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Firearms legislation and reductions in firearm-related suicide deaths in New Zealand.

OBJECTIVE: To examine the impact of introducing more restrictive firearms legislation (Amendment to the Arms Act, 1992) in New Zealand on suicides involving firearms. METHOD: National suicide data were examined for 8 years before, and 10 years following the introduction of the legislation. RESULTS: After legislation, the mean annual rate of firearm-related suicides decreased by 46% for the total population (p < 0.0001), 66% for youth (15-24 years; p < 0.0001) and 39% for adults (> or = 25 years; p < 0.01). The fraction of all suicides accounted for by firearm-related suicides also reduced for all three populations (p < 0.0001). However, the introduction of firearms legislation was not associated with reductions in overall rates of suicide for all three populations. CONCLUSIONS: Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth. Overall rates of youth suicide also decreased over this time but it is not possible to determine the extent to which this was accounted for by changes in firearms legislation or other causes.

Adolescent↗

Dimensions underlying legislator support for tobacco control policies.

OBJECTIVE: To propose and test a new classification system for characterising legislator support for various tobacco control policies. DESIGN: Cross sectional study. SUBJECTS: Federal and provincial legislators in Canada serving as of October 1996 who participated in the Canadian Legislator Study (n = 553; response rate 54%). MAIN OUTCOME MEASURES: A three factor model (Voters, Tobacco industry, Other interest groups) that assigns nine tobacco control policies according to legislators' hypothesised perceptions of which group is more directly affected by these policies. RESULTS: Based on confirmatory factor analysis, the proposed model had an acceptable fit and showed construct validity. Multivariate analysis indicated that three of the predictors (believing that the government has a role in health promotion, being a non-smoker, and knowledge that there are more tobacco than alcohol caused deaths) were associated with all three factor scales. Several variables were associated with two of the three scales. Some were unique to each scale. CONCLUSIONS: Based on our analyses, legislator support for tobacco control policies can be grouped according to our a priori factor model. The information gained from this work can help advocates understand how legislators think about different types of tobacco control policies. This could lead to the development of more effective advocacy strategies.

Analysis of Variance↗

An evaluation of the effectiveness of tobacco-control legislative policies in European Community countries.

The purpose of this paper was to assess the effectiveness of anti-tobacco smoking legislation from 1948 onwards in reducing actual per capita tobacco consumption in the twelve countries of the European Economic Community (EEC). In order to undertake these assessments a score was assigned to every legislative measure, indicating the a priori likely impact of this measure on tobacco consumption. Two approaches were then utilized. In the first, it was found that the cumulative anti-tobacco legislative score correlates well in time with a reduction of tobacco consumption. In the second, cross-sectional data from the EEC countries and multiple regression modelling were used to estimate the elasticities of tobacco price, per capita income and cumulative anti-tobacco legislation score; it was found that legislation has an impact on tobacco consumption which, although considerably smaller than the corresponding impact of tobacco price levels, is nominally significant and potentially important. The evaluative approaches utilized in this paper are based on observational data of ecologic nature and can provide only weak evidence about the causal nature of the reported associations. Nevertheless, this limited evidence suggests that legislative measures may be effective both by affecting price levels and through other mechanisms, including health education and the formation of a more general anti-smoking ethos.

Europe↗

Texas passes first law for safe patient handling in America: landmark legislation protects health-care workers and patients from injury related to manual patient lifting.

