Gregory Tung

Political Factors Affecting the Enactment of State-Level Clean Indoor Air Laws

OBJECTIVES We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws. METHODS We performed an observational study of state-level clean indoor air law enactment among all 50 US states from 1993 to 2010 by using extended Cox hazard models to assess risk of enacting a relevant law. RESULTS During the 18-year period from 1993 to 2010, 28 states passed a law covering workplaces, 33 states passed a law covering restaurants, 29 states passed a law covering bars, and 16 states passed a law covering gaming facilities. States with term limits had a 2.15 times greater hazard (95% confidence interval [CI] = 1.27, 3.65; P = .005) of enacting clean indoor air laws. The presence of state-level preemption of local clean indoor air laws was associated with a 3.26 times greater hazard (95% CI = 1.11, 9.53; P = .031) of state-level policy enactment. In the presence of preemption, increased legislative professionalism was strongly associated (hazard ratio = 3.28; 95% CI = 1.10, 9.75; P = .033) with clean indoor air law enactment. CONCLUSIONS Political institutional factors do influence state-level clean indoor air law enactment and may be relevant to other public health policy areas.

Legislator voting and behavioral science theory: a systematic review.

OBJECTIVES To examine the application of behavioral science theories to explain the voting behavior of legislators for public health policies. METHODS We conducted a systematic review to identify studies that examined factors associated with legislator support, intention to vote, or actual votes on public health policies, emphasizing those grounded in behavior science theory. RESULTS Twenty-one papers met our inclusion criteria, and 6 were explicitly grounded in a behavioral science theory. CONCLUSIONS Behavioral science theories, and the theory of planned behavior in particular, provide a framework for understanding legislator voting behavior and can be used by advocates to advance pro-health policies.

Law Enforcement and Gun Retailers as Partners for Safely Storing Guns to Prevent Suicide: A Study in 8 Mountain West States

Objectives To examine the extent to which law enforcement agencies (LEAs) and gun retailers are willing to offer voluntary, temporary storage as a part of an overall suicide prevention effort. Methods We invited all LEAs and gun retailers in 8 US states to respond to questionnaires asking about their willingness to offer temporary gun storage and their recommendations to gun owners about safe storage. Results We collected data in 2016 from 448 LEAs and 95 retailers (response rates of 53% and 25%, respectively). Three quarters of LEAs (74.8%; 95% confidence interval [CI] = 72.1, 77.5) indicated they already provided temporary storage compared with 47.6% (95% CI = 39.2, 56.0) of retailers. LEAs were most willing to provide storage when a gun owner was concerned about the mental health of a family member. Retailers were more receptive than were LEAs to providing storage when visitors were coming or for people wanting storage while traveling. Both groups recommended locking devices within the home, but LEAs were slightly more favorable to storing guns away from the home. Conclusions Law enforcement agencies and gun retailers are important resources for families concerned about suicide.

Ignition Interlock Laws: Effects on Fatal Motor Vehicle Crashes, 1982–2013

INTRODUCTION Alcohol-involved motor vehicle crashes are a major cause of preventable mortality in the U.S., leading to more than 10,000 fatalities in 2013. Ignition interlocks, or alcohol-sensing devices connected to a vehicles ignition to prevent it from starting if a driver has a predetermined blood alcohol content (BAC) level, are a promising avenue for preventing alcohol-involved driving. This study sought to assess the effects of laws requiring ignition interlocks for some or all drunk driving offenders on alcohol-involved fatal crashes. METHODS A multilevel modeling approach assessed the effects of state interlock laws on alcohol-involved fatal crashes in the U.S. from 1982 to 2013. Monthly data on alcohol-involved crashes in each of the 50 states was collected in 2014 from the National Highway Traffic Safety Administration Fatality Analysis Reporting System. Random-intercept models accounted for between-state variation in alcohol-involved fatal crash rates and autocorrelation of within-state crash rates over time. Analysis was conducted in 2015. RESULTS State laws requiring interlocks for all drunk driving offenders were associated with a 7% decrease in the rate of BAC >0.08 fatal crashes and an 8% decrease in the rate of BAC ≥0.15 fatal crashes, translating into an estimated 1,250 prevented BAC >0.08 fatal crashes. Laws requiring interlocks for segments of high-risk drunk driving offenders, such as repeat offenders, may reduce alcohol-involved fatal crashes after 2 years of implementation. CONCLUSIONS Ignition interlock laws reduce alcohol-involved fatal crashes. Increasing the spread of interlock laws that are mandatory for all offenders would have significant public health benefit.

Hospital Emergency Department Lethal Means Counseling for Suicidal Patients

INTRODUCTION Lethal means counseling of suicidal individuals in emergency departments has the potential to reduce suicide. This study examines the provision of lethal means counseling and the presence of written protocols in a region with high rates of both firearm ownership and suicide. METHODS In 2015-2016, emergency department nurse managers in hospital-based emergency departments throughout eight states were surveyed using an 80-item survey developed through qualitative interviews and pilot testing. Questions focused on discharge counseling with suicidal patients and the presence of written protocols. Using survey weights to adjust for nonresponse, relationships of protocols with counseling practices were examined. RESULTS Data were obtained from 52.3% of all 363 eligible hospital emergency departments in the region. Among facilities that discharge suicidal patients, 79.7% (95% CI=75.0%, 84.4%) reported asking about access to firearms and 68.9% (95% CI=62.9%, 74.8%) counsel about safe storage when patients reported access. Forty-four percent of emergency departments reported having written protocols for lethal means counseling. Presence of written protocols was associated with a higher rate of counseling for all suicidal patients even if they were not planning to use a gun (45.0% [95% CI=33.4%, 56.7%] in hospitals with protocols vs 21.5% [95% CI=14.9%, 29.0%] in facilities without protocols). CONCLUSIONS There are significant gaps in attention to lethal means counseling in emergency departments. This signals an opportunity to increase consistency and thoroughness of care for suicidal patients in the emergency department and for leadership from key professional organizations to advocate for protocols.

