Public Health Topics
Local
This project considers children who are overweight, the most common health problem facing American childeren. States, and to a lesser extent, local governments, have passed a variety of laws aimed at reducing youths’ exposure to high-calorie, low-nutrient foods and encouraging physical activity. What measures work?
Funding Date: Tue, 12/01/2009
Researching Institution: Harvard University
Researcher: Michelle Mello, J.D., Ph.D.
This project explores the nexus between criminal justice and public health. Criminal justice professionals are increasingly concerned with developing ‘evidence-based’ policy, and making sure that their efforts are targeted and effective. This is the case with the Philadelphia Police Department, which is seeking to build evidence around the contribution of foot-beat policing to reductions in urban violence, including that associated with gang and drug-related activity. This project uses a randomized controlled design to asses the impact of the foot-beat enforcement strategy.
Researching Institution: Temple University
Researcher: Jerry Ratcliffe, Ph.D.
Publication Date: 12/07/2009
The Problem:
Tobacco use is a source of chronic and fatal illnesses for users and persons with secondary exposure. In the United States, cigarette smoking contributes to one in five deaths and costs more than $193 billion in annual lost productivity and healthcare expenditures. CDC: Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004.
The Law:
Smoking bans and restrictions prohibit smoking in specified areas. These restrictions aim to eliminate or reduce exposure to second hand smoke. Smoking bans and restrictions are found in state and local laws as well as regulations governing workplace safety. For examples of state smoking regulations, see ARS 36-601.01 (Arizona), Utah Health Code § 26.83.3 (Utah), VT Health Code § 1742 (Vermont), and RI Health & Safety Code § 23-20.10-3 (Rhode Island).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed 10 studies that assessed the effectiveness of smoking bans and restrictions as means of reducing exposure to secondhand smoke in workplaces. Hopkins DP et al. Reviews of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. Am J Prev Med 2001; 20(2S). Some of the underlying studies measured the impact of specific smoking restriction laws; others measured the impact of policies initiated and enforced by private entities. The reviewers identified reductions in self-reported exposure or actual nicotine vapor in 9 of the 10 studies. Reductions in vapor measures ranged from 44 percent to 97 percent.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence supporting smoking bans and restrictions as effective public health interventions aimed at decreasing exposure to secondhand smoke.
Additional Information:
An interactive map from the Robert Wood Johnson Foundation gives policy-makers and advocates a nationwide picture of continuing state efforts on key tobacco control policies.
Additional Resources: Smoke-free Laws by State
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for vaccine preventable disease is an essential public health goal. Vaccination against specific diseases is particularly important for high risk populations, which may include individuals of a certain age (e.g., greater than 68 years for Pneumococcal Polysaccharide) or with specified medical conditions (e.g., HIV/AIDS for influenza). CDC: General Recommendations on Immunization.
The Law:
Laws and policies require vaccination (subject to enumerated exceptions) as a condition of certain jobs. In some states, state law or hospital policies require hospital staff to be vaccinated against influenza. In Rhode Island, for example, health care workers with direct patient contact must be vaccinated for measles, mumps, and rubella. RI Code R. 14-090-007. Illinois requires rubella vaccinations for nursery workers. Ill. Admin. Code tit. 77, § 250.1820.
The Evidence:
In a systematic review, a Community Guide expert panel attempted to systematically review the evidence concerning the impact of requiring vaccinations outright or as a condition of specified activities such as employment as a healthcare worker. Ndaiye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28(5S):248-79. The reviewers were unable to locate any studies that measured the impact of these laws in the U.S. As a result, the reviewers concluded there is insufficient evidence to currently evaluate the effectiveness of these laws and policies as public health measures aimed at protecting vulnerable populations against specific diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specified jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to state laws requiring or encouraging vaccination of health care workers.
Additional Resources: Centers for Disease Control and Prevention
Publication Date: 12/07/2009
The Problem:
The leading cause of death for people age 34 and below in the United States is motor vehicle crashes. CDC: Motor Vehicle Safety Factsheet. Crashes occur due to impaired driving, inexperience, faulty vision and general recklessness. In congested areas, pedestrian safety is major public health concern. Approximately 700 children are killed each year by motor vehicles while walking. CDC: Reducing Childhood Pedestrian Injuries: Summary of a Multidisciplinary Conference.
The Law:
Traffic laws are designed to minimize motor vehicle crashes and to improve driver, passenger and pedestrian safety. Enforcing traffic laws can be difficult. Red light cameras take a picture of any car that fails to appropriately abide by a red light thereby endangering other drivers and pedestrians. The pictures are used to issue traffic citations, which often include sizable mandatory fines ($446 in Los Angeles: Photo Red Light Program). Twenty-four states and the District of Columbia have red light programs operating somewhere within their jurisdiction authorized either through state or local law. Governors’ Highway Association: Red Light Cameras. For an example of a state law authorizing the use of red light cameras, see RI Stat 42-28.9
The Evidence:
In a systematic review, Aeron-Thomas and Hess reviewed ten studies measuring the impact of red light cameras on motor vehicle crashes. Aeron-Thomas A, Hess, S. Red-Light Cameras for the Prevention of Road Traffic Crashes. The Cochrane Library. 2009, v.2. The reviewers found that the studies generally identified an association between the red light cameras and reductions in fatal crashes. However, weaker and often statistically insignificant relationships were observed between the cameras and overall crashes. On this basis, the reviewers concluded that there was sufficient evidence to establish the effectiveness of red light cameras as an intervention aimed at reducing fatal crashes, but that additional research is needed to validate the impact of these cameras on overall crashes and reckless driving generally.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, sufficient evidence exists to support red light cameras as an effective public health intervention to reduce motor vehicle crash fatalities, but there is insufficient evidence to validate the effectiveness of the cameras in reducing overall crashes.
Additional Information:
The Governors’ Highway Association provides online access to a table indicating in which states red light cameras are authorized or prohibited under state law.
Additional Resources: Governors’ Highway Association