On June 17,2005, Texas Governor Rick Perry (R) signed into law Senate Bill 1525, making Texas the first state in the nation to require hospitals and nursing homes to implement safe patient handling and movement programs. Governor Perry is to be commended for this heroic first stand for safe patient handling in America. The landmark legislation will take effect January 1, 2006, requiring the establishment of policy to identify, assess, and develop methods of controlling the risk of injury to patients and nurses associated with lifting, transferring, repositioning, and movement of patients; evaluation of alternative methods from manual lifting to reduce the risk of injury from patient lifting, including equipment and patient care environment; restricting, to the extent feasible with existing equipment, manual handling of all or most of a patient's weight to emergency, life-threatening, or exceptional circumstances; and provision for refusal to perform patient handling tasks believed to involve unacceptable risks of injury to a patient or nurse. Manually lifting patients has been called deplorable, inefficient, dangerous to nurses, and painful and brutal to patients; manual lifting can cause needless suffering and injury to patients, with dangers including pain, bruising, skin tears, abrasions, tube dislodgement, dislocations, fractures, and being dropped by nursing staff during attempts to manually lift. Use of safe, secure, mechanical lift equipment and gentle friction-reducing devices for patient maneuvering tasks could eliminate such needless brutality. Research has proven that manual patient lifting is extremely hazardous to health-care workers, creating substantial risk of low-back injury, whether with one or two patient handlers. Studies on the use of mechanical patient lift equipment, by either nursing staff or lift teams, have proven repeatedly that most nursing staff back injury is preventable, leading to substantial savings to employers on medical and compensation costs. Because the health-care industry has relied on people to do the work of machines, nursing work remains the most dangerous occupation for disabling back injury. Back injury from patient lifting may be the single largest contributor to the nursing shortage, with perhaps 12% of nurses leaving or being terminated because of back injury. The US health-care industry has not kept pace with other industries, which provide mechanical lift equipment for lifting loads equivalent to the weight of patients, or with other countries, such as Australia and England, which are more advanced in their use of modern technology for patient lifting and with no-lifting practices in compliance with government regulations and nursing policies banning manual lifting. With Texas being the first state to succeed in passing legislation for safe patient handling, other states are working toward legislative protection against injury with manual patient lifting. California re-introduced safe patient handling legislation on February 17, 2005, with CA SB 363, Hospitals: Lift Teams, following the September 22, 2004, veto of CA AB 2532 by Governor Arnold Schwarzenegger, who said he believes existing statutory protection and workplace safety standards are sufficient to protect health care workers from injury. Massachusetts HB 2662, Relating to Safe Patient Handling in Certain Health Facilities, was introduced December 1, 2004. Ohio HB 67, signed March 21, 2005 by Governor Bob Taft (R), creates a program for interest-free loans to nursing homes for implementation of a no-manual-lift program. New York companion bills AB 7641 and SB 4029 were introduced in April, 2005, calling for creation of a 2-year study to establish safe patient handling programs and collect data on nursing staff and patient injury with manual patient handling versus lift equipment, to determine best practices for improving health and safety of health-care workers and patients during patient handling. Washington State is planning re-introduction of safe patient handling legislation, after WA HB 1672, Relating to reducing injuries among patients and health care workers, was stalled in committee in February, 2005. Language from these state initiatives may be used as models to assist other states with drafting safe patient handling legislation. Rapid enactment of a federal mandate for Safe Patient Handling No Manual Lift is essential and anticipated.

Back Injuries↗

Breast cancer screening legislation in the United States.

We discuss some of the issues emerging from a powerful legislative movement for preventive services over the past three years. During this time an increasing number of states passed, considered, or are currently developing breast cancer screening legislation. Most of these laws require some form of third party payment for mammography or establish breast cancer screening programs. The legislation varies markedly with regard to periodicity of examinations, ages covered, type and extent of third party coverage, dosage regulation, and radiographic equipment standards. This shows a need for common standards. Legislation provides an essential incentive for a public health response to a serious problem, but more than laws are needed. Health care providers and the general public need to be aware and take advantage of the coverage provided as a result of legislation. Moreover, public health officials need to be aware that such legislation may lead to a demand for services that exceeds present capacity to deliver them.

Aged↗

Are tobacco industry campaign contributions influencing state legislative behavior?

