Public Health Topics
Federal
Publication Date: 12/07/2009
The Problem:
Tooth decay, also known as dental caries, remains a major public health problem. Fifty-nine percent of persons aged 12 to 19 suffer from tooth decay. CDC: Dental Caries Fact Sheet. Advanced tooth decay can cause significant pain and loss of the teeth, and can be costly to treat. CDC: Oral Health: At a Glance: 2009
The Law:
Milk fluoridation is required or authorized in various countries in Europe and elsewhere. In the US, milk fluoridation is not currently legal because it lacks FDA approval. However, for US jurisdictions without community water fluoridation, fluoridated milk may be a promising alternative source of fluoride.
The Evidence:
In a systematic review, Yeung et al. reviewed two randomized trials evaluating the effectiveness of milk fluoridation programs on reducing dental caries. Yeung A, et al. Fluoridated milk for preventing dental caries. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.:CD003876. Both trials compared the effects of fluoridated milk with non-fluoridated milk on community dental health. Effectiveness was measured by changes in decayed, missing, or filled teeth. One of the studies found a significant association between fluoridated milk and reduction in tooth decay; the other found a much less substantial association over a longer time period. Based on these findings and the limited number of primary studies, the reviewers concluded that milk fluoridation may be a promising intervention, but that there is currently insufficient evidence to establish its effectiveness as a measure aimed at improving oral health.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to establish the effectiveness of milk fluoridation as a public health intervention aimed at reducing tooth decay.
Publication Date: 12/07/2009
The Problem:
Firearms are the second leading cause of injury and deaths in the United States accounting for 30,896 deaths and 71,417 injuries in 2006. Over 80 percent of teen homicides and almost half of teen suicides in involved a gun in 2005. CDC: WISQUARS. Overall, more than half of all homicides involve a gun. US Department of Justice: Crime Statistics.
The Law:
The federal government, through the Interim Brady Handgun Violence Prevention Act, in place from 1993 to 1998, established a five-day waiting period for the purchase of a firearm. In 1998, the Brady Handgun Violence Prevention Act (18 U.S.C. §921-922) updated the Interim Brady Law, replacing the five day waiting period and the mandatory background check conducted by law enforcement officials with an instant computerized background check that typically takes a few seconds (but may take up to three days). Some states have implemented longer waiting periods; for example, California’s waiting period is 10 days (Cal. Penal Code §§ 12071(b)(3)(A), 12072(c)(1)) and New York’s waiting period can be up to six months (NY PEN § 400.00(4-a)). The aim of waiting periods is to allow time to complete background checks on the purchaser and to provide time for individuals with impulsive violent intentions to “cool off.”
The Evidence:
Hahn et al. reviewed seven studies that measured the effects of waiting periods on murder, aggravated assault, robbery, rape, firearm-related suicide, and unintentional firearm injury. Hahn, et al. Firearms laws and the reduction of violence: a systemic review. Am J Prev Med. 2005;28(2S1):40-71. The reviewers found the underlying studies to have a number of methodological limitations. The findings of the underlying studies were inconsistent and or statistically insignificant. For there reasons, the reviewers were unable to determine the effectiveness of waiting periods laws as interventions aimed at reducing gun-related harms.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to determine the effectiveness of waiting period laws as public health interventions aimed at preventing gun-related violence and suicide.
Additional Information:
For more information on the Brady Act National Instantaneous Criminal Background Check System (NICS), see the FBI’s NICS factsheet.
A new firearms research database launched by the Harvard School of Public Health makes scholarly articles more accessible to reporters, law enforcement, public health officials, policymakers, and the general public. The Firearms Research Digest provides summaries of articles gathered from social science, criminology, medical and public health journals and is written in clear, accessible language for use by those outside academia.
The website currently covers six years of research published between 2003 and 2008. The digest will be expanded over time to include articles from 1988 to the present.
