HW 6

HW 6

by Martin -

Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.

 

Firearm regulations.

 

Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)

 

Given the controversy and lobbying that surrounds guns ownership in the US, having an evidence-based approach can be used to strength the arguments for the most effective forms of regulation.  

 

Specify the outcomes and populations you think most affected or least affected by the policy.

 

Outcomes: reduction is firearm related injuries and deaths.

Populations most affected: There were 21,175 self-inflicted deaths from firearms in 2013, and 11,208 homicides by discharge of firearms.  http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf

 

"Firearm injury remained one of the 5 leading causes of fatal injuries in 2013, and the highest burden is in the black male population." –CDC's Melonie Heron.

 

Propose a study design to evaluate the policy

–Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health

Ecological, cross-sectional (serial sampling) of state/region using "firearm legislative strength score.” Score would include policies related to firearm trafficking; background checks on purchasers of firearms; child safety policies; access to military style assault weapons; and restriction of guns in public places. Outcome would be firearm injury/mortality data from CDC's Web-based Injury Statistics Query and Reporting System. Previous studies using this design have demonstrated lower firearm injuries/deaths in states with higher levels of regulation. Although evaluating the cause and effect relationships are not possible with this design, I would argue the magnitude of the effect and trend are sufficient forms of evidence to justify implementing more regulation. 

Re: HW 6

by Maria Glymour -

Martin

This is a great example of a topic where really rigorous designs are important.  This topic is so partisan that only the most rigorous designs can move people's prior views.  One issue with cross-sectional designs for this type of policy is that places with the biggest problem are also the most likely to implement restrictive policies. A bias in the other direction is that places where gun ownership is most common (and therefore gun-related deaths most common) may also have the most difficulty getting gun ownership restrictions passed. It's also really important to be specific about what types of restrictions are effective and in what situations.  I think more convincing studies are coming out of longitudinal data, when a state or municipality has changed their law, e.g., Kara Rudolph's recently published study in Am J Public Health on Connecticut's policy change.  The lack of data on this issue, due to federal funding restrictions, has been incredibly limiting for the research progress.

Maria