Increasing Documentation and Referral for Youth at Risk for Violence Through the Primary Health Care Setting

Objective. Evaluate the use of a previsit violence risk screen to determine whether screening during routine care increases health care practitioner’s (HCP’s) documentation of violence risk. Methods. Once consented, adolescents filled out the Violence Injury, Protection and Risk Screen Tool (VIPRS). For usual care screen results were not viewed by the HCP. For the intervention screen results were imbedded in the electronic medical record and viewed by the HCP. The primary outcome—documented reference to violence risk—was determined by chart review. Results. Three hundred and fifty-six youth participated. Age was 14.5 years (SD 0.3); 65% female, 45% Hispanic, 38% black. Odds of violence related documentation was 47.4 (P < .001) in the intervention compared with usual care. Those who were positive on the VIPRS had a 10 times greater odds of receiving a violence intervention compared with controls. Conclusions. Previsit screening for violence risk significantly increases HCP’s documentation of violent behavior and referral for intervention.

Federal actions to incentivise state adoption of 0.08 g/dL blood alcohol concentration laws

Objective To model rates of 0.08 g/dL blood alcohol concentration (BAC) per se law implementation among the states associated with (1) a federal incentive grant programme and (2) a threat from the federal government to withhold highway transportation funds. Methods An observational study of state-level 0.08 g/dL BAC per se law enactment among all 50 US states from 1982 to 2006 using a parametric survival analysis to assess the time-dependent risk of policy enactment. Results The federal governments threat to withhold transportation funds was associated with a 10.30 times greater hazard (HR: 10.30, 95% CI 3.88 to 27.36) of states adopting a 0.08 g/dL BAC law compared with periods of time when this threat was not in place. The incentive grant programme created by the federal government was associated with a non-significant 17% decrease in the hazard of states adopting a 0.08 g/dL BAC law (HR: 0.83, 95% CI 0.35 to 2.0). Conclusion In the case of 0.08 g/dL BAC per se laws, the federal governments threat to withhold transportation funds was effective at accelerating policy adoption.

Using health impact assessments to advance the field of injury and violence prevention

Injuries remain a leading cause of death and disability globally. A growing body of evidence shows that decisions made in sectors such as transportation, housing and urban planning affect injury risk. Health impact assessment (HIA) is a pragmatic process to identify the potential health risks and benefits of proposed policies and to inform decision-making. HIAs help policymakers broadly weigh the trade-offs of proposals, for which health risks including injury and violence might not otherwise be fully recognised or addressed. The aim of this article is to describe HIA and its application to the field of injury and violence prevention. In 2011, the National Research Council Committee on Health Impact Assessment presented a framework for HIA practice and a consensus definition of HIA: “A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects.”1 As of November 2013, approximately 300 HIAs have been completed or are in progress in the USA, a …

Legal issues affecting children with preexisting conditions during public health emergencies.

Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment regimens or cause children to be separated from caregivers. Ongoing shortages of pediatricians and pediatric subspecialists may further exacerbate the risks that children with preexisting conditions face in disaster circumstances. The US Department of Homeland Security recently called for better integration of childrens needs into all preparedness activities. To aid in this process, multiple legal concerns relevant to pediatricians and pediatric policymakers must be identified and addressed. Obtaining informed consent from children and parents may be particularly challenging during certain public health emergencies. States may need to invoke legal protections for children who are separated from caregivers during emergencies. Maintaining access to prescription medications may also require pediatricians to use specific legal mechanisms. In addition to practitioners, recommendations are given for policymakers to promote effective pediatric response to public health emergencies.

126 Law enforcement agencies’ and gun retailers’ roles in gun storage for suicide prevention

Purpose Safe storage of guns is critical to suicide prevention. This study examines the extent to which law enforcement agencies (LEAs) and gun retailers (GRs) are willing to offer safe gun storage in a variety of circumstances, including mental health crises. Methods We invited, with two follow-up reminders, all LEAs and GRs with storefronts in the eight-state Mountain West region to respond to questionnaires. We asked about current storage practices and conditions under which they would offer temporary storage. We also asked about their recommendations for safe storage. We weighted data to adjust for non-response. Results We collected data from 448 LEAs and 95 GRs, representing response rates of 55% and 25% respectively. Most LEAs 74.8% (CI 72.1–77.5) indicated they already provide temporary storage, compared to 47.6% (CI 39.2–56.0) of GRs. LEAs were most willing to provide storage when a family member was concerned about mental health of a teenager (84.8%; CI 82.5–87.1) or adult (83.5%; CI 81.1–85.8) but less likely to offer storage when the reason was protection of visitors, for persons who may be travelling, or when no reason accompanies the request. GRs, while less willing to offer storage in many situations, were open to providing storage for some circumstances not favoured by LEAs. Both groups locking devices within the home but LEAs were slightly more favourable to storage sites (e.g., law enforcement, gun stores) away from the home. Conclusion LEAs and GRs are important resources for gun owning families concerned about suicide, and possibly other risks associated with gun injury. Significance and Contributions to Injury and Violence Prevention Science This is the first study to examine the practices of these key community resources for providing through voluntary and temporary gun storage as a form of injury control.