Additional Resources: Brady Act National Instantaneous Criminal Background Check System , The Firearms Research Digest
Publication Date: 12/07/2009
The Problem:
Firearms are the second leading cause of injury and deaths in the United States accounting for 30,896 deaths and 71,417 injuries in 2006. Over 80 percent of teen homicides and almost half of teen suicides involved a gun in 2005. CDC: WISQUARS. Overall, more than half of all homicides involve a gun. US Department of Justice: Crime Statistics.
The Law:
Federal, state, and local laws prohibit specific firearms and ammunition. These bans often apply to firearms and ammunition viewed as exceedingly dangerous and not regularly used for hunting (e.g., hollow point bullets in New Jersey, N.J.S. 2C:39-3(f)). In 1994 Congress passed the Violent Crime Control and Law Enforcement Act (VCCLEA), which proscribed the manufacture, transfer, and possession of semiautomatic assault weapons and large capacity magazines. VCCLEA expired in 2004. State laws have also targeted guns disproportionately involved in crimes, such as inexpensive, small-caliber handguns (e.g., “Saturday night specials,” in Massachusetts, 140 MGL 123, 501 CMR 7.00) and assault pistols (e.g., MD Crim Code §4-303 (Maryland)). In 1976, Washington D.C. banned the transfer and possession of all handguns (DC ST §§7–2502.01(a), 7–2502.02(a)(4)). Provisions of this law were found unconstitutional in District of Columbia v. Heller, 128 S.Ct. 2783 (2008).
The Evidence:
Hahn et al. reviewed nine studies that measured the impact of state or local bans on specific firearms and ammunition. Hahn, et al. Firearms laws and the reduction of violence: a systemic review. Am J Prev Med. 2005;28(2S1):40-71. Five of the studies examined the impact of the Washington D.C. handgun ban; one study examined the impact of the VCCLEA provisions banning assault weapons and large capacity ammunition; and one measured the impact of a ban on Saturday night specials. Outcomes measured included intentional firearm injury, gun-related suicide, and unintentional firearm injury. The remaining studies measured the proportion of banned firearms (Saturday Night Specials and assault pistols) in Maryland among all firearms involved in crimes. Although there was some positive evidence suggesting a link between VCCLEA and reductions in homicides and between the banning of Saturday Night Specials in Maryland and reduction of such guns in Maryland crime, the studies also found inconsistent results. Based on the findings and the limited number of primary studies, the reviewers concluded that there is currently not enough evidence to validate the effectiveness of bans on specific firearms and ammunition as a public health measure.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to establish the effectiveness of such bans as public health interventions aimed at reducing gun-related harms.
Additional Information:
A new firearms research database launched by the Harvard School of Public Health makes scholarly articles more accessible to reporters, law enforcement, public health officials, policymakers, and the general public. The Firearms Research Digest provides summaries of articles gathered from social science, criminology, medical and public health journals and is written in clear, accessible language for use by those outside academia.
The website currently covers six years of research published between 2003 and 2008. The digest will be expanded over time to include articles from 1988 to the present.
Additional Resources: Bureau of Alcohol, Tobacco and Firearms, The Firearms Research Digest
Publication Date: 12/07/2009
The Problem:
The operation of motor vehicles while intoxicated is a major public health problem. Each year in the United States roughly 13,400 people die and an additional 255,500 are injured in motor vehicle crashes involving an alcohol-impaired driver. In 2006, these crashes accounted for almost a third of all U.S. traffic-related deaths. Drivers age 16 to 20 who engage in drunk driving pose an especially dangerous risk to themselves and other motorists. CDC: Impaired Driving Factsheet.
The Law:
All U.S. states currently set the minimum legal drinking age at 21 years (MLDA21). Federal legislation withholds federal highway funds from states that do not adopt an MLDA of 21 years (23 U.S.C. § 158). For examples of MLDA21 laws, see TX Alcoholic Beverage Code § 106.04 (Texas), Conn. Gen. Stat. 30-1(12) and Conn. Gen. Stat. §30-89 (Connecticut).
