minors
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. Initiation of smoking and other tobacco use generally starts in adolescence; more than 80% of adult smokers started smoking as young children or teenagers. CDC: Youth Tobacco Use Fact Sheet.
The Law:
Pursuant to the 1997 federal “Synar law” states must prohibit the sale of tobacco products to children and take steps to ensure effective enforcement. 42U.S.C. 300x-26, 45 C.F.R. 96.130. States and localities have adopted numerous legal interventions to increase compliance with this prohibition. For example, some states prohibit the handling of tobacco products by minors working in retail and require posting of signs explicitly prohibiting sale of tobacco products to minors (Oklahoma, 37 O.S. §600.1-§600.12). Under age purchasers of tobacco face fines and community service (Washington, RCW 70.155.080). To increase compliance with youth access laws, localities and states also conduct compliance investigations (Missouri: Restricting Youth Access to Tobacco).
The Evidence:
Stead and Lancaster systematically reviewed studies assessing the effect of laws restricting youth access to tobacco and interventions aimed at increasing compliance with youth access laws. Lindsay F Stead and Tim Lancaster. A systematic review of interventions for preventing tobacco sales to minors. Tob Control 2000 9: 169-176. The reviewers identified 27 studies that fit their criteria of employing either experimental or observational designs with data both before and after the adoption of a law or compliance intervention. The studied laws included requirements for compliance checks; the evaluated interventions included experiments with compliance checks and education campaigns with retailers about fines and enforcement of youth access laws. Most of the included studies found reductions in prevalence of smoking among youths or decreases in reported ease of purchasing tobacco for minors. Although the reviewers were cautious because of methodological limitations in the studies such as the inability to control for potentially confounding effects from other youth smoking prevention programs and the possibility that effects wane over time, they view the collective body of studies as sufficient evidence to conclude that laws restricting youth access and interventions aimed at increasing compliance do indeed reduce access to tobacco for minors. The reviewers observed that greater levels of compliance activity – such as personal visits to retailers – were more likely to result in greater reductions in smoking or access.
The Bottom Line:
According to the authors of a peer-reviewed systematic review, there is sufficient evidence to support the effectiveness of youth access laws and interventions aimed at increasing compliance as a means of decreasing access to tobacco for minors.
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations.
The Law:
State vaccination laws require children to be immunized prior to entering school. National Vaccine Program Office: Immunization Laws. Subject to instances where exemptions apply, these laws require written proof of a child’s immunization status provided from a health provider. For examples of state vaccination laws, see Colorado (6 CCR 1009-2), Iowa (Iowa Administrative Code), Nebraska (173 NAC 3) and Massachusetts (105 CMR 220.000).
The Evidence:
In a systematic review, a Community Guide expert panel reviewed the evidence concerning the effectiveness of requiring vaccinations as a condition of matriculation into child care, secondary school or college. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. The review identified nine studies in the U.S. and Canada that measure the impact of these requirements. Of the nine studies, seven examined the impact of school laws; one examined vaccination mandates for child care, and one looked at requirements for college attendance. Six studies measuring the effect of vaccination requirements on the incidence of specific diseases (e.g., measles) found an inverse relationship suggesting that laws reduce rates of the targeted diseases. Three studies also observed a positive relationship between mandated immunization programs and rates of vaccination among the target populations. On the basis of this evidence, the reviewers concluded that there is sufficient evidence that school vaccination requirements are an effective public health intervention aimed at increasing vaccination coverage and decreasing the incidence of certain diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is sufficient evidence supporting the effectiveness of requiring vaccinations as a condition for attending child care facilities and schools.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to all state vaccination laws.
The Immunization Action Coalition also has online maps showing specific legal requirements for the fifty states.
Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition
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.
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. CDC: Impaired Driving Factsheet.
The Law:
Blood alcohol per se laws set a blood alcohol limit at which an individual is considered legally impaired (i.e., impairment is “per se” because actual inability to function need not be established). Currently, all states set their BAC limit at 0.08 percent; some previously set the BAC levels at 0.10 percent. For examples of BAC per se laws, see Cal. Veh. Code §23152 (California), Fla. Stat. §316.193 (Florida), K.S.A. §8-1567 (Kansas), M.R.S. §2411 (Maine), N.M. Stat. Ann. §66-8-102 (New Hampshire), N.M. Stat. Ann. §66-8-102 (New Mexico), N.C. Gen. Stat. §20-138.1 (North Carolina), O.R.S. 813.010 (Oregon), Utah Code §41-6a-502 (Utah), 23 V.S.A. §1201 (Vermont), and Va. Code Ann. §18.2-266 (Virginia).
The Evidence:
In a Community Guide systematic review, Shults et al. reviewed nine studies that examined the impact of lowering the BAC limit to 0.08 percent on the rate of alcohol-related motor-vehicle deaths. Shults, et al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving. Am J Prev Med. 2001;21(4S):66-88. According to the reviewers, the underlying studies reveal a considerable association between the adoption of 0.08 percent BAC laws and a decline in alcohol-related motor-vehicle deaths; the median reduction in motor vehicle fatalities after the laws were adopted was 7 percent. Shults et al view these studies as strong evidence of the effectiveness of 0.08 BAC laws as a public health intervention. However, they caution that most of the BAC laws analyzed were enacted along with, or were supplemented by, other preventive drunk-driving laws, such as Administrative License Revocation (ALR) laws, making it difficult to isolate the exact magnitude of the impact of BAC laws.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence that laws adopting decreased BAC levels effectively reduce alcohol-related motor-vehicle deaths.
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:
According to the Centers for Disease Control and Prevention, inexperienced drivers are a significant public health problem. Motor vehicle accidents is the leading cause of death of young adults between age 15 and 20. CDC. Teen Drivers: Fact Sheet.
The Law:
Graduated driver licensing (GDL) laws require inexperienced drivers to satisfy one or more requirements before being granted full privileges to operate a motor vehicle without supervision. For example, a common feature of these programs is the issuance of a provisional license authorizing an inexperienced driver to operate a vehicle exclusively under the supervision of a fully licensed adult. In many instances, inexperienced drivers must also adhere for a period of time to other restrictions such as not driving at night or with more than one passenger. If an inexperienced driver satisfies the requirements of the provisional period, a fully unrestricted license may be issued. For examples of graduated license laws, see Fla. Stat. § 322.16 (Florida), MCLS § 257.310(e)( Michigan), and ORC Ann. 4507.05(Ohio).
The Evidence:
Harling et al. systematically reviewed fifteen studies measuring the impact of graduated driver licensing programs on one or more of the following: overall crashes, crashes with an injury, hospitalization, fatal crashes, crashes at night, alcohol-related crashes, injured teen passengers, convictions and license suspensions, and property damage. Hartling L et al. Graduated driver licensing for reducing motor vehicle crashes among young drivers. Cochrane Database Syst Rev. 2004;(2):CD003300. The review found a median reduction of 31 percent in crash rates among 16 year-old drivers following the adoption of GDL laws. These findings indicate that GDL programs are effective reducing crashes among novice drivers.
The Bottom Line:
In the judgment of a Cochrane Collaboration expert panel, the current evidence suggest that graduated driver licensing programs are effective public health interventions aimed at significantly reducing the incidence of motor vehicle morbidity and mortality attributable to inexperienced drivers.
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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Public Health Law Research is a national program of the Robert Wood Johnson Foundation. It is housed at the Temple University Beasley School of Law.