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PubMed2003

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.

OBJECTIVE: To evaluate the influence of average family income in a geographic area on the effectiveness of helmet legislation on observed helmet use by children (5-14 years). METHODS: The study was conducted in East York, a health district of Metropolitan Toronto, in collaboration with the East York Health Unit. In 1996, the total population was 107 822, 11 340 of which were children 5 to 14 years. Census data were used to group the 21 census tracts in East York into 7 geographically distinct areas. The boundaries of these areas are natural barriers to travel, such as expressways, ravines, railway tracks, and hydroelectric power lines. The areas were also ranked according to average family income (based on Statistics Canada data). For analytical purposes, areas were defined as low-, mid-, and high-income areas. Census data profiles of the areas have been previously described. For each consecutive year from 1990 to 1997 inclusive, direct observations of children riding bicycles in East York during the months of April through October were made. In 1995, observations were completed before the introduction of the law on October 1, 1995. Only children who were between 5 and 14 years of age and riding a 2-wheeled bicycle were included in the study. In total, 111 sites across all 7 areas were selected for observation. Observational sites included school yards of all elementary and middle schools (kindergarten to grade 8) and all parks in East York. In addition, 5 major intersections and 5 residential streets from each area were randomly selected. Observers were trained and used a standardized data collection form. A pilot study showed that the data collected by observers were reliable and valid. Observers remained at each site for 1 hour and collected data on helmet use and sex. Ethical approval for the study was obtained from the Hospital for Sick Children Research Ethics Board, the East York Board of Education, and the Metropolitan Separate School Board. The proportion of children who were wearing a bicycle helmet was estimated by year (1990-1997, inclusive), sex (male, female), location (school, park, major intersection, residential street), and income area (low, mid, high). For estimating the effect of legislation on helmet use, data from the year immediately after legislation (1996) were compared with data from the year preceding legislation (1995). The relative risk (RR) of helmet use (after vs before legislation) was calculated along with a 95% confidence interval (CI). Logistic regression analysis was used to adjust for potential confounding variables (sex and location). RESULTS: During the 8-year study period, 9768 observations were made (range: 914-1879 observations per year). The proportion of child cyclists who wore a bicycle helmet increased steadily during the first 4 years of the study period, from 4% in 1990 (34 of 914), to 16% in 1991 (303 of 1879), to 25% in 1992 (383 of 1563), and to 45% in 1993 (438 of 984). During 1994 (460 of 1083) and 1995 (568 of 1227), helmet use remained relatively stable at approximately 44%. Helmet use rose markedly in 1996 (the first year after helmet legislation was introduced) to 68% (818 of 1202) and remained stable at 66% (609 of 916) in 1997. Throughout the study period, girls were consistently more likely to wear helmets than were boys. In total, 47% (1420 of 3047) of girls wore helmets, compared with 33% (2193 of 6721) of boys (RR: 1.43; 95% CI: 1.36-1.50). In addition, children who were riding to school were more likely to use helmets, compared with children who were riding on residential streets, major intersections, and parks. Overall, 48% (1497 of 3129) of children who were riding to school wore bicycle helmets, compared with 32% (2116 of 6639) of children who were riding at other locations (RR: 1.50; 95% CI: 1.43-1.58). Children in the high-income areas were consistently more likely to wear helmets, compared with children in the mid- and low-income areas. Helmet legislation was associated with a significant increase in helmet use by children in East York. In 1995, 46% (ast York. In 1995, 46% (568 of 1227) of children wore bicycle helmets, compared with 68% (818 of 1202) of children in 1996 (RR: 1.47; 95% CI: 1.37-1.58). The effect of legislation, however, varied by income area. In low-income areas, helmet use increased by 28% after legislation, from 33% (213 of 646) in 1995 to 61% (442 of 721) in 1996 (RR: 1.86; 95% CI: 1.64-2.11). In mid-income areas, helmet use increased by 29% after legislation, from 50% (150 of 300) in 1995 to 79% (185 of 234) in 1996 (RR: 1.58; 95% CI: 1.39-1.80). In high-income areas, helmet use increased by only 4%, from 73% (205 of 281) in 1995 to 77% (191 of 247) in 1996 (RR: 1.06; 95% CI: 0.96-1.17). This finding of a significant increase in helmet use after legislation in low- and mid-income areas but not in high-income areas remained even after logistic regression analysis adjusted for sex and location. CONCLUSIONS: This study showed that bicycle helmet use by children increased significantly after helmet legislation. In this urban area with socioeconomic diversity and in the context of prelegislation promotion and educational activities, the legislative effect was most powerful among children who resided in low-income areas.

