While a growing number of major league sports teams have policies on concussion assessment and return to play, many youth and school sports leagues and teams do not have similar rules, despite thousands of sports-related traumatic brain injuries (TBIs) reported in children and adolescents every year.

Hosea H. Harvey, PhD, JD, Assistant Professor of Law in Temple University’s Beasley School of Law, has just published an article in the American Journal of Public Health analyzing how this health issue is being addressed across the country. He found that there are laws dealing with concussions in youth sports in 44 states and D.C.—but none are focused on preventing the injuries. The laws only address detecting the injuries or preventing an additional injury after one has already occurred.

The study also revealed that many laws don’t draw on evidence around what works. For example, most state laws establish a minimum 24-hour period of youth athlete removal, but there is no scientific agreement about the optimal minimal time someone who has suffered a sports-related TBI should be removed from play. The study utilized an open source dataset from Robert Wood Johnson Foundation grantee Public Health Law Research called LawAtlas.

>>Read the full study.

NewPublicHealth previously spoke with Harvey and Kerri McGowan Lowrey, JD, MPH, Senior Staff Attorney with the Public Health Law Network, about legal and legislative approaches to addressing concussions in youth sports. The previous interview is included below:

Crime and violence in U.S. inner cities has a profound impact on public health. The question is how best to combat it. According to recent studies, one answer could be as simple as assigning more police officers to foot patrols in crime hotspots.

With funding in part from the Robert Wood Johnson Foundation’s Public Health Law Research program, researchers from Temple University worked with the Philadelphia Police Department to conduct a study on the impact of police foot patrols on inner city crime. Findings published in Criminology in 2011 found foot patrols helped reduce violent crime — at least temporarily — by 23 percent in high-crime areas of the city. A recent follow-up study in Policing and Society revealed a qualitative look at how the participating officers developed extensive local knowledge and formed community relationships — both of which contributed to the cuts in crime.

These and other results demonstrate the need to involve officers on foot patrol in the development of violence prevention strategies, according to researchers.

>> Read more about the study.

While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.

In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.

“This problem requires a public health solution since [preventing childhood] lead exposure…involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.

NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.

NewPublicHealth: What did your study find?

Nearly 40 percent of private-sector employees in the United States do not have access to paid sick days, making it difficult for them to miss work when they are ill or have a doctor’s appointment. Those who do stay home often suffer lost wages and risk being fired from their jobs. To avoid financial insecurity, employees often go to work while sick, according to the Network for Public Health Law.

Paid sick days, on the other hand, allow employees to stay home or seek preventive care without risking a family’s income or endangering the health of co-workers, customers and others. In fact, one study found that 7 million workers were infected with H1N1 in 2009 because their co-workers came to work sick. To combat this trend, some U.S. cities and one state (Connecticut) have enacted laws requiring employers to provide paid sick days, which was a topic explored in a webinar earlier this year from the Network for Public Health Law.

But as some cities are making moves toward paid sick leave, some state-level legislation is cropping up that could prevent cities and counties from passing their own paid sick days standards and enacting other workplace protections. Such preemption laws are being considered in at least six states, according to a post by Vicki Shabo, Director of Work and Family Programs, for the National Partnership for Women and Families.

"No matter where you live or work, no one should have to choose between job and family because he or she cannot earn paid sick days," said Shabo in the post.

>>Read the full blog post on paid sick leave preemption laws.
>>Read more on preemption.

While laws to help make it easier for everyone to get their veggies are cropping up all over, some would-be planters get stopped in their carrot tracks by regulations that prohibit use of public spaces for planting, or even limit what can be grown on private property, according to a recent article in the Wall Street Journal [note: subscription required]. In some jurisdictions, according to the article, sidewalk gardeners have been fined and may lack the clout to advocate for changing the laws.

>>Bonus Link: Read about Urban Farming, a nonprofit group with high-profile corporate sponsors that supports gardens on unused land.

Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government. 

This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.

>>View the original posting of this interview over at GrassrootsChange.net.
>>Read more on preemption and grassroots movement building.

Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?

Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention]. 

Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science. 

Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.

GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies. 

Later today Lisa Simpson, MB, BCh, MPH, president and CEO of AcademyHealth, will moderate a “Washington Update” panel discussion at the sixth annual Keeneland Conference taking place this week in Lexington, Ky. The discussion will focus on issues to watch at the federal level and panelists include Paul Jarris, MD, MBA, Executive Director of the Association of State and Territorial Health Officials; Jeff Levi, PhD, Executive Director of Trust for America's Health; and Robert Pestronk, MPH, Executive Director of the National Association of County and City Health Officials.

NewPublicHealth spoke with Dr. Simpson ahead of the session.

NewPublicHealth: What will your “Washington Update” focus on?

Dr. Simpson: I have the good fortune of moderating a discussion with three important leaders from Washington—Jeff Levi, Paul Jarris and Bobby Pestronk—and we’ll be bringing an update about what is going on in Washington that affects the field of public health and public health services research (PHSR) specifically. We’re going to be talking about the general policy context and the conversation in Washington in terms of budget and priority and tradeoff, but also talking about how we think public health services research is informing the conversation and the kinds of questions that policymakers have.

NPH: How has public health services research evolved in the last few years in terms of informing the conversation? 

Study: Chickenpox Vaccine Provides Long-Term Protection
A new study published online in the journal Pediatrics confirmed that the chickenpox (varicella) vaccine is effective at preventing chicken pox, and that the effectiveness does not wane over a 14-year period. One dose provided excellent protection against moderate to severe disease. Consistent protection was important because chickenpox infection in older teens and adults can be much more serious than it generally is in childhood, according to the study author, in an interview with HealthDay. The study data also suggest that the vaccine may also reduce the risks of shingles, another type of infection caused by the chickenpox virus that tends to affect people later in life. The study followed a total of 7,585 children vaccinated with varicella vaccine in their second year of life in 1995 for 14 years to see if they developed either chickenpox or shingles. Read more on vaccination.

EPA Proposes Measures to Cut Air Pollution, Improve Population Health
Based on input from auto manufacturers, refiners, and states, the U.S. Environmental Protection Agency (EPA) proposed new standards for cars and gasoline that will significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. Once fully in place, experts say the standards will help avoid up to 2,400 premature deaths per year and 23,000 cases of respiratory ailments in children. The measures will also prevent 3,200 hospital admissions and asthma-related emergency room visits, and 1.8 million lost school days, work days and days when activities would be restricted due to air pollution. Total health-related benefits in 2030 are expected to be between $8 and $23 billion annually. The new standards will reduce gasoline sulfur levels by more than 60 percent, which will also enable vehicle emission control technologies to perform more efficiently. Read more on environmental health.

New Jersey Bans Children from Tanning Beds
New Jersey Governor Chris Christie signed a bill into law on Monday banning children under 17 from using commercial tanning beds. Tanning before age 35 has been shown to increase the risk for melanoma by 75 percent. The new law also bans children under 14 from getting spray tans in tanning salons, which could impact social norms around young teens wanting to look tan if their friends look tan. Read more on safety.

While twelve states currently have laws regulating sales of electronic cigarettes (known as e-cigarettes) to minors, a new post on the Network for Public Health Law blog calls on more states to restrict sales to minors while the Food and Drug Administration continues their review of the device.

E-cigarettes contain nicotine, but no tobacco and often come in kid-alluring flavors such as chocolate and vanilla. According to the Network post, one small FDA study found carcinogens and toxins in e-cigarettes. Health experts are concerned that the electronic devices may also be a gateway tool for young adults to actual, cancer-causing, tobacco-filled cigarettes.

E-cigarette use has skyrocketed among adults, according to a recent study by researchers funded by the Centers for Disease Control and Prevention. In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, up from about 10 percent in 2010. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011. 

>>Read the post.

State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.

Critical issues include:

• A smoking ban in Kentucky which could stall in committee
• A bill in Kentucky which could restrict the work of local boards of health.
• A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.  

>>Bonus Links:

• Read the Network blog post.
• Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.