Legal Epidemiology Research Articles

Legal Epidemiology: The Science of Law.

The importance of legal epidemiology in public health law research has undoubtedly grown over the last five years. Scholars and practitioners together have developed guidance on best practices for the field, including: placing emphasis on transdisciplinary collaborations; creating valid, reliable, and repeatable research; and publishing timely products for use in decision-making and change. Despite the energy and expertise researchers have brought to this important work, they name significant challenges in marshalling the diverse skill sets, quality controls, and funding to implement legal epidemiology activities. The Centers for Disease Control and Prevention (CDC) has worked to develop cross-cutting research and translation on issues of national priority in legal epidemiology, and has explored ways to overcome some of these challenges. As such, this article describes a case study of the use of law to characterize states' prior authorization policies regarding medication used to treat attention-deficit/hyperactivity disorder (ADHD), a central component of a broader effort to improve behavior therapy options for young children with ADHD. This article highlights the types of legal epidemiology work we have undertaken, the application of this work to an emerging public health problem, and the lessons learned in creating impactful research for the field.

A Scan of CDC-Authored Articles on Legal Epidemiology, 2011-2015.

The Centers for Disease Control and Prevention (CDC) conducts research on legal epidemiology, the scientific study of law as a factor in the cause, distribution, and prevention of disease. This study describes a scan of articles written by CDC staff members to characterize the frequency and key features of legal epidemiology articles and their distribution across CDC departments and divisions. CDC librarians searched an internal repository for journal articles by CDC staff published from January 1, 2011, to May 31, 2015. Researchers reviewed and coded the abstracts to produce data on key features of the articles. Researchers identified 158 CDC-authored legal epidemiology articles published in 83 journals, most frequently in Preventing Chronic Disease (14 publications), Journal of Public Health Management Practice (10 publications), and Morbidity and Mortality Weekly Report (9 publications). Most articles concerned the use and impact of law as a deliberate tool of intervention. Thirteen articles addressed the legal infrastructure of public health, and 3 assessed the incidental or unintended effects of nonhealth laws. CDC-authored articles encompassed policy making, implementation, and impact. Literature reviews and studies mapping laws across multiple jurisdictions constituted one-quarter of all publications. Studies addressed laws at the international, national, state, local, and organizational levels. Results of the scan can be used to identify opportunities for the agency to better support research, professional development, networking, publication, and tracking of publication in this emerging field.

A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology.

Public health law has roots in both law and science. For more than a century, lawyers have helped develop and implement health laws; over the past 50 years, scientific evaluation of the health effects of laws and legal practices has achieved high levels of rigor and influence. We describe an emerging model of public health law that unites these two traditions. This transdisciplinary model adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation. These practices include policy surveillance and empirical public health law research on the efficacy of legal interventions and the impact of laws and legal practices on health and health system operation. A transdisciplinary model of public health law, melding its legal and scientific facets, can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health.

Scan of CDC Legal Epidemiology Articles, 2011-2015

Law is a significant factor in public health, and an important tool government can use for protecting and promoting well-being. Legal risks and interventions can only be properly understood through epidemiological and evaluation research. “Legal epidemiology,” the scientific study of law as a factor in the cause, distribution, and prevention of disease in a population, is funded and conducted by the Centers for Disease Control and Prevention (CDC), but the level of work and its distribution across the agency has not been assessed.The EndNote library maintained for Science Clips (publications by CDC authors) was searched by CDC librarians for journal articles published by CDC staff from January 2011 to May 2015. A team at the Public Health Law Research program reviewed and coded the abstracts to produce data on key features of the articles. The Public Health Law Research program identified 225 articles in the realm of legal epidemiology, comprised of 158 scientific evaluations and 67 commentaries or other forms of non-empirical legal scholarship. Most of the scientific studies concerned the use and impact of law as a deliberate tool of intervention. Only 13 of the empirical studies addressed the legal infrastructure of public health (powers, duties and organization of health agencies) and, despite the recognized importance of structural factors on population health, only three scientific studies addressed the incidental or unintended effects of non-health laws. CDC scientific legal studies encompassed policy making, implementation, and impact. Literature reviews and studies scientifically mapping the characteristics and geographic distribution of law made up a quarter of all the empirical publications. Studies addressed a wide range of laws at the international, national, state, local and organizational levels. The scan did not assess the quality or rigor of the research, but did observe that only a minority of the legal epidemiology included a legally-trained co-author.CDC’s scientific legal work was published in a total of 83 different journals. The three most frequent publishers were Preventing Chronic Disease (14 publications), Journal of Public Health Management Practice (10 publications) and MMWR – Morbidity and Mortality Weekly Report (9 publications).CDC researchers make a substantial contribution to the emerging field of legal epidemiology, in both scientific research and commentary on law and its applications in public health. Results of the scan can be used to identify opportunities for the agency to better support research, professional development, networking and publication in this emerging field.