Accidents, Traffic↗
PubMedDate not supplied

State legislator gender and other characteristics associated with sponsorship of child health bills.

OBJECTIVE: To examine the characteristics of state legislators who introduce child health bills. METHODS: We conducted a cross-sectional analysis of all bills introduced in Colorado, Louisiana, and Michigan during the 1997-1998 legislative session. We identified the topic for each bill while blinded to legislator characteristics. The primary study outcome was whether the bill topic related to child health. We also categorized whether the bill was signed into law. We examined associations between the outcomes and characteristics of the sponsoring legislators (gender, political party, terms served, chairpersonship of committees, legislative chamber, membership in the legislature's Black Caucus). RESULTS: During 1997 and 1998, legislators in the 3 study states introduced 9833 bills (1234 in Colorado, 4905 in Louisiana, and 3694 in Michigan). Sixty-five bills (0.66%) related to child health issues. Child health bills comprised a significantly higher proportion of all legislation introduced by female legislators compared with male legislators (1.5% vs 0.5%, P <.001). Of bills introduced by Black Caucus members, 1.4% pertained to child health compared with 0.59% of bills introduced by nonmembers (P <.01). In contrast, 0.23% of bills introduced by committee chairpersons pertained to child health versus 0.96% of bills introduced by nonchair legislators (P <.001). These associations remained statistically significant in multivariate analyses controlling for state effects. Whether child health bills were signed into law was not associated with other legislator characteristics. CONCLUSIONS: This study offers valuable insights about the different roles of women, Black Caucus members, and committee chairpersons in the state legislative process regarding children's health.

Administrative Personnel↗
PubMed2006

Legislative issues facing pediatric ophthalmology in 2006.

PURPOSE OF REVIEW: There has been a surge in legislative activity concerning children's vision in recent years. This review will summarize and compare newly enacted state statutes and review legislation that has been introduced at both the state and federal level. Detailed reference sites are provided and may be a useful resource for those involved in legislative advocacy. RECENT FINDINGS: The legislative arena has often mirrored the disparate views of ophthalmology and optometry regarding the most appropriate methods for identifying vision problems in young children. While state legislation mandating comprehensive eye examinations for all asymptomatic and risk free children was passed in Kentucky in 2000, no other state since has successfully enacted and implemented similar legislation. In contrast, numerous states, have enacted mandatory preschool vision screening legislation. Federal legislation, introduced separately by ophthalmology and optometry, would provide funds for uninsured children's eye exams, but the two bills have important differences in eligibility requirements. Issues such as eye safety and retinoblastoma detection have also been addressed through the legislative process. SUMMARY: There has been a myriad of state and federal legislative activity in the area of children's vision. The momentum is likely to continue as additional states file new legislation.

Child↗
PubMed2000

State parity legislation and changes in health insurance and perceived access to care among individuals with mental illness: 1996-1998*

