Measuring the comprehensiveness of state health laws, 1980-2005

Background: Assessment of new health laws has often been conducted without taking into account the presence of existing laws that address the targeted behavior. This study quantifies the level of comprehensiveness of state health laws over time. Methods: We identify 30 public health laws (in tobacco, alcohol, and firearm control and motor vehicle safety) and constructed a dataset of each law in each state from 1980 to 2005 using secondary data. Original legal research supplemented missing or conflicting data. We calculate indices within and across public health domains by summing the number of laws by state for each year. We then construct clusters by observing state score trajectories over time. The relationship between state characteristics and the comprehensiveness of health laws was tested using panel data models. Results: Preliminary results show there is a secular trend towards increased adoption of public health laws at the state level, but there is great variation among states during the time period observed. Analysis identified 5 main state clusters of public health policymaking both within and across different health domains. State political orientation (p <0.001) and tax resources (p<0.01) are associated with more comprehensive state health laws across multiple domains and more comprehensive state laws were associated with lower premature mortality (p<0.01) after controlling other health determinants. Conclusions: Measures of the comprehensiveness of the state health law environment can aid in the study of the effects of new laws on the public's health and help avoid mis-attribution of any single law's effects.