Cannabis Retailer Communication About Cannabis Products, Health Benefits, and Risks: A Mystery Shopper Study of Licensed Retailers in Five U.S. Cities.

OBJECTIVE: As the U.S. cannabis market expands, surveillance of retailer practices, especially product health claims and risks, is crucial to protect consumers. In this study, mystery shoppers (i.e., staff not explicitly identified as researchers) examined retail personnel communication regarding product recommendations, health benefits, safety, and/or risks among U.S. cannabis retailers. METHOD: In Summer 2022, mystery shoppers audited 140 licensed cannabis retailers in 5 cities in states with established nonmedical (i.e., recreational) cannabis sales and diverse regulations (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive and bivariate analyses characterized retail personnel communication overall and across cities. RESULTS: Common product recommendations for new users included edibles, pre-rolled joints, and bud/flower, and 8.6% offered free/inexpensive ways to sample products. Although Colorado, Washington, and Oregon explicitly prohibited health claims in advertising or labels, more than 90% of retailers there endorsed use for anxiety, insomnia, and/or pain. Whereas 54.3% endorsed use for pregnancy-related nausea (least common in Denver, 23.3%; most common in Seattle, 76.7%), 26.4% warned against use during pregnancy (most frequently in Denver, 46.7%; least frequently in Seattle and Portland, 13.3%). Overall, 52.1% warned against driving after use (most frequently in Denver, 80.0%; least frequently in Las Vegas, 20.0%). Almost all (≥90%) sold cannabidiol (CBD) products and endorsed their health benefits and safety, but few (<10%) sold or endorsed delta-8 tetrahydrocannabinol (THC), etc. (all of which were in Los Angeles). CONCLUSIONS: Ongoing cannabis retail surveillance, particularly using protocols assessing factors outside those visibly observable, is needed to inform regulatory and enforcement efforts, especially related to health claims.

Building A Comprehensive, Longitudinal Dataset to Advance Research on the Efficacy of State-Level Anti-bullying Legislation: 1999 to 2017.

Bullying is one of the most common forms of youth violence and is associated with myriad adverse consequences over the life course. There has been increasing interest in examining whether anti-bullying legislation is effective in preventing bullying victimization and its negative effects. However, a lack of data structures that comprehensively and longitudinally assess anti-bullying legislation and its provisions has hampered this effort. We provide 18 years of data (1999-2017) on anti-bullying legislation and amendments across 50 U.S. states and the District of Columbia, which we are making publicly available at LawAtlas.org. This article describes how the legal content analysis was conducted, provides information on the reliability of the coding, and details provisions of the legislation that were coded, such as funding provisions and enumerated groups (a total of 122 individual codes are provided). Over 90% of states had at least one amendment to their legislation during this 18-year period (range: 0-22; Mean = 6.1), highlighting both the evolving content of anti-bullying statutes and the importance of tracking these changes with longitudinal data. Additionally, we offer illustrative examples of the kinds of research questions that might be pursued with these new data. For instance, using survival analyses, we show that a variety of state characteristics (e.g., political leaning of state legislatures) predict time to adoption of key provisions of anti-bullying legislation (e.g., the comprehensiveness of legal provisions). Finally, we end with a discussion of how the dataset might be used in future research on the efficacy of anti-bullying legislation.

Which Skills Are Key to Public Health Leaders' Success in Crisis Management?

Under-resourced and fragmented public health infrastructure has contributed to a poor pandemic response in the United States. There have been calls to redesign the Centers for Disease Control and Prevention and to increase its budget. Lawmakers also have introduced bills aiming to change public health emergency powers at the local, state, and federal levels. Public health is ripe for reform, but reorganization and enhanced funding will not address an equally pressing problem: chronic failures of judgment in the definition and implementation of legal interventions. Without a more informed and nuanced appreciation for the value and limits of law as an instrument of health promotion, the public will remain at unnecessary risk.

Trends in US State Public Health Emergency Laws, 2021-2022.