BACKGROUND: The 1990's witnessed a new wave of state and federal legislation affecting mental health insurance in the United States. Although patient advocacy groups have hailed the passage of numerous "parity" laws that require insurance coverage for mental illnesses to equal that for physical ailments, it is unclear whether this activity represents a major improvement in insurance benefits among mentally ill or significantly increases their access to care. AIMS: This paper contrasts how insurance coverage has changed among individuals with mental health problems in states with and without parity legislation. METHODS: National survey data from 1996 to 1998, subset to a panel of 1220 individuals exceeding clinical screeners for a mental health disorder. Dependent variables are change in insurance status, insurance generosity and perception of access to care. The analysis contrasts changes in dependent variables between states with and without parity legislation (a difference-in-differences analysis). RESULTS: There are no statistical significant effects of state parity; point estimates suggest that parity mandates are associated with a slightly higher number of mentally ill reporting improved insurance generosity and access to care, but also with a higher number of mentally ill losing all insurance coverage in parity states. The estimated effects are too small to be statistically significant, although the sample size is limited and the study had only good statistical power to detect large effects. DISCUSSION: At the population level, state parity legislation appears to have not had large effects on the insurance coverage of the group that was intended as the primary beneficiary of legislation. Likely reasons include the limited scope of the actual legal requirements and large numbers of mentally ill that are not covered by health insurance subject to such legislation. The results do not exclude the possibility that some subgroups experienced substantial improvements in their insurance coverage. At the population level, large effects experienced by small subgroup are diluted by groups that experienced no similar changes. However, parity legislation was not considered a minor issue by advocates and opponents and this analysis has the statistical power to detect the sizeable differences that were argued in the policy debate. IMPLICATIONS FOR HEALTH POLICIES: While state parity legislation may have improved insurance benefits for some, it appears not to have resulted in substantial improvements for the mentally ill as a whole. The results could be very different, however, if strong federal legislation were passed that has a broader scope than state legislation. IMPLICATIONS FOR RESEARCH: The parity debate provides an important reminder of how little research is available to inform policy. This study provides a crude picture, but it is far from being a conclusive evaluation. The most urgent need is for data that continue to track changes in markets and policies.

Journal Article↗
PubMed2006

Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review.

BACKGROUND: Head injuries related to bicycle use are common and can be serious. They can be prevented or reduced in severity with helmet use; however, education has resulted in modest helmet use in most developed countries. Helmet legislation has been proposed as a method to increase helmet wearing; while this social intervention is thought to be effective, no systematic review has been performed. OBJECTIVES: This review evaluates the scientific evidence for helmet use following legislation to identify the effectiveness of legislative interventions to increase bicycle helmet use among all age groups. SEARCH STRATEGY: Comprehensive searches of CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, British Education Index, LILACS Database, TRIS (Transport Research Information Service), the grey literature, reference lists, and communication with authors was performed to identify eligible studies. SELECTION CRITERIA: Eligible studies for this review were community based investigations including cohort studies, controlled before-after studies, interrupted time series studies, non-equivalent control group studies Data collection and analysis: Two reviewers extracted the data regarding the percentage of helmet use before and after legislation from each study. Individual and pooled odds ratios were calculated along with 95% confidence intervals. MAIN RESULTS: Out of 86 prescreened articles, 25 were potentially relevant to the topic and 11 were finally included in the review. Of 11 studies, eight were published articles, two were published reports, and one was an unpublished article. One additional survey was incorporated following personal communication with the author. While the baseline rate of helmet use among these studies varied between 4% and 59%, after legislation this range changed to 37% and 91%. Helmet wearing proportions increased less than 10% in one study, 10-30% in four studies, and more than 30% in seven studies. While the effectiveness of bicycle helmet legislation varied (n = 11 studies; OR range: 1.2-22), all studies demonstrated higher proportions of helmet use following legislation, particularly when the law was targeted to a specific age group. CONCLUSIONS: Legislation increased helmet use among cyclists, particularly younger age groups and those with low pre-intervention helmet wearing proportions. These results support legislative interventions in populations without helmet legislation.

Adolescent↗
PubMed1997

Evaluating compliance with Australia's first smoke-free public places legislation.