OBJECTIVES: This study tested the hypothesis that tobacco industry campaign contributions influence state legislators' behavior. METHODS: Multivariate simultaneous equations regression was used to analyze data on tobacco industry campaign contributions to state legislators and legislators' tobacco control policy scores in 6 states. Campaign contributions were obtained from disclosure statements available in the specific state agency that gathers such information in each state. Tobacco policy scores were derived from a survey of key informants working on tobacco issues in each state. RESULTS: As tobacco industry contributions increase, a legislator's tobacco policy score tends to decrease (i.e., become more pro-tobacco industry). A more pro-tobacco position was associated with larger contributions from the industry. These results were significant even after controls for partisanship, majority party status, and leadership effects. In California, campaign contributions were still significantly related to tobacco policy scores after controls for constituent attitudes and legislators' personal characteristics. CONCLUSIONS: Tobacco industry campaign contributions influence state legislators in terms of tobacco control policy-making.

Financial Support↗

Public opinion and legislators' views on tobacco policy.

We explored the relationship between public opinion and Kentucky state legislators' views on increasing the cigarette excise tax to curb smoking, local option to pass stricter youth access to tobacco laws, and smoking restrictions in public places. The relationship of gender, education, political party affiliation, tobacco use, and tobacco allotment ownership to public and legislators' opinions was examined using logistic regression. Data from the random, statewide University of Kentucky Public Opinion Poll (n = 628 Kentucky adults) and a Delphi study of Kentucky legislators (n = 116 members of the Kentucky General Assembly) were used in this study. Controlling for the demographic differences in gender, age, ethnicity, education, and tobacco allotment ownership between the public opinion and legislator samples, legislators were far less likely than the public to support workplace or restaurant smoking restrictions. Participants with a college education were twice as likely to favor cigarette tax hikes and four to five times more likely to favor workplace and restaurant smoking restrictions than were those without a college degree. Tobacco allotment owners and tobacco users were less likely to support raising cigarette taxes and local option to curb teen tobacco use compared to nonowners and nonusers. Findings of this study suggest that Kentucky legislators are not keeping up with public opinion about tobacco control, particularly in regard to smoking restrictions in workplaces and restaurants. Health professional organizations can play a role by educating both their membership and lawmakers about public support for tobacco control policy.

Adult↗

Does legislation reduce harm to doctors who prescribe for themselves?

OBJECTIVE: To consider the issue of legislation restricting self prescribing by doctors. METHOD: Searches of the medical literature in Medline, Australian Medical Index and CINAHL using the terms 'medical', 'legislation' and 'physician impairment' from 1966-2003 supplemented by checking citations of review papers. RESULTS: We found 144 articles, although no trials of legislation. The remaining research was inadequate to answer the question of whether restricting self prescribing reduces doctor impairment. However, descriptive studies suggest that impairment attributed to self prescribing is most often from self administration, which is not altered by legislation to restrict self prescribing. DISCUSSION: There are important theoretical adverse consequences of legislation that restrict self prescribing. Apparently self evident legislation may be counter productive. The need for doctors to have an independent general practitioner is reinforced.

Drug Prescriptions↗

The WHO European program of health legislation and the Health for All policy.

The purpose of this paper is to provide a comprehensive review of the work of the World Health Organization (WHO), begun a decade ago in Europe, in the field of health legislation. This program is the result of the interaction between two important factors: the trends in national health policy and legislation at the country level, and the implementation of the Health for All policy, which has been collectively adopted by the European Member States in various WHO fora. Health legislation has proved to be a valuable tool in supporting National Health Policies in European countries and a key element in international health activities. The paper will be presented in three main parts. The first examines the legislative implications of the Health for All policy and strategy. The second gives an overview of developments in health legislation in Europe, focusing on national achievements in three areas in which change is necessary to achieve Health for All: health care systems, the environment, and lifestyles. The third part gives an account of activities carried out by the Regional Office for Europe of WHO in the health legislation field, recalls the organization of the first WHO medium-term program in this field, and summarizes its four current subprograms on health policy, health situation, exchange of information, and training. The conclusion briefly outlines the prospects for further developments in Europe.

Delivery of Health Care↗

Epidemiology of failed tobacco control legislation.

