Uncertain
IMPACT:
ORIGIN: Peer-reviewed Systematic Review
The Problem:
Youth violence is the second leading cause of death for people between the ages of 10 and 24 in the United States. Among individuals age 15-24, there are over 8,000 homicides each year. CDC, National Center for Injury Prevention and Control. WISQRS.
The Law:
Laws setting curfews are a popular tool for reducing crime in major urban areas. Although objections about the constitutionality of curfews are common, permanent nighttime youth curfews have been routinely upheld by courts as an authorized use of government power, particularly when exceptions are provided for employment and other legitimate activities. In a 1997 survey of 347 cities, about 80% had a curfew law limiting the extent to which youths could congregate in public without parental supervision during nighttime hours. U.S. Conference of Mayors, 1997. For examples of local curfew laws, see Philadelphia Ordinance § 10-303, San Francisco Ordinance § 539, and Chicago Ordinance § 8-16-020.
The Evidence:
Kenneth Adams systematically reviewed studies assessing the effect of permanent curfews (permanent in the sense that not adopted only during exigent events like riots or natural disasters) that limit the hours during which minors may be in public without parental supervision. Kenneth Adams, The Effectiveness of Juvenile Curfews at Crime Prevention, Annals of the American Academy of Political and Social Science 2003; 587: 136. Adams identified 10 quasi-experimental studies that fit the criteria of evaluating the relationship between youth curfew laws and public safety and victimization. All 10 studies measured the difference before and after the adoption of a curfew. Overall, the findings from the studies were mixed. In almost all instances in which imposition of a curfew was associated with a subsequent improvement in public safety, the effect was small and or statistically insignificant. In a number of places, implementation of curfews was associated with reductions in public safety as indicated by increased rates of violent crime. Given the inconsistency of the findings and the failure of many of the studies to include comparison areas and or longer periods of observation, Adams concluded that the current research has not established the effectiveness of permanent curfews as an effective long-term measure for improving public safety.
The Bottom Line:
According to the author of a peer-reviewed systematic review, there is insufficient evidence to support the effectiveness of youth curfew laws as means on decreasing crime and increasing public safety.
The Problem:
Tuberculosis is a classic public health scourge. Globally, there are over 9 million new cases of TB each year. World Health Organization: Tuberculosis Fact Sheet. The risks associated with TB have increased with the emergence of more virulent and drug-resistant strains of the disease. In the United States, the rate of TB incidence and associated mortality declined precipitously for most of the 20th century. In 1900 TB was the second leading cause of mortality accounting for over 10% of deaths; by 1980s deaths attributed to TB were in the hundreds. CDC: MMWR: Achievements in Public Health: Infectious Disease. In the early 1990s, however, incidence of TB began to increase again due to the HIV/AIDS epidemic and the synergistic risks of co-infection. Although these increases appear to have leveled off in the last few years, the risks associated with drug resistant strains continue to make TB an important public health challenge. CDC: MMWR: Trends in Tuberculosis.
The Law:
There are numerous legal measures for controlling the spread of TB. Law authorizes surveillance and specifies treatment requirements like Directly Observed Therapy (DOT). The most extreme and controversial legal measures involve the involuntary detention of individuals who are suspected or known to have infectious TB. In the United States, state statutes (Ca. Health & Safety Code § 121366) and regulations (New Jersey, N.J. Admin. Code § 8:57-5.7 et seq) define the procedural and substantive requirements for detaining an individual who presents a putative risk to the community as the carrier of an infectious disease. A sizable body of case law has also developed providing guidance about how and when an individual can be detained against their will to protect the public from disease. One of the seminal cases interpreting state power over coercive tuberculosis control measures is Green v. Edwards, 263 S.E. 2d 661 (1980).
The Evidence:
Coker systematically reviewed studies assessing the effect of detention of individuals with TB on public health. R.J. Coker. Public Health Impact of Detention of Individuals with Tuberculosis: Systematic Literature Review. Public Health (2003) 117, 281–287. Twenty-two studies fit the inclusion criteria. One of the studies employed a molecular finger printing design and found evidence that removing some infected individuals from the population would significantly decrease population incidence. Other modeling studies, however, suggested that the presence of coercive measures might increase transmission by decreasing the proportion of infected individuals that seek treatment. Observational and case control studies were few and small. According to Coker, there is insufficient evidence to sustain inferences about the effects of detention on population health.
The Bottom Line:
According to the author of a peer-reviewed systematic review, there is insufficient evidence at this time to conclude that detention of individuals with infectious tuberculosis improves population health.
The Problem:
Domestic violence – the physical, sexual, or emotional abuse of intimate partners or cohabiters – is a significant public health problem. Annually, intimate partner violence accounts for almost 5 million assaults or rapes of women and almost 3 million assaults or rapes of men; more than 1,500 of these incidents resulted in death in 2005. CDC Factsheet: Intimate Partner Violence. Sexual violence is a particularly common occurrence in intimate relationships. More than 10 percent of all women report being forced into sex at some time in their lives; almost 55 percent of rapes of women are committed by family members or intimate partners. CDC Factsheet: Sexual Violence.
