State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.

Critical issues include:

• A smoking ban in Kentucky which could stall in committee
• A bill in Kentucky which could restrict the work of local boards of health.
• A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.  

>>Bonus Links:

• Read the Network blog post.
• Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.

The Aspen Institute’s Justice and Society Program, with funding from the Robert Wood Johnson Foundation, is accepting applications for a new project, the Excellence in State Public Health Law program. 

The one-year program will bring together and provide resources to teams in eight states to work together to address their respective public health priorities, such as tobacco control and disaster preparedness. At the program’s conclusion, each team member will be recognized as a Fellow in the Excellence in State Public Health Law Program.

>>Apply here for the Excellence in State Public Health Law program, and join a web conference the program hosted by the Aspen Institute on Wednesday February 20 from 1-2 pm EST.

As the application process begins, NewPublicHealth spoke with Meryl Chertoff, JD, Director of The Aspen Institute’s Justice and Society Program, and program director of the Excellence in State Public Health Law Program, and Leah Devlin, DDS, MPH, former health official of North Carolina and a past president of the Association of State and Territorial Health Officials, who is a consultant to this program.

NewPublicHealth: Tell us about the program.

Meryl Chertoff: The post-Affordable Care Act period is an excellent opportunity to focus on public health innovation through state legislative and regulatory activities. The goal of the program is to provide key people working in public health law with additional tools, networks and opportunities to share best practices and innovations in their state.  Especially in a time of economic shortfalls, we have to do more with less. We have to support legislators, advisors to governors and relevant agency officials in their ongoing efforts to use public funds in the smartest way and to build the partnerships that they need in order to effectively leverage the assets that are available to them. We are very much hoping that the initiatives that are undertaken will utilize evidenced-based research in order to improve public health

Leah Devlin: And it’s about building partnerships, which is important in this environment because there are so many new governors, new legislators, and new state health officials. We have our biggest health gains when we develop a sound health policy. So bringing together these high level leaders within a state who may be working together on a public health issue for the first time will be a very powerful approach.  It is important to note that the teams can also include local health directors who are also critical players for successful health policy development in states.

NPH: Who will be part of the teams?

A new study funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation at Temple University, addresses the consequences of weak penalties for domestic violence offenders in the U.S.

Domestic violence, also known as intimate partner violence, accounts for an estimated 1,200 deaths and two million injuries among women each year. The new study, authored by Frank Sloan, PhD, professor of health policy and management at Duke University, and published in the journal Risk and Uncertainty, reviewed data from the North Carolina administrative courts and found that there are often repeat offenses for men arrested for domestic violence and that penalties don’t seem to significantly reduce repeat arrests or convictions.

Sloan points to low prosecution rates and minimal fines as reasons behind many repeat offenses. The study did find, however, that defendants who hired a private lawyer are less likely to be arrested or convicted during the follow-up period because the added costs may be a deterrent.  

The keynote address at last week’s 2013 Public Health Law Research (PHLR) annual meeting was from Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

“People are just beginning to wake up to the knowledge that behavioral health [issues are] so common and that half of all Americans have a mental health issue at sometime in their lives,” Hyde told meeting attendees. Depression, according to the World Health Organization, is the most common medical disorder worldwide. And among the eight million people in the past year who had a mental illness or a substance abuse disorder, only 6.9 percent received treatment.

“The country has to spend as much time helping children develop their emotional skills as they do their soccer skills,” said Hyde.

Just prior to the PHLR meeting, NewPublicHealth spoke with Administrator Hyde about public health law research and some new initiatives aimed at helping address behavioral health in the United States.

NewPublicHealth: What research is critically needed on mental health issues to help improve awareness and treatment?

Pamela Hyde: Often people don’t think of behavioral health as part of the larger public health message or initiatives or infrastructure in the country and so they don’t think about mental health research when they think about other kinds of public health research. But you can think about behavioral health needs in the same way. It is just important to protect people from lost hope as it is to protect them from bacteria in the water.

Thomas Farley, MD, MPH, Health Commissioner of the New York City Department of Health and Mental Hygiene, is the keynote speaker at the opening session of the Public Health Law Research annual meeting that started yesterday afternoon in New Orleans. In advance of the meeting, NewPublicHealth spoke with Dr. Farley about the role of legal research in moving the public health agenda forward, how New York City is doing in the weeks following Hurricane Sandy, and the flu epidemic hitting the city that prompted New York State Governor Cuomo to declare a public health emergency earlier this week.

NewPublicHealth: What will you focus on during your address at the Public Health Law Research Program annual meeting?

Dr. Farley: I will be going through a number of policies that we have put in place here in New York City to promote health. Most of those will be around food, but some will be around tobacco. So that includes things such as our raising of tobacco taxes, our smoke-free air rule and around our prohibition on the use of trans fats in restaurants, our calorie labeling initiative and our portion rule [limits on beverage sizes at some food outlets]. And I will share some thoughts about the role researchers can play in policy development for an agency like ours.