OBJECTIVE: To measure the level of compliance among businesses with legislation prohibiting smoking in public places. DESIGN: A representative sample of businesses in the Australian Capital Territory (ACT) was selected. A two-phase survey design was used: in phase 1, interviewers observed business premises to evaluate their compliance with the legislation, observing the display of no-smoking signs and noting any evidence of smoking in smoking-prohibited areas; in phase 2, a short questionnaire was completed by the business owner or manager. SETTING: Observations of business premises and self-completion interviews with owners or managers of those premises. SUBJECTS: 938 respondents who were either owners, managers, or employees of ACT businesses. MAIN OUTCOME MEASURES: Compliance with legislation prohibiting smoking in the public areas of business premises; businesses' own perceptions of the extent of their compliance; and the factors affecting the discrepancy between actual and perceived compliance. RESULTS: A total of 22% of the businesses complied fully with the legislation, whereas 56% partially complied by displaying external or internal signage. Most respondents (84%) believed that they were complying fully with the legislation. Only 21% of the businesses complied and correctly assessed their compliance. Evidence of smoking was detected in only 5% of no-smoking premises. The type of business and the smoking policy of the establishment at the time the legislation came into force were important influences on compliance, followed by whether the premises were free-standing or located within shopping malls. The mass media was identified as the main source of information about the legislation. CONCLUSIONS: Ensuring the successful implementation of non-smoking legislation is facilitated by (a) widespread publicity to make business proprietors and their customers and clients aware of the legislation; (b) first implementing legislation in premises where there is strong public support for such measures; and (c) targeting information to premises that have pre-existing policies prohibiting smoking on their premises.

Australia↗
PubMed2004

Impact of early newborn discharge legislation and early follow-up visits on infant outcomes in a state Medicaid population.

OBJECTIVE: Scant information exists on the effects of legislation mandating coverage of minimum postnatal hospital stays on infant health outcomes. There are also gaps in knowledge regarding the effectiveness of early follow-up visits for newborns. The objective of this study was to determine the impact of 1) legislation mandating coverage of minimum postnatal hospital stays and 2) early follow-up visits by the age of 4 days on infant outcomes during the first month of life. METHODS: A retrospective analysis was conducted of Ohio Medicaid claims data linked with birth certificate data for the period 1991-1998. The impact of the legislation was evaluated using interrupted time-series analysis of health-related utilization. The effects of early follow-up visits for vaginally delivered newborns with short stays were analyzed using the day of the week on which the birth occurred (eg, Monday, Tuesday) as an instrumental variable to account for potential confounding. A total of 155,352 full-term newborns who were born to mothers who receive Medicaid were studied. The main outcomes measured were rehospitalizations, emergency department (ED) visits, and diagnoses of dehydration and infection within 10 and 21 days of birth. RESULTS: Few outcomes exhibited significant changes after legislation mandating coverage of minimum postnatal hospital stays. Rates of rehospitalization for jaundice within 10 days of birth fell from 0.78% to 0.47% in the year after legislation was introduced but leveled off after the legislation took effect. Rates of ED visits within 21 days increased from 6.0% to 10.4% during periods of increasing short stay but fell to 8.0% during the year after introduction of the legislation and leveled off when the legislation took effect. Rates of all-cause rehospitalization, dehydration, and infection diagnoses showed no consistent relationship to Ohio's legislation. Using instrumental variable analysis, newborns who received early follow-up visits were significantly less likely to have rehospitalizations within the first 10 days of life than those who did not. CONCLUSIONS: In this state Medicaid population, legislation mandating coverage of minimum postnatal hospital stays was associated with reductions in the rates of rehospitalization for jaundice and ED visits. For newborns with short stays, early follow-up visits may reduce rehospitalizations in the early postpartum period.

Dehydration↗
PubMed2000

Overview of legislation and tobacco control in Singapore.

Legislative measures against smoking in Singapore began in the early 1970s, and can be said to have been the start of a comprehensive smoking control programme. With the launch of the National Smoking Control Programme (NSCP) in 1986, a National Smoking Control Coordinating Committee was set up to look into legislation and fiscal measures. To further increase the dimension and impact of the programme, a Civic Committee on Smoking Control was formed in 1996. This committee also looks into and recommends legislative measures. The NSCP is an ongoing programme that aims to reduce smoking rates through a combination of strategies, including education, establishment of no-smoking areas and increasing taxation and legislative measures. Existing legislation is regularly and systematically reviewed and revised, and new laws are recommended to strengthen our smoking control efforts. Concurrently, penalties and ways to improve enforcement of the legislation are also updated. The legislative measures that have been implemented in Singapore over the years include prohibition of tobacco advertising and promotion, restrictions on the sale of tobacco products, licensing of sales outlets, use of health warnings on cigarette packets, controlling and labelling of tar and nicotine contents, restriction of smoking in public places and prohibition of smoking in public by the under-eighteens. Several factors have helped make legislative measures work in Singapore. These include political will and support, starting legislation early, comprehensive legislative measures, enforcement measures and continuous review. To sustain these efforts, Singapore needs to continue to stay abreast of world-wide measures on smoking control.