OBJECTIVE: To evaluate the influence of tobacco industry campaign donations, district location, and political party affiliation on tobacco control legislation among members of the US Congress. DESIGN: Data were obtained from the Federal Election Commission on money contributed by the 10 leading tobacco political action committees and by tobacco industry-aligned individuals to members of the US House of Representatives (1991-1992) and Senate (1987-1992). Logistic regression analyses were performed using recorded votes and cosponsorship activities concerning tobacco control legislation during the 102nd and 103rd Congresses and membership on the House Congressional Task Force on Tobacco and Health as the dependent variables and tobacco money received, party, district location, and caucus or committee membership as the independent variables. SETTING: United States Congress in 1991 and 1992. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Support for federal tobacco control legislation. RESULTS: The tobacco industry donated approximately $2.4 million to members of Congress from January 1991 through December 1992. House members received an average of $2943 (1991-1992) and senators received an average of $11,593 (1987-1992). The more tobacco money a member received, the less likely the member was to support tobacco control legislation. In the Senate, on a vote to end the taxpayer subsidy of tobacco products in military stores, the odds ratio that senators in the top quartile of tobacco money recipients did not support the measure vs senators in the lowest quartile of tobacco money recipients was 42.2 (95% confidence interval, 4.1 to 430.0; P < .001). In the House, on a vote to end a $3.5 million subsidy to promote American tobacco abroad, the odds that House members in the top third of tobacco money recipients would oppose the legislation were 14.4 times greater (95% confidence interval, 5.5 to 39.0; P < .001) than for House members in the lowest third of tobacco money recipients. Receiving more tobacco money, being a member of the Republican party, and representing a tobacco-producing state were all associated with decreased support for tobacco control issues. The amount of tobacco money received was the variable most strongly and consistently associated with a lack of support for tobacco control legislation, even when we controlled for additional factors such as district location and party. CONCLUSION: Tobacco industry contributions to members of the US Congress strongly influence the federal tobacco policy process. Unless this influence is diminished through a combination of members refusing tobacco money and campaign finance reform, this process of contributing to death by thwarting tobacco control will continue to claim hundreds of thousands of lives a year.

Fund Raising↗

The politics of antismoking legislation.

To understand why some states have enacted relatively stringent laws to control smoking in public places while others have not, we examined the political evolution of tobacco control initiatives in six states: New York, Minnesota, Florida, Illinois, Texas, and Arizona. Taken together, the case studies demonstrate the difficulties inherent in enacting strong statewide tobacco control legislation. More important, several unmistakable themes emerge from these case studies, shedding light on the barriers to greater legislative success. These themes include the manner in which the legislative debate is framed by antismoking advocates and the tobacco industry, the relative dearth of leadership provided by medical and health organizations, the role of public opinion, and the complex interaction that exists between statewide antismoking legislation and local antismoking ordinances. Understanding how these issues affect legislative outcomes may help antismoking advocates enact future statewide tobacco control initiatives. It may also present lessons applicable to future battles over other public health legislation.

Arizona↗

[Legislative bases for the prevention of smoking in school].

For the last years we have witnessed and increasing awareness of the part of doctors and teachers who by means of the education for the health (EpS) promote the acquisition of healthy habits among students at schools. One of those educational contents is the smoking prevention. The participation of pneumologists in those activities is still rather limited. Doctors and teachers should reach a better understanding and doctors should get more involved helping the school boards and the teaching staff to outline these aspects regarding health in the educational project of each school. Their collaboration is essential in the training on health topics made by the teaching staff and their later development. Smoking prevention among young people can't be viewed from a detached perspective and comprehensive health policies, with a legislative development including all aspects, become absolutely necessary. In order to provide such activities, western governments have developed a various non-smoking legislation for the last years. Knowing the legislation which holds the achievement proves to be interesting for the teachers responsible of the carrying-out as well as for the doctors willing to participate in their project. The most important Spanish legislation about smoking is the Royal Order 192/1988 of the Ministry of Health. The legislation of the Ministry of Education concerning the educational contents for compulsory education in nursery, primary and secondary schools includes the EpS and shapes a legislative framework which enables to develop those preventing activities at schools.