NPH: How important has legal research been for some of the recent public health initiatives that have been introduced in New York City?

Citric acid-based drinks have been linked to devastating tooth erosion, especially in Central Appalachia where the drinks are widely consumed by people of all ages. The issue was selected for a five-minute “Critical Opportunities” presentation that garnered more votes than any other issue in the session at the most recent Public Health Law Conference. This year, the issue has moved to a general session on the main day of the Public Health Law Research (PHLR) Annual Meeting, as an emerging issue in public health law. Priscilla Harris, JD, an associate professor with the Appalachian School of Law in Grundy, Va., will present “Finding Legal Interventions to Impact Purchase and Consumption of Sugar-Sweetened Beverages and Citric Acid Drinks: Trying to undo the damage of the Dew.”

According to the American Dental Association, 65 percent of West Virginia's children ages three through seven suffer from tooth decay—and near-constant sipping of Mountain Dew and other citric acid-based drinks plays a role. Harris, together with Dana Singer, JD, a program developer and researcher at the Mid-Ohio Valley Health Department and Mary Beth Shea, a dental hygienist with the health department, spoke at an information session to the Mid-Ohio Valley Board of Health a few weeks ago to present the research they have worked on to show the damaging health effects of the beverages for the people of the region. NewPublicHealth spoke with the three public health professionals just before the PHLR annual meeting began.

NewPublicHealth: What research are you working on to look at the impact of citric acid on tooth health?

Priscilla Norwood Harris: We conducted surveys to determine purchase and consumption patterns for sugar-sweetened beverages and citric acid drinks. We also interviewed and sent surveys to dentists in Central Appalachia about their perceptions of oral health problems in the region. We also went to five clinics that offer medical, dental and vision care to low-income people, and asked patients about these drinks. In addition, have almost 2,000 surveys of students in grades K through 12. We have also reviewed journal articles, many from Europe, that examine the issue of dental erosion. While it’s under the radar here in America, the studies we’ve reviewed are making the connection between dental erosion and the citric acid in drinks.

A lot of the attention in the U.S. has been focused on the sugar in these drinks and their contribution to obesity as well as the sugar with regard to oral health and cavities. Unfortunately, the acids in these drinks and the connection to dental erosion have been almost ignored. “Mountain Dew Mouth,” a term used in Central Appalachia for severely damaged teeth, involves the acids in these drinks, which can take away the tooth’s enamel.

Mary Beth Shea: From a dental health professionals’ perspective, we see a high number of adults who have said they didn’t have a clue that the beverages they’re consuming are causing the damage in their mouth and they haven’t had money for dental care.

Scott Burris, JD, is the director of Public Health Law Research, a program at the Robert Wood Johnson Foundation at Temple University. Ahead of PHLR’s annual meeting in New Orleans this week, NewPublicHealth spoke with Burris about the meeting and the impact of legal research on the public’s health.

NewPublicHealth: What’s most exciting for you about the upcoming conference?

Scott Burris: We’re very excited that we sold out again. We’re going to be standing-room only. That’s great enthusiasm. We all want to see the results of research in the field and so I’m looking forward to those sessions on Thursday when people present their work. And I’m really looking forward to what’s signified by the great interest in attendance beyond our grantee pool, and that is the momentum that’s now behind law as a tool for intervention in public health. And I think, even more than that, the real momentum is behind using research as the key way to figure out which laws you want to use [to impact public health] and which you don’t. The fight now about the gun issue has been coming back to that theme again and again. It’s not just that there’s an appetite for reasonable, effective regulation of firearms—it’s that it’s often hard to know what that would be because of two decades of efforts to suppress data and suppress research. People are saying we’ve got to have good research to help us come up with common ground.

NPH: How much do you think the gun issue will be a factor in discussions both in presentations and in audience conversation when you meet this week?

Scott Burris: I actually think it won’t leap out as a primary, explicit focus of discussion because it represents the same issue we talk about again and again that says that we have health threats, health problems that can effectively be addressed by law, but we have to have enough political space for innovation, for people to try things on a small scale. We have to have support for evaluation so we can figure out whether those innovations are effective. And then we have to go through a cycle of continuing to look at the refinements of the interventions and figuring out which parts of them work best. We’ve seen that happen in a lot of the public health law research area around driving. We’ve seen it happen, to some degree, in the smoking area. Really, every area we have people working in that same dynamic is relevant, and so I think that the gun example is just an instance of this broader theme that law is making a huge difference in public health. But law also often requires politics, law requires lawmaking, and to get laws passed requires consensus, and consensus requires a common view of reality. We all don’t have to agree on everything and there are definitely important values that can differ and then make a difference to public health politics, but it really helps to know that we can save lives or prevent injuries if we do X, Y and Z. It’s surprising how often people come to that point; you can have enough consensuses to get law passed.

