· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
One proposed legislation currently being considered is SB-58, proposed by California State Senator Scott Weiner, which would extend the current bar closing time in California from 2am later to 3am or 4am. The intention of this policy is to give an economic boost to nightlife businesses especially bars and have major cities like San Francisco and Los Angeles have comparable nightlife scenes to other major US metropolitan cities like New York City. While not intended to be a health policy, extending the closing time for bars would have significant health implications, including more assaults, more DUIs, and more public safety concerns, increasing the demands on Emergency Departments, first responders, and California Highway Patrol. Infectious disease epidemiologists also fear that extending bar closing time could also increase rates of high risk sex practices in San Francisco and add to already high rates of gonorrhea, chlamydia and syphilis in the city. Sex workers would also be impacted and their safety may be more at risk, given the majority of their business occurs at night time and may be more vulnerable to violence.
According to this article (https://losangeles.cbslocal.com/2019/08/28/council-adopts-resolution-opposing-bill-that-would-extend-bar-hours/):
"...a report released in July by the Alcohol Research Group and Public Health Institute that found if 5% the city’s bars stayed open until 4 a.m., it would cost Los Angeles $50.2 million annually due to public safety needs and other social burdens. It estimated the cost could rise into the billions if 20 percent of the market participated over five years.
According to a legislative analysis of the bill, it would cost the state at least $2-$3 million just to implement the program, along with a $500,000 allocation for the California Highway Patrol during the first year. But net revenue statewide from excise taxes could be about $1.6-$3 million annually during the pilot phase, according to the analysis."
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).An evaluation of the policy would be helpful in determining whether extending the bar closing time in California would lead to increasing burdens on the public health care system as originally feared including increased assaults, police arrests, ED presentations/hospitalizations, traumas, STI rates, as well as a cost benefit analysis of whether extending the bar closing time would actually lead to a stimulus in nightlife businesses.
· Specify the outcomes and populations you think most affected or least affected by the policy.
Outcomes most affected by the policy:
- Assaults
- Rates of public intoxication
- Arrests for intoxication or violence in public
- DUIs
- Rates of STIs like gonorrhea, chlamydia, syphilis
- Rates of HIV
- Total Emergency Room Visits
- Emergency Room visits for Trauma-related causes
- Increased costs of Highway Patrol
- Predominantly young people < 50 years old
- People with at risk drinking behaviors
- Men who have sex with men (in SF, MSM are disproportionately affected by STIs)
- Sex workers
· Propose a study design to evaluate the policy.
Focusing only on the outcome of STIs among men who have sex with men in San Francisco, you could follow the epidemiologic rates of different STIs before and after policy implementation, you could also determine rates of high risk sex practices in a single site study like at STI Clinic in San Francisco which assesses for epidemiologic trends of STIs before and after policy implementation, etc to determine whether these public health concerns were worsened by the extension of bar closing time.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.