Objectives. To identify and categorize US state legislation introduced between January 1, 2021, and May 20, 2022, that addresses emergency health authority. Methods. We adapted standard policy surveillance methods to collect and code state bills and enacted laws limiting or expanding the emergency public health authority of state and local officials and agencies. Results. State legislators introduced 1531 bills addressing public health authority; 191 of those were enacted in 43 states and the District of Columbia, including 17 expanding and 65 contracting emergency authority, 163 regulating use, and 30 preempting local use of specific measures such as mask mandates. Conclusions. State laws setting the scope and limits of emergency authority are crucial to effective public health response. These laws are changing in ways that threaten to reduce response capacity. Tracking changes in health law infrastructure is important for evaluating changes in health authority and ensuring that stakeholders recognize these changes. Public Health Implications. The COVID-19 pandemic called for quick, decisive action to limit infections, and when the next outbreak hits, new laws limiting health authority will make such action even more difficult. (Am J Public Health. 2023;113(3):288-296. https://doi.org/10.2105/10.2105/AJPH.2022.307214).

Law and urban governance for health in times of rapid change.

Governance is an important factor in urban health, and law is an important element of healthy governance. Law can be an intervention local government wields to influence behavior and shape environments. Law can also be an important target of health promotion efforts: Law and the enforcement and implementation behaviors it fosters can promote unhealthy behaviors and environmental conditions, and can act as a barrier to healthy interventions or practices. Finally, law is a design and construction tool for the organization of governance. Law is the means through which cities are formally established. Their powers and duties, organizational structure, boundaries and decision-making procedures are all set by law. Regardless of the form of government, cities have legal levers they can manipulate for health promotion. Cities can use tax authority to influence the price of unhealthy products, or to encourage consumption of healthy foods. Cities can use their legal powers to address incidental legal effects of policies that they themselves cannot control. Cities may also have the authority to use law to address deeper determinants of health. The overall level of income or wealth inequality in a country reflects factors well-beyond a local government's control, but city government nonetheless has levers to directly and indirectly reduce economic and social inequality and their effects. A renewed focus on law and urban governance is the key to assuring health and well-being and closing the health equity gap.

Identifying data for the empirical assessment of law (IDEAL): a realist approach to research gaps on the health effects of abortion law.

Reproductive rights have been the focus of United Nations consensus documents, a priority for agencies like the WHO, and the subject of judgments issued by national and international courts. Human rights approaches have galvanised abortion law reform across numerous countries, but human rights analysis is not designed to empirically assess how legal provisions regulating abortion shape the actual delivery of abortion services and outcomes. Reliable empirical measurement of the health and social effects of abortion regulation is vital input for policymakers and public health guidance for abortion policy and practice, but research focused explicitly on assessing the health effects of abortion law and policy is limited at the global level. This paper describes a method for Identifying Data for the Empirical Assessment of Law (IDEAL), to assess potential health effects of abortion regulations. The approach was applied to six critical legal interventions: mandatory waiting periods, third-party authorisation, gestational limits, criminalisation, provider restrictions and conscientious objection. The IDEAL process allowed researchers to link legal interventions and processes that have not been investigated fully in empirical research to processes and outcomes that have been more thoroughly studied. To the extent these links are both transparent and plausible, using IDEAL to make them explicit allows both researchers and policy stakeholders to make better informed assessments and guidance related to abortion law. The IDEAL method also identifies gaps in scientific research. Given the importance of law to public health generally, the utility of IDEAL is not limited to abortion law.

Global Policy Surveillance: Creating and Using Comparative National Data on Health Law and Policy.

Throughout the world, laws play an important role in shaping population health. Law making is an intervention with measurable effects yet often unfolds without evaluation or monitoring. Policy surveillance-the systematic, scientific collection and analysis of laws of public health significance-can help bridge this gap by capturing important features of law in numeric form in structured longitudinal data sets.Currently deployed primarily in high-income countries, methods for cross-national policy surveillance hold significant promise, particularly given the growing quality and accessibility of global health data. Global policy surveillance can enable comparative research on the implementation and health impact of laws, their spread, and their political determinants. Greater transparency of status and trends in law supports health policy advocacy and promotes public accountability. Collecting, coding, and analyzing laws across countries presents numerous challenges-especially in low-resource settings.With insights from comparative politics and law, we suggest methods to address those challenges. We describe how longitudinal legal data have been used in limited, but important, ways for cross-national analysis and propose incorporating global policy surveillance into core global public health practice.

State Laws Governing Syringe Services Programs and Participant Syringe Possession, 2014-2019.

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.