Adolescent↗

Employment equality legislation, 3 March 1988.

On 1 April 1988, new employment equality legislation came into effect in Israel. The new legislation outlaws discrimination at work on the grounds of sex, marital status, and parenthood with respect to recruitment, terms of employment, promotion, vocational training, retraining, dismissal, and severance pay. Under the legislation, 1) employers may not cause prejudice to workers who allege discrimination, help others to do so, or decline sexual advances by a direct or indirect supervisor; 2) the burden of proof in discrimination claims against an employer is on the employer if the worker can show that requirements set by the employer have been met; 3) company managers and co-owners in a partnership are personally liable for violations on the part of the employer if the firm has over six workers unless they prove that the offense was committed without their knowledge or that they had taken all appropriate measures to prevent it; and 4) no special rights given to women by law, collective agreement, or other work contract are to be considered discrimination. The legislation establishes a Public Council to advise the Minister of Labour and Social Affairs on implementing and publicizing the legislation. It also allows a father to receive the following work benefits that were previously restricted to mothers: 1) leave of absence to care for a sick child and 2) statutory leave and statutory entitlement to severance pay for resigning to care for a newborn or adopted baby if the father is the sole guardian or if the mother renounces her right because she is working.

Asia↗

Protective medical legislation deficient knowledge of maternity (health and safety) rights for work-adjustment exists amongst flexible trainee doctors: is there a risk to maternal and foetal health?

OBJECTIVE: To assess awareness, identify knowledge source and evaluate uptake amongst doctors of "health and safety rights" (HSR) contained within the current European protective medical legislation for pregnant workers. STUDY DESIGN: A descriptive cross-sectional pilot study, by a postal questionnaire during the period 1998-1999, targeted 97 UK doctors (West Midlands region) after their first pregnancy. RESULTS: Of 67 respondents (response rate 73%), 41 (61%) were Registrars (SpR) and 25 (37%) SHOs: 80% work-schedules did not change during pregnancy. Only 11% (95% CI, 4-21%) of the doctors surveyed actually knew their maternity rights. 66.2% had no knowledge of maternity legislation; 80% of respondents had not taken up health and safety rights. Fifty-two percent (95% CI, 40-65%) reported maternal and neonatal complications. CONCLUSIONS: In a self-selected group of flexible trainees following their first pregnancy, only one in five female doctors have adequate knowledge about the legislative "health and safety rights" of work-schedule adjustment. A combination of reasons may contribute to the low uptake of these rights. The question of whether or not poor knowledge and uptake of legislative rights may be detrimental towards pregnancy and neonatal complications requires a large prospective study. An improvement in the knowledge of current maternity legislation could occur by targeting all medical students, all doctors, postgraduate trainers and National Health Service (NHS) employers.

Adult↗

The effect of legislative requirements on the use of breast-conserving surgery.

BACKGROUND: We studied the effect of state legislation requiring the disclosure of options for the treatment of breast cancer on the use of breast-conserving surgery in clinical practice. METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results registry provided data on women from 30 through 79 years of age who underwent breast-conserving surgery or mastectomy for local or regional breast cancer from 1983 through 1990. We examined the trend over time in use of breast-conserving surgery among patients in four sites (Connecticut, Iowa, Seattle, and Utah) where there were no state laws specifically requiring the disclosure of options for the treatment of breast cancer by physicians. For four additional sites (Detroit, Atlanta, New Mexico, and Hawaii) that had such legislation, we determined whether the rate of breast-conserving surgery after the legislation was different from the expected rate. RESULTS: An attorney rated the legislation as giving most direction to physicians in Michigan, followed by Hawaii, Georgia, and New Mexico. The rate of breast-conserving surgery was up to 8.7 percent higher than expected in Detroit for six months after the passage of the Michigan law (P<0.01). The rate was up to 13.2 percent higher than expected in Hawaii for 12 months after that state's law was passed (P<0.05) and up to 6.0 percent higher than expected in Atlanta for 3 months after the passage of the Georgia law (P<0.01). After these transient increases, the surgery rates reverted to the expected levels. No significant effect was detected in New Mexico, where only a resolution without legal force was passed. CONCLUSION: Legislation requiring physicians to disclose options for the treatment of breast cancer appeared to have only a slight and transient effect on the rate of use of breast-conserving surgery.