The Law:
As cultural norms have changed over the last half century, the laws and legal response to domestic violence have changed markedly. Starting in the early 1980s states began to take domestic violence much more seriously by adopting mandatory arrest laws, which require police officers arriving at domestic disturbances to issue one or more arrests, and instituting court-mandated batterer intervention programs (BIPs). These intervention programs attired to prevent repeat domestic abuse by educating the batterer – typically male – to better understand gender equality and constructive anger management. Although they vary in some key aspects, these programs are widely implemented in U.S. jurisdictions. California law, for example, sets as a condition of probation or parole for individuals convicted of domestic abuse the completion of a batterer’s program that lasts at least one year and includes two hours or more of class time per week. Cal Pen Code § 1203.097(A)(6). For other examples laws requiring BIPs, see Fla. Stat. § 741.281 (Florida) and R.I. Gen. Laws § 12-29-5 (Rhode Island).
The Evidence:
Feder et al. reviewed and conducted a meta-analysis of studies that assess the impact of court-mandated batterer intervention programs. Feder et al. Court-mandated interventions for individuals convicted of domestic violence. Campbell Systematic Review 2008:12. Of the 10 studies that met the authors’ inclusion criteria, 4 employed experimental designs and 6 employed quasi-experimental designs. The measures that were subject to meta-analysis were official reports of post-BIP abuse and victim reports of post-BIP abuse. Across the studies, Feder et al. found a small association between BIPs and reductions in official reports of re-battery, though they caution that some of the underlying studies have been subject to reinterpretation and methodological criticism. For example, one of the studies initially presented as evidence of the effectiveness of BIP programs was subsequently reinterpreted by its authors as showing the impact of another intervention (monitoring) rather than the BIP. For victim reported re-battery, the evidence is inconsistent and statistically insignificant. According to Feder et al., the methodological problems in studies reporting a beneficial effect of BIPs, along with the weak effects found in meta-analysis, raise significant doubts about the effectiveness of BIPs in preventing repeat domestic violence.
The Bottom Line:
According to the authors of a systematic review sponsored by the Campbell Collaborative, there is not enough evidence to establish that batterer intervention programs effectively reduce recidivism.
Publication Date: 12/07/2009
The Problem:
The shortage of adequate, affordable housing can create pockets of concentrated poverty, exposing children and others to lead and other pathogens, which affects the health of children and families. The Urban Institute. Research on Record: Housing. Also, housing expenses draw resources away from health expenditures (e.g., nutritious food and healthcare). CDC and U.S. Department of Housing and Urban Development. Healthy Housing Reference Manual.
The Law:
States and localities have attempted to address the inadequate supply of affordable housing and its associated harms by facilitating the creation of mixed income housing developments through a number of legal mechanisms. Mixed-income housing developments provide affordable housing for low-income residents in rental units that are interspersed with market-rate housing. Laws promote mixed-income housing developments by subsidizing the construction of multi-family residences and reserving a portion of units for low-income residents at affordable prices. Hope VI is federal housing program that funds mixed-income housing fully or in partnership with private developers. HOPE VI Revitalization Notices of Funds Availability; 24 C.F.R. 941.600. Some municipalities have used zoning law to increase mixed income housing. For example, Sacramento, Calif. ( Sacramento City Code § 17.190.030) and Burlington, Vt. (Burlington Comprehensive Zoning Ordinance §§ 9.1-9.2)) have inclusionary zoning requirements that require that a certain percentage of new housing units are affordable to low-income residents.
The Evidence:
In a Community Guide review, Anderson et. al. could not find any qualifying studies that measured the impact of mixed-income housing developments in creating and maintaining safe and affordable housing for low-income residents. Anderson LM, et al. Providing affordable family housing and reducing residential segregation by income: a systematic review. Am J Prev Med. 2003;24(3S):S47-67. As a result, the reviewers could not ascertain the effectiveness of mixed-income housing developments as a public health intervention.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is currently insufficient evidence to establish the effectiveness of mixed income housing as a public health intervention.
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:
In the United States, motor vehicle–related accidents are the leading cause of death for all people under the age of 34. In 2000, motor vehicle crashes cost roughly $230 billion. CDC: Motor vehicle safety. The number of licensed drivers over the age of 65 has increased dramatically over the last decade. Drivers ages 80 and over have a higher rate of fatal crashes per miles driven than all other demographic groups except teenagers. The impact of aging on vision, cognitive functions, and other physical capacities has been identified as a contributing factor in motor vehicle crashes. CDC Website – Older Adult Drivers: Fact Sheet.
The Law:
State transportation and safety laws require different procedures and apply different standards in screening the vision of older drivers. For instance, to renew a license in California, an individual must have visual acuity of 20/40 with both eyes together and at least 20/40 in the stronger eye and 20/70 in the weaker eye, California Department of Motor Vehicles, CA Vehicle Code §12805; in Arizona, a minimum of 20/40 in one eye is required. Arizona Administrative Code: R17-4-502, R17-4-503. The age at which vision tests are required for renewal also varies (e.g., 40 years in Maryland (Maryland Transportation Code 16-115(h)) to 80 years in Virginia. Va. Code Ann. § 46.2-330 (C)). For another example of a state law requiring vision screening for individuals above a specified age, see FL Rev. State 322.18(5) (Florida).
