunger and rapid weight gain that resists diet and exercise alone. (Most often, the condition follows treatment for brain tumors, but traumatic brain injuries and strokes can trigger it too.)

Pharmacist pointing at a medication bottle while a woman and a young man listen

Those with this condition previously have nowhere to turn for real help, but that changed on March 19, 2026: the U.S. Food and Drug Administration approved setmelanotide, sold as Imcivree, as the first therapy specifically designated for this rare disease. The drug works by restoring hormone signaling along the MC4R pathway, which is the same circuit the injury disrupts.

The approval followed the largest placebo-controlled study ever conducted for this condition, published in the New England Journal of Medicine on July 8, 2026. Patients on the drug saw a 16.5 percent average drop in BMI, compared with a 3.3 percent increase among those on the placebo. Trial co-author Dr. Reema Habiby confirms, “These results offer real hope to children and families who have had very few options.”

Group-home Debate in NH Focuses on Those With Brain Disorders

Elderly man with walker, young woman wearing helmet, and caregiver talking outside a blue assisted living home

New Hampshire’s group homes for people with brain injuries and developmental disabilities are getting new legislative scrutiny: Gov. Kelly Ayotte signed House Bill 1763 into law on June 19, 2026, creating a committee to study how these residences are sited, built and maintained statewide, and whether siting disputes push vulnerable residents from needed care.

The panel, which was formed after neighbors in towns like Bow objected to state-backed homes appearing without notice, must report findings by Nov. 1, 2026. Sponsor Rep. Mike Drago said “residents feel blindsided” when facilities open unannounced. Disability advocate Lisa Beaudoin countered that “it is perfectly safe to have people with developmental disabilities in one’s neighborhood.” More so, advocates state that it is needed, as New Hampshire’s estimated 2,000 residents with acquired brain disorders rely on such housing to stay near family and services.

New Hampshire isn’t first to grapple with this tension. California has guaranteed small group homes equal footing with single-family houses since 1978. Connecticut adopted similar zoning-parity protections around 1980, later adding density limits after litigation. New York took a study-first approach in 2025, forming a working group on group-home families – a path New Hampshire now follows, as well.

Update: Mercury on the Mind

Industrial refinery at sunset with a yellow danger sign warning of mercury area and hazardous chemicals

Mercury is a potent neurotoxin. It is particularly dangerous for pregnant women and young children. As a 2018 TBI on the Hill piece noted, mercury exposure “may delay developmental milestones” in fetuses and children, and acute poisoning can bring tremors, slurred speech, and hallucinations.

The EPA finalized the 2012 Mercury and Air Toxics Standards, targeting coal- and oil-fired power plants. In 2024, these standards were tightened by Congress. Supporters of this heightening of standards argued that the tighter limits reduced toxic exposures tied to neurological harm. Critics countered that by 2021 mercury emissions were already down 90% from pre-2012 levels, and the 2024 update’s compliance costs outweighed its measurable benefits.

In February 2026, the EPA repealed the 2024 update, reverting to 2012 standards. In turn, on April 27, 2026, Senator Whitehouse (RI) introduced S.J.188 to reinstate 2024 standards, which would nullify the presidential proclamation from earlier this year. When the Act went to the Senate floor on June 3, 2026, the resolution failed 46-53, with voting falling in party lines, as they considered (1) Did the 2024 rule cause unnecessary economic stress on the industry, costs that are then passed on to the consumer”, and/or (2) Are the brain-protective regulations too great for the government to ignore?

A Dangerous TBI Two-Way Street

A traumatic brain injury doesn’t just raise your risk of later neurological disorders; preexisting neurological disorders may raise the risk of brain injury, concludes a recent 2026 study from the San Francisco Veterans Affairs Health Care System.

Diagram showing circular relationship between brain injury and epilepsy with arrows indicating feedback loop and mutual exacerbation of seizures and brain damage

Published June 17, 2026. in the journal Neurology, the Department of Defense-supported study tracked more than 55,000 older veterans. Scientists found that traumatic brain injury was tied to higher rates of stroke, dementia, epilepsy, and Parkinson’s disease both before and after the injury. “Our findings raise the possibility that… [pre-existing brain diseases] are themselves risk factors for TBI in older people,” said study author Carrie Peltz, PhD, of the San Francisco Veterans Affairs Health Care System.

In the year before a TBI, older veterans were about three times more likely to have been diagnosed with stroke, dementia, or Parkinson’s and more than four times more likely to have epilepsy. After a TBI, they were roughly twice as likely to have a stroke or epilepsy. This results greatly build on an Oxford Academic, PubMed-accessible, 2025 study that found, “Among those with TBI, patients with pre-injury dementia had particularly high chronic mortality.” While causality has not firmly been medically defined, the study’s results are clear.

Women With Brain Injuries Less Likely to Reach Trauma Centers – But the Full Picture Matters

Male patient with head injury eating with visitor and female patient with head injury writing

A major new study published June 15, 2026, in the Canadian Medical Association Journal (CMAJ), and found in the PubMed database, reveals a striking inequity: women hospitalized with traumatic brain injury (TBI) in Ontario are significantly less likely than men to be admitted to specialized (Level I or II) trauma centers. After adjusting for age, injury severity, comorbidities, and income, women’s odds for prompt treatment remain 26% lower (OR 0.74) than that of men.

The finding echoes earlier work: a 2022 US study found that female trauma patients, including those with TBI, experienced longer delays to reach trauma care than men even after accounting for injury severity and type. An accompanying editorial was pointedly titled “Sex Disparities in Trauma Care -Why Are the Women Waiting?” Other U.S. research similarly documents women being undertriaged in emergency departments despite comparable injuries.

Yet context is essential. Per CDC data reported in 2018 and 2020, males were nearly two times more likely to be hospitalized for a TBI (79.9 age-adjusted rate versus 43.7) and three times more likely to die from one than females (28.3 versus 8.4). Even in the Ontario study, men had more severe head trauma (33% vs 25%). The disparity in care is real and demands attention, but men remain more likely to sustain, and die from, TBI overall.