The Evidence:
Two independent systematic reviews of the relevant studies of this intervention have found a robust association between raising the MLDA to 21 and reductions in alcohol-related crashes. In a Community Guide systematic review, Shults et al. reviewed 33 studies that examined the effect of MLDA21 on fatal and nonfatal crashes likely to have involved alcohol. Shults, et al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. Am J Prev Med. 2001;21(4S):66-88. Seventeen of the underlying studies evaluated the impact of raising the MLDA to 21, 11 evaluated laws that lowered the MLDA, and remaining 18 used regression analysis to measure changes in both directions. The review found a median reduction in alcohol-related crashes of 17 percent associated with raising the MLDA and a median increase of 8 percent in alcohol-related crashes associated with lowering the MLDA.
Wagenaar and Toomey reviewed 48 studies that measured the impact of MLDA21 on alcohol consumption and reviewed 57 studies that measured the impact of MLDA21 on alcohol-related crashes. Wagenaar, Toomey. Effects of Minimum Drinking age Laws: Review and Analyses of the Literature from 1960 to 2000. Journal of Studies on Alcohol. 2002(14 Suppl):206-25. Across the 48 studies, the authors identified 27 measures finding a statistically significant inverse relationship between MLDA21 and alcohol consumption (8 found a statistically insignificant inverse relationship; 5 found a positive relationship). Some of the measures included, for example, self-reported alcohol consumption and sale of particular alcoholic beverages. Fifty-two measures were indentified finding a statistically significant inverse relation between MLDA21 and crashes (12 found a statistically insignificant inverse relationship; 2 found a positive relationship). These measures included a broad range of types of injuries and crashes outcomes (e.g., nighttime fatal crashes, alcohol-related crashes).
The Bottom Line:
In the judgment of a Community Guide expert panel and the authors of a peer-reviewed systematic study, there is strong evidence to support the effectiveness of MLDA21 as an intervention aimed at reducing alcohol involved motor vehicle crashes.
Additional Information:
The Community Guide provides online access to a table summarizing the results of each study it reviewed.
Additional Resources: The Community Guide
Publication Date: 12/07/2009
The Problem:
Youth violence is an enormous public health problem in the United States, standing as the second leading cause of death for people between the ages of 10 and 24. CDC, National Center for Injury Prevention and Control. WISQRS. Juvenile court systems have often been criticized for inadequately deterring and poorly preventing recidivism among violent youthful offenders. Steiner B, Hemmens C, Bell V. Legislative Waiver Reconsidered: General Deterrent Effects of Statutory Exclusion Laws Enacted Post-1979. Justice Quarterly. 2006;23(1):34-59.
The Law:
All states have adopted laws that allow judicial waiver of jurisdiction by the juvenile court system, which sends young offenders to adult criminal systems. Some states use a discretionary approach, giving deference to the juvenile court judge. Other states employ an automatic approach: jurisdiction is waived for specific violent offenses or when the offender has prior violent arrests. For examples of juvenile waiver laws, see RCW 13.40.110 (Washington), Fla Stat § 985.556 (Florida), and MN Stats 260B.101 (Minnesota).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed seven studies evaluating the impact of six laws allowing juvenile transfer. McGowan A, Hahn R, Liberman A, et al. Effects on violence of laws and policies facilitating the transfer of juveniles from the juvenile justice system to the adult justice system: a systematic review. Am J Prev Med 2007;32(4S):S7–S28. Across the studies, the reviewers observed an overall negative effect. Notably, there was a 34 percent median increase in recidivism among youths processed though adult systems compared to those retained in the juvenile courts. In addition, transfer of youths led to an increase in pretrial violence, victimization and violence in adult facilities, and elevated suicide rates among the incarcerated youths. According to the expert panel, there was not enough evidence to determine the true effect of waiver as a deterrent.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is sufficient evidence to conclude that processing youths through adult systems has a negative impact on public health.
Additional Resources: Heilbrun, et al. A National Survey of US Statutes on juvenile transfer: implications for policy and practice. Behavioral Sciences and the Law. 1998;15(2):125-149.