Advertising↗
PubMed2002

Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study.

OBJECTIVE: Childhood bicycle-related head injuries can be prevented through the use of helmets. Although helmet legislation has proved to be a successful strategy for the adoption of helmets, its effect on the rates of head injury is uncertain. In Canada, 4 provinces have such legislation. The objective of this study was to measure the impact of helmet legislation on bicycle-related head injuries in Canadian children. METHODS: Routinely collected data from the Canadian Institute for Health Information identified all Canadian children (5-19 years) who were hospitalized for bicycling-related injuries from 1994-1998. Children were categorized as head or other injury on the basis of International Classification of Diseases, Ninth Revision, codes. Rates of head injuries and other injuries were compared over time in provinces that adopted legislation and those that did not. RESULTS: Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction). CONCLUSION: This country-wide study compared rates of head injury in regions with and without mandatory helmet legislation. Comparing head injuries with other non-head-injured children controlled for potential differences in children's cycling habits. The strong protective association between helmet legislation and head injuries supports the adoption of helmet legislation as an effective tool in the prevention of childhood bicycle-related head injuries.

Accidents, Traffic↗
PubMed2002

Predictors of Canadian legislators' support for tobacco control policies.

It is clear that regulatory strategies can be effective in reducing tobacco use. Because legislators ultimately determine whether many of these policies are enacted, they are a key focus for tobacco policy research. This study identifies political and personal predictors of Canadian legislators' support for tobacco control policies. Data are from a 1996-97 survey of federal, provincial and territorial legislators. Multivariate regression analysis was used to assess relationships between five groups of variables (political factors including political ideology, personal characteristics, tobacco experiences, tobacco knowledge, interest group saliency) and support for tobacco control based on an 11-item scale. Support for tobacco control varied by political party. Support was higher among legislators who thought government had a duty to promote healthy lifestyles, knew second-hand smoke could cause lung cancer, knew tobacco caused more deaths than alcohol, and said they wanted more contact with medical associations about tobacco issues. Support was lower among current smokers and those with tobacco industry jobs in their ridings. The findings indicate that political party membership cannot be ignored in enlisting legislator support for tobacco control. It also appears that legislators who oppose tobacco control measures may not be opposed to tobacco control per se, but are more generally opposed to a government role in health promotion. Thus, public health professionals and tobacco control advocates need to be more attentive to the way tobacco control issues are framed for particular legislators. Further, meetings with health groups about tobacco issues would be welcomed by many legislators; non-governmental organizations and other health advocates could work to increase tobacco knowledge among legislators.

Attitude to Health↗
PubMed1994

Legislation for school entry immunisation certificates in Victoria.

In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid-year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.

Child↗
PubMed2000

Mental health parity legislation: much ado about nothing?

OBJECTIVE: To determine whether state-level parity legislation has led to an increase in utilization of mental health services. DATA SOURCES: Healthcare For Communities (HCC), a multi-site nationally representative study sponsored by the Robert Wood Johnson Foundation that tracks health care system changes for mental health and substance abuse treatment. Information on state-level parity legislation was provided by state offices of the National Alliance for the Mentally Ill (NAMI); local and state market data come from the Area Resource File; information on other health mandates from Blue Cross/Blue Shield. STUDY DESIGN: Two-stage regressions are used to estimate the effect of state parity legislation on use of any mental health services, use of specialty mental health services, and number of specialty visits in the past year. In the first stage, we predicted the probability that a state decides to pass parity legislation as a function of state health care market indicators and previous legislative activity. The fitted probability is used in the second stage to determine the effect of this legislation on access and utilization. PRINCIPAL FINDINGS: State parity legislation is not associated with a significant increase in any of our measures of mental health services utilization. These results are robust to various specifications of the models. CONCLUSIONS: Those states that are able to pass parity legislation do not experience significant increases in the utilization of mental health services. This may be due in part to a loss of coverage for those people most at risk for mental health disorders. The results could be very different, however, if strong federal legislation were passed.

Health Policy↗