The Evidence:
A Cochrane Collaboration Task Force attempted to conduct a systematic of studies assessing the impact of vision screenings for older drivers on motor vehicle crashes, but did not find any studies meeting its criteria. Subzwari S et al. Vision screening of older drivers for preventing road traffic injuries and fatalities. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.:CD006252. The task force accordingly concluded that there is insufficient evidence to determine whether vision screening programs for individuals above a specified age are effective in reducing crashes among older adults.
The Bottom Line:
In the judgment of a Cochrane Collaborative expert panel, laws requiring vision screening are a plausible means of reducing crashes involving older drivers, but there is insufficient evidence to rigorously assess their effectiveness at this time.
Additional Information:
The Physician’s Guide to Assessing and Counseling Older Drivers, created by the American Medical Association (AMA) with support from the National Highway Traffic Safety Administration (NHTSA), is available online and provides substantial information about state policies regarding vision screening.
The International Council of Ophthalmology provides online access to a table of vision requirements for the fifty US states.
Additional Resources: Physician’s Guide to Assessing and Counseling Older Drivers, AMA, NHTSA, International Council of Ophthalmology
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 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:
State “shall issue laws” require state and local authorities to issue licenses to individuals authorizing the carrying of a concealed firearm as long as the individuals meet enumerated criteria. These laws are distinguishable from “may issue laws,” which require an individual to establish a compelling need to carry a concealed firearm. For examples of shall issue laws, see Minn. Stat. § 624.714, subd. 1(a) (Minnesota) and 18 Pa C.S. §6109(e)(1) (Pennsylvania). It has been suggested that shall issue laws reduce violent crime by facilitating the carrying of concealed weapons by non-criminals.
The Evidence:
In a systematic review, Hahn et al. reviewed four studies that measured the national impact of shall issue laws on homicide, aggravated assault, robbery, rape, and killing of police officers. Hahn, et al. Firearms laws and the reduction of violence: a systemic review. Am J Prev Med. 2005;28(2S1):40-71. Two studies found a reduction in homicides associated with shall issue laws, but a third found mixed results across different counties and an overall increase in homicides. The fourth study, which focused on whether shall issue laws harmfully increase gun-related crime, found a statistically insignificant reduction in killings of police. In view of these findings and the limited number of relevant primary studies, the reviewers concluded that there is insufficient evidence to support the effectiveness of shall issues laws as public health interventions aimed at reducing violent crime.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is not enough evidence to establish the effectiveness of shall issue laws as a public health intervention to reduce violent crime.
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 (www.firearmsresearch.org) 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: 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:
Firearms are the second leading cause of injury deaths in the United States accounting for 30,896 deaths and 71,417 injuries in 2006. CDC: WISQUARS. Firearms are used in 84 percent of the homicides of persons between the ages 10 and 24. CDC: Youth Violence Fact Sheet.
The Law:
Child access prevention (CAP) laws are a relatively recent legislative intervention intended to prevent firearm injuries caused by children by limiting their access to firearms. CAP laws establish criminal penalties for owners who do not store their firearms appropriately (e.g., unloaded, in a locked compartment). It is a felony offense for an owner under some CAP laws if an injury results from a child accessing an unsecured gun. In 2008, 27 states and the District of Columbia had adopted CAP laws. Legal Community Against Violence: CAP Laws Brief. For examples of CAP laws, see F.S. § 790.174(Florida), Texas Penal Code Annotated § 46.13(Texas) and CGS §29-37i(Connecticut).
The Evidence:
In a systematic review, Hahn et al. reviewed three studies that measured the impact of CAP laws on juvenile unintentional firearm-related deaths. Hahn et al. Firearms laws and the reduction of violence: a systemic review. Am J Prev Med. 2005;28(2S1):40-71. One of the three studies examined the impact of CAP laws on firearm-related and non-firearm-related juvenile suicides and homicides. The second study evaluated the impact of CAP laws on overall violent outcomes (all homicide, aggravated assault, robbery, and rape) to test the hypothesis that CAP laws impede self-defense. The third study measured the impact of unintentional firearm-related deaths among juveniles under the age of 15 in states with felony CAP laws. The findings on juvenile homicide and violent outcomes were inconsistent and mostly lacked statistical significance. A few of the underlying studies found associations between CAP laws and juvenile violent outcomes in a few states. However, the reviewers did not view the available evidence as sufficient to establish the effectiveness of CAP laws as a public health intervention.
The Bottom Line:
Although CAP laws may represent a promising intervention for reducing gun-related morbidity and mortality among children, in the judgment of a Community Guide expert panel, there is currently insufficient evidence to validate their effectiveness as a public health intervention 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: The Firearms Research Digest
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