Resources for Policy Surveillance: A Report Prepared for the Centers for Disease Control and Prevention Public Health Law Program

Law is one of the primary tools used in public health to promote healthier environments and behaviors. Governments at all levels use statutes, regulations and other policies, often in innovative ways, to make our communities healthier and safer. The effective and efficient use of law as a public health intervention depends upon research to evaluate what works and what does not, and diffusion of information to speed the adoption and implementation of laws that improve health. The term “Legal Epidemiology” is apt for this public health law work, capturing both its importance and its scientific nature. Legal epidemiology may be defined as “the scientific study of law as a factor in the cause, distribution and prevention of disease in a population.” Within legal epidemiology, “policy surveillance,” the systematic tracking of policies of public importance, is an emerging practice that supports both scientific evaluation and the diffusion of policies the work for health. The Robert Wood Johnson Foundation’s Public Health Law Research program (PHLR), working in collaboration with the Centers for Disease Control and Prevention’s Office of State, Tribal, Local, and Territorial Support (OSTLTS), ChangeLab Solutions, The Network for Public Health Law, the Public Health Law Center, and many expert volunteers, undertook a series of research and consultation projects intended to advance the understanding and practice of legal epidemiology at CDC and state, local and tribal health agencies, with special focus on policy surveillance.The results of this work are collected in this report and include:• A Scan of Explicit Legal Recommendations in Federal Guidance Documents, to document the important place of law in the nation’s health strategies;• A Scan of Existing 50 State Survey and Policy Surveillance Resources, to describe the current investment in legal monitoring, and the state of the art;• Criteria for Selecting Policies for Surveillance: Recommendations of an Expert Committee, to provide initial guidance to decision-makers on the wise use of limited legal monitoring resources;• Technical Standards for Policy Surveillance and Legal Datasets: Report of a Delphi Process, to define consensus expert standards for the conduct of scientific legal surveillance; and• Policy Surveillance Competencies (1.0), embodying the expert standards in measurable workforce capacities.Together, these resources provide a foundation for building a stronger, transdisciplinary practice of public health law.

A Scan of Existing 50 State Survey and Policy Surveillance Resources

Policy surveillance, the systematic tracking of policies of public importance, is an emerging practice within legal epidemiology that supports both scientific evaluation and the diffusion of policies the work for health. The emergence of policy surveillance as a distinct practice has been gradual. Although there is a long tradition of state in public health, the use of scientific methods to create datasets of legal variables suitable for use in evaluation research has emerged in the last twenty years as a result of sustained research funding for legal evaluation in key areas, most notably alcohol and tobacco control. In contrast to traditional legal research, policy surveillance entails tracking policies over time, and the use of systematic quantitative or qualitative coding to create scientific datasets.This report describes the results of a panel of experts who requested PHLR to conduct a scan identifying currently available policy surveillance portals and 50 state surveys of public health law. Our process scanned over 10,500 individual internet search results, returning over 160 individual policy surveillance resources created in the past four years. Many of these resources are static surveys that are updated either not at all or inconsistently, with different levels of supporting documentation, and across a broad range of health-related topics. This represents a significant investment of resources in policy surveillance and demonstrates the need for standards and protocols that more efficiently allocate the resources used to conduct policy surveillance.

THE "LEGAL EPIDEMIOLOGY" OF THE TEEN SEXTING EPIDEMIC: HOW THE MEDIA INFLUENCED A LEGISLATIVE OUTBREAK

This article considers the media‟s impact on the “legal epidemiology” of the teen sexting epidemic. Here, “teen sexting epidemic” refers to two things: (1) the belief that sext messaging by teens is rampant and spreading, hence, is an epidemic; and (2) the process by which a piece of information spreads like a virus, came to be understood as a pathogen infecting teens, resulted in a rash of child pornography prosecutions, and erupted into an outbreak of sexting legislation, hence, the epidemiology of the legal issue. This article argues that the media was both a carrier of this virus, in that it communicated the information and conceptual frameworks that formed the public‟s knowledge base of sexting and its legal implications, and a host environment in which forces interacted and transformed. To better understand the media‟s role, this article includes an empirical analysis of the past five years of media coverage of teen sexting, and identifying both its temporal and topical trends. With this quantitative and qualitative base, the article then analyzes the relationship between coverage and the progression of the teen sexting epidemic from a social issue to a legal issue and, ultimately, to an outbreak of “curative” legislation. In doing so, it focuses on the child pornography prosecutions of teen sexters, the media‟s criticism of that course of action, the reincarnated stories of sext-related suicides, and the nation‟s recent sext-related legislation.