Lainie Rutkow

Preemption and the obesity epidemic: state and local menu labeling laws and the nutrition labeling and education act.

Obesity is widely recognized as a preventable cause of death and disease. Reducing obesity among adults and children has become a national health goal in the United States. As one approach to the obesity epidemic, public health practitioners and others have asserted the need to provide consumers with information about the foods they eat. Some state and local governments across the United States have introduced menu labeling bills and regulations that require restaurants to post information, such as calorie content, for foods offered on their menus or menu boards. A major dilemma is whether state and local menu labeling laws are preempted by the federal Nutrition Labeling and Education Act (NLEA). While few courts have addressed this issue, ongoing litigation in New York City provides an early glimpse of judicial interpretation in this area. This article explores these preemption issues, arguing that appropriately written and implemented menu labeling laws should not be preempted by the NLEA. We offer guidance for states and localities that wish to develop and implement menu labeling laws.

Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis

BACKGROUND Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. METHODS We used IMS Healths LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. RESULTS We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p<0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p<0.01). Following policy implementation, Floridas high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. CONCLUSIONS High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers.

Trends in prescribing of sedative-hypnotic medications in the USA: 1993–2010

Non‐benzodiazepine receptor agonists (nBZRAs) were developed as an alternative to benzodiazepines (BZDs) to treat insomnia. Little is known about how the introduction of nBZRAs influenced trends in BZD prescribing. We examined BZD and nBZRA prescribing trends from 1993 to 2010.

Protecting the mental health of first responders: legal and ethical considerations.

journal of law, medicine & ethics Introduction The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.1 Not surprisingly, first responders may experience physical injuries or psychological harms due to their work. In recent years, emergency preparedness researchers have focused on environmental exposures and other risk factors,2 such as structural instabilities within the built environment, which may impact first responders’ physical health. Harms to first responders’ mental health, however, are equally important to consider. Although mental health conditions may be overlooked because they can be difficult to visibly identify and diagnose, their presence may significantly affect first responders’ ability to function.3 Studies have demonstrated that, after participating in disaster responses, first responders experience elevated rates of depression, stress disorders, and posttraumatic stress disorder (PTSD) for months and sometimes years.4 Those without disaster response training face a greater risk of receiving a PTSD diagnosis after the response concludes.5 Trained responders may not be prepared for a disaster response’s psychological challenges, because training cannot truly replicate a disaster environment. Furthermore, most trainings do not explicitly include sufficient content regarding psychological self-aid. Given these findings, measures must be taken to protect first responders’ mental health. The development of laws and policies at the federal, state, tribal, and local levels provides numerous opportunities to implement standardized mental health protections for first responders. In some instances, these legal opportunities may benefit from guidance afforded by a consideration of relevant ethical concerns. This article discusses the legal and ethical issues raised in three key areas that are fundamental to protecting and promoting first responders’ mental health: (1) mental health screening for first responders; (2) licensure portability of mental health care providers; and (3) workers’ compensation for mental health claims.

Changing the Constitutional Landscape for Firearms: The US Supreme Court's Recent Second Amendment Decisions

In 2 recent cases-with important implications for public health practitioners, courts, and researchers-the US Supreme Court changed the landscape for judging the constitutionality of firearm laws under the Constitutions Second Amendment. In District of Columbia v Heller (2008), the court determined for the first time that the Second Amendment grants individuals a personal right to possess handguns in their home. In McDonald v City of Chicago (2010), the court concluded that this right affects the powers of state and local governments. The court identified broad categories of gun laws-other than handgun bans-that remain presumptively valid but did not provide a standard to judge their constitutionality. We discuss ways that researchers can assist decision makers.

Improving Access To Care And Reducing Involvement In The Criminal Justice System For People With Mental Illness

People with mental illness make up a disproportionate share of the criminal justice-involved population. The passage of critical new reforms affecting health care for vulnerable populations under the Affordable Care Act and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 presents unique opportunities to transform systems of care and avert criminal justice involvement. In addition, state and local jurisdictions have implemented a number of strategies to divert people with mental illness from the criminal justice system and reduce recidivism. In this article we summarize current knowledge about the involvement of people with mental illness in the criminal justice system and consider the recent opportunities presented by national and local policies that aim to lower the proportion of such people who are incarcerated.

Availability of Litigation as a Public Health Tool for Firearm Injury Prevention: Comparison of Guns, Vaccines, and Motor Vehicles

The Protection of Lawful Commerce in Arms Act (PLCAA), enacted in 2005, grants the firearm industry broad immunity from liability. The PLCAA not only prevents most people from receiving compensation for their firearm-related injuries, it erodes litigations ability to serve its public health role of providing manufacturers with a financial incentive to make their products safer. When the viability of the vaccine industry was threatened in the 1980s, Congress provided limited protection from liability and also established the Vaccine Injury Compensation Program. The liability of nearly all other products, for example motor vehicles, is governed by traditional common law principles. The absence of both litigation and product safety rules for firearms is a potentially dangerous combination for the publics health.

Legal challenges for substance abuse treatment during disasters

Certain groups with preexisting mental and behavioral health conditions, such as substance use disorders, may be especially vulnerable during and shortly after disasters. Researchers have found that substance abuse treatment programs and the individuals they serve experienced major disruptions after the September 11, 2001, attacks on the World Trade Center and the Pentagon and after Hurricane Katrina. This column considers legal challenges that may arise when a rapid influx of licensed providers is needed for substance abuse treatment during disasters and reviews specific legal issues that disasters may raise for opioid treatment programs. Opportunities to mitigate legal challenges and facilitate substance abuse treatment during disasters are discussed.

Emergency Legal Authority and the Opioid Crisis

Six U.S. states have declared their opioid-overdose situation an emergency. Though the scope of these declarations has been limited, they could suggest additional responses to multiple facets of the crisis, especially if emergency powers are used in innovative ways.

The Voices for Healthy Kids Campaign and US State Legislation to Prevent Childhood Obesity

We documented childhood obesity legislative activity in all 50 US states that occurred in parallel to the first year of Voices for Healthy Kids (Voices), a campaign to mobilize evidence-based legislation addressing childhood obesity. We identified 217 bills in the year before Voices (November 2012 to October 2013) and 304 bills at follow-up (November 2013 to October 2014). In states with active Voices grantees, the bill enactment rate was 50% higher (increasing from 10% at baseline to 15% at follow-up).