Two examples of public health law research: Methods, challenges and considerations

Two studies contrast measurement and coding issues for PHLs & two rare health events:  1) Complex law mapping with considerable variability between states, health outcomes that are difficult to identify; 2) Straightforward law mapping with considerable consistency between states and an easily measured outcome.  Presentation elaborates mapping/analytic challenges. 

 Study 1: Availability and administration of emergency epinephrine in school settings and mortality/morbidity.  Considerable variability across states in law organization and details; 250+ laws identified and categorized.  Most states have some laws addressing student, school, and employee responsibilities:  Student self-carry and administration of medication, School protocols, and employee designation, administration, training and Good Samaritan protections.  Identification of health outcome death or hospital visit made difficult by rarity of anaphylactic events; inconsistent death certificate/claims coding. 

 Study 2: Rear-facing child seat laws (RFCSLs) and infant motor vehicle accident (MVA) fatality.  RFCSLs are straightforward, easily found and categorized.   Infant RFCSLs use age, weight or both to set requirements.  12 states have passed RFCSLs (2001-2012) specific to infants; little variability in content.  Accurate MVA fatality data is available:  National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS) database.  A state fixed effects model of infant fatalities predicted by state law status and total vehicle miles driven found a 28% reduction in states with RFCSLs.  Law status became insignificant when all-age MVA mortality was added.

 Public health law mapping and outcome analysis using natural experiment design can be straightforward or complex depending on the law and outcome chosen to be studied.