Category Archives: Public health law
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.
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.
Inspired by the 2012 American Public Health Association (APHA) Annual Meeting, the Robert Wood Johnson Foundation recently talked with a range of national thought leaders to discuss what’s needed—and what works—to achieve better health.
Today, we're featuring video interviews with Mel Kohn, MD, MPH, Public Health Director and State Health Officer for Oregon.
Kohn spoke with us about the important roles that law and policy will play in the future of public health—especially as health care reform continues and expands.
He also explained how injury prevention, while a relatively new area of practice in the world of public health, can help to dramatically reduce human and financial costs for both individuals and communities.
Public Health Law Research, a national program of the Robert Wood Johnson Foundation housed at the Temple University Beasley School of Law, recently released a new, comprehensive online portal called LawAtlas that allows users to explore variation in laws across U.S. states and over time. Having more information about state laws, and their effect on health over time, is a critical step toward understanding what works to improve health. LawAtlas offers:
- Interactive Law Maps to show how certain laws differ by state and how they have changed over time.
- Policy Surveillance Reports to summarize the state of various public health laws across the country
- Data that public health law researchers can work with to expand upon existing research
NewPublicHealth caught up with Damika Webb, JD, Law Fellow at the Center for Health Law Policy and Practice at Temple University, at last week’s APHA Annual Meeting to chat about LawAtlas and how it can be used to better understand why policy surveillance is critical, and what we can learn from a program like LawAtlas.
NewPublicHealth: Why is it important to conduct research to know whether particular laws and policies are working to improve public health?
Damika Webb: By measuring the dimensions of a law, you can figure out which components of the law are having a positive or negative effect on health outcomes.
NPH: Why is it important to track how public health laws and policies differ from state to state?
Childhood lead poisoning is 100% preventable. So what's stopping us from eliminating it all together?
This week marks the 13th annual National Lead Poisoning Prevention Week, a chance to energize efforts to keep all kids safe from the dangers of lead-based paint.
Nearly one million children are affected by lead poisoning in the United States today, with 38 million U.S. households currently at risk. Lead poisoning knows no boundaries and can affect children of all races and ethnicities, in rural and urban communities, and at every socioeconomic level.
Recently, the Coalition to End Childhood Lead Poisoning, the U.S. Environmental Protection Agency (EPA), the U.S. Department of Housing and Urban Development (HUD) and the Ad Council rolled out a new partnership with the goal of eliminating childhood lead poisoning in the United States. Facts about lead poisoning:
- If not detected early, lead paint poisoning causes lifelong learning disabilities, hearing loss, speech delays, developmental disabilities and aggressive/violent behaviors
- Children under age 6 are most at risk for lead poisoning
- Any home built before 1978 is at risk for lead-based paint hazards
Lead poisoning prevention resources are available at www.LeadFreeKids.org, including information on:
Watch a Public Service Announcement from the Ad Council about the danger lead-based paint continues to have on young children.
Read more on lead poisoning prevention:
- The Centers for Disease Control and Prevention offers a map of healthy home efforts from health departments across the country.
- HUD’s Healthy Home Rating System helps identify household conditions that affect health and safety. Download the HHRS Hazards Chart to learn more about all dangers – in addition to lead – found in the home.
>>Read a Q&A on local lead laws and their impact on ending childhood lead poisoning.
A new study out this week finds New Jersey’s law requiring novice drivers to display a red decal on their license plates was effective in helping police officers enforce regulations unique to new drivers, and in preventing crashes. New Jersey is the first state in the nation to enact a decal law, which went into effect in May 2010 as part of N.J.’s Graduated Driver Licensing (GDL) law. Nearly every state has a GDL law on the books, but “Kyleigh’s Law,” named for a teen driver killed in a 2006 N.J. crash, is the first one that helps support enforcement of GDL restrictions using a visible decal.
The study showed that in its first year of implementation, the New Jersey decal law prevented an estimated 1,624 crashes by probationary drivers. Allison E. Curry, PhD, MPH, director of Epidemiology and Biostatistics at the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia, was a lead author on the study, published in the American Journal of Preventive Medicine. The study was funded by a grant from Public Health Law Research, a national program of the Robert Wood Johnson Foundation.
NewPublicHealth caught up with Allison Curry to get her take on why decals work as a law to help protect the public’s health.
NewPublicHealth: Can you summarize the new study?
Allison Curry: Graduated driver licensing (GDL) was first introduced in the U.S. around the mid-1990s and since then it’s been really effective in reducing the burden of crashes on teens. New Jersey in particular has a really progressive GDL program, and it’s served as one of the models in the U.S. But even so it still has what we would still consider an unacceptable number of crashes each year. So by introducing decals, New Jersey was trying to take their law a step further in improving the effectiveness of their GDL program.
What we wanted to understand was if the decals really did have an additional safety benefit for both adolescents and other road users. The aims were to examine the effect of the decals on both the police’s ability to enforce graduated driver licensing restrictions among probationary or intermediate drivers, as well as the crash rate among intermediate drivers (those who are in the stage between licensed permit holder and full unrestricted driver). We did this by linking New Jersey’s crash and licensing database in order to compare the rate of crashes and citations in the two years before the decal requirement was implemented, compared to the year after it was implemented.
NPH: And what were the findings?