Adult↗

[Comparative analysis of Brazil, Mercosul, Great Britain and European Union of food labeling legislation].

OBJECTIVE: To analyze the Brazilian/Mercosul and the British/European Union food labeling legislation. METHODS: The analysis was carried out using a set of 19 questions considered important to describe and compare the different sets of legislation. RESULTS: The results showed that all sets of legislation were very similar. Regarding health claims, the legislation differentiates content from effect claims. However, it is shown to be difficult to do so because both of them express the same message, that a product is good for the health. Concerning nutrition label, the problem is that in all sets of legislation it is only compulsory when a health claim is made. Another problem is that the nutritional description is required to be by weight, while international nutritional recommendations are made as percentage of energy. CONCLUSIONS: Health claims should not be allowed, they are potentially misleading and do not convey more information than nutrition label. Nutrition label should be compulsory, and the macronutrients presented as percentage of energy together with the international nutritional recommendations.

Brazil↗

Communicating hospitals' concerns to legislators and the community.

The time is past when voluntary hospitals could afford to be uninformed and inactive in public affairs. As decisions in the public sector increasingly threaten not-for-profit institutions, Catholic hospitals particularly must pursue an action-oriented program of communication with legislators and the community. At Carney Hospital, Boston, an especially effective forum for the past eight years has been buffet dinners held on a quarterly basis with state and congressional legislators and representatives of the hospital's management team, board of trustees, associate board, and medical staff. These dinner meetings provide a singular opportunity for law-makers to learn hospitals' perspective on key issues such as the effect of tightened reimbursement on care of the poor. The dinners not only have enhanced relations with legislators but also raised the consciousness of the business community, consumers, and the general public. Frequent mailings to legislators and members of the board of trustees and the associate board also have beeN helpful. The associate board was formed to augment the expertise of the board to trustees and to increase lay participation in the hospital's affairs. Composed of 20 lay leaders representing a diversity of disciplines, the associate board provides a strong base for influencing public policy and community action. Moreover, the hospital's various constituencies--physicians, employees, volunteers, and auxilians-are recruited as appropriate to contact legislators, write letters to the editor, and give media interviews. Also important in the facility's public affairs efforts have been timely responses to requests for action from The Catholic Health Association, the American Hospital Association, and the state hospital association.

Boston↗

Attitudes towards anti-smoking legislation in Israel: a Jerusalem study.

BACKGROUND: With smoking on the rise among teenagers, the United States has recently implemented anti-smoking legislation, though with questionable success. OBJECTIVES: To examine the attitudes in Israel to such legislation. METHODS: An interviewer-administered questionnaire was completed by 505 adults: 217 undergoing general employment checkups and 288 amateur athletes requiring medical testing for certification. Smoking habits and attitudes toward anti-smoking legislation were examined. RESULTS: The overall rate of smoking was 25.3%, with a male:female ratio of 1:24 (P = 0.232). Most smokers (65.6%) started smoking before the age of 20, and only 47.7% tried to quit at least once. Both the smokers and the non-smokers who were interviewed were in favor of legislation that recognized cigarettes as an addictive substance, restricted the sale of cigarettes to people aged 18 and older, and banned cigarette advertisements. CONCLUSIONS: Anti-smoking legislation is looked upon favorably by Israelis, though the true benefit of such measures is questionable. Priority must be given to primary prevention through education and empowering youth to choose not to smoke.

Adult↗