Public Health Law Research (PHLR), a program of the Robert Wood Johnson Foundation, will hold its annual meeting in New Orleans this week. NewPublicHealth will be on the ground covering sessions on research in public health law as well as posting interviews with conference speakers including Thomas Farley, MD, MPH, Health Commissioner of New York City and Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

In advance of the conference, NewPublicHealth spoke with Diana Silver, PhD, MPH, assistant professor of public health at the Steinhardt School of Culture, Education and Human Development at New York University. Silver’s research looks at the impact of public and private services on health and well-being for children and families, especially in urban America. Her presentation at the PHLR annual meeting is called “Are More Laws Better?” with a specific  look at what has happened to traffic fatalities between 1980 and 2009 as new laws have been implemented in some parts of the country.

NewPublicHealth: Tell us about your research on laws and traffic fatalities.

Diana Silver: The motivating idea here was that there are multiple laws at the state level that govern traffic safety. Some deal with alcohol, some deal with restraining children one way or another in the car, some are about the vehicle itself such as seatbelts or speed limits. The laws vary at the state level, and they create, in some sense, really different environments that people are exposed to. We have now categorized across 30 years 25 different laws in all 50 states. 

What we found is that there are some laws that virtually all states have adopted, mostly because there’s been a federal mandate to do so, like a minimum legal drinking age. But many laws vary across states, and so we were interested to find out what factors predicted whether a state would pick up new laws and how quickly they would do that. Then, how do these different packages predict, or are they associated with reductions in motor vehicle fatalities?

NPH: How was your research different than other research that looks at this data?

Following the shootings of 26 people, including twenty children, in Newtown earlier this month, three American Medical Association journals have published articles that take a hard look at gun violence in the United States.

• An article in the Journal of the American Medical Association looks at reduced funding in the last few years for gun injury prevention research, while increased funding for other types of injury prevention such as motor vehicle crashes, has resulted in fewer deaths.
• An essay in the Archives of Internal Medicine looks at guns as “weapons of mass destruction” and suggests strategies to reduce citizen casualties and mass shootings.
• Two contributors in the Archives of Pediatric and Adolescent Medicine write about the Florida law that prevents health care professionals from asking patients or families about firearms in the home.

 Bonus Links:

Read a blog post from the Network for Public Health Law on strategies that may help reduce mass shootings in the U.S. The author, Leila Barraza, JD, MPH, Deputy Director, Network for Public Health Law-Western Region, says that while increased mental health coverage and screenings and gun controls alone will likely not be enough to prevent mass shootings, “the public health law community will have a vital role to play as policies are created and evaluated.”

Read a recent NewPublicHealth interview with Jeffrey Swanson, PHD, a professor of psychiatry and behavioral sciences at Duke University School of Medicine, on how laws can help prevent gun violence.

As the nation grapples with last week’s school shooting in Connecticut, discussions across the nation are focused on how we can reduce gun-related violence and the devastation it causes. NewPublicHealth joins that conversation today, beginning with an interview with Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University School of Medicine. Swanson is a member of the Methods Core of the Public Health Law Research (PHLR) program at Temple University, a project of the Robert Wood Johnson Foundation. The researchers analyze the intersection of public health and law, selecting studies for funding and providing technical assistance and support to strengthen research on law and health.

>> Read a blog post by Scott Burris, director of PHLR, on developing new laws to increase the safety of having guns in society.

An article published last year by Dr. Swanson following the shooting of Congresswoman Gabrielle Giffords and eighteen other people in Tucson, Arizona, argued that homicides committed with guns against strangers by individuals with mental disorders occur far too infrequently to allow for explanatory statistical modeling and predictability. However, improving treatment access, continuity and adherence for people with serious mental illnesses can help prevent some violent episodes, according to Swanson.

NewPublicHealth spoke with Swanson a few days after the shooting in Newtown, Conn.

NewPublicHealth: What is the role of law and public health in efforts to prevent gun and other forms of violence?

Swanson: We need to think about gun violence as a public health problem. Homicide and suicide are the second- and third-leading causes of mortality in the U.S. population ages 15-34, and firearms are involved in most violent fatalities. In theory, the law should be an effective public health tool in trying to address the problem. Law can regulate what kinds of guns are available, where they can used, by whom, and even how they are stored. But since the U.S. Constitution protects a citizen’s basic right to possess a gun, the law can’t go too far in limiting legal access to guns in the population. That means we have to focus more on trying to identify dangerous people who should not have guns. That’s very complicated, because violence is complicated and so are people. The law could be used even more effectively, though, if we had better research evidence about what features of gun laws and policies work best to protect safety while safeguarding civil rights. That’s what we’re trying to do.