Health Law and Policy

Legal epidemiology unites public health lawyers, researchers, and practitioners toward a common pursuit to inform public health decision-making that affects which laws work, for whom, and in what context. In addition, public health practitioners use legal epidemiology to examine law's direct and indirect effects on populations at risk for chronic health conditions, thereby providing a powerful tool to gain insights and pursue more effective, equitable public health strategies.

Alcohol Policy
The Alcohol Policy Information System (APIS)

The Alcohol Policy Information System (APIS), funded by the National Institute on Alcohol Abuse and Alcoholism and implemented by CDM, provides accurate, reliable, and up-to-date information on alcohol policies adopted by governments at the state and federal levels in the United States.

The past 30 years have brought increasing recognition that public policy can help prevent and ameliorate alcohol-related problems. Broadly speaking, alcohol public policy seeks to moderate consumption, restrict underage access to alcohol and exposure to alcohol marketing, control the settings in which consumption occurs, separate consumption from risky behaviors such as operating a motor vehicle or watercraft, and regulate the provision and reimbursement of alcohol prevention and treatment services.

APIS is primarily designed for researchers seeking to study the effects of alcohol policies, either as single policies or as combinations of policies. It is also widely used by policymakers, advocates, and concerned citizens. The information provided by APIS is available in searchable form through a publicly accessible website. CDM staff develop summary indicators, measures, and variables to characterize alcohol-related policies to facilitate comparisons of policies across jurisdictions and/or over time, and prepare background information on each policy, including limitations to the APIS analyses. Staff also implement rigorous quality assurance procedures to ensure the utility, reliability, and integrity of the system and its various components and devise suitable display formats to represent policy characteristics and variation. APIS provides links to key alcohol policy resources and posts staff-authored scholarly papers on topics such as enforcement and compliance, the intersection of social science and legal analysis, and conceptual approaches to improving the measurement of state alcohol taxes. More recently, NIAAA has tasked APIS staff with developing a policy topic on the legalization of nonmedical cannabis. This analysis will be posted to the APIS website in the first half of 2016.

Sober Truth on Preventing Underage Drinking Act (STOP Act)

From 2010 to 2020, SAMHSA contracted with CDM to prepare and submit an annual Report to Congress (RTC) assessing the status of underage drinking in the United States, describing federal prevention programs, and evaluating state progress in addressing the problem.

For each RTC, CDM prepared a systematic review of underage drinking epidemiology and consequences to provide contextual information for the analyses presented in the report. CDM also conducted a policy analysis of 25 state policies designed to reduce underage drinking, developed conceptual structures and definitions for each policy, applied an innovative and comprehensive legal research of statutes and regulations in the 50 states and the District of Columbia, and developed a profile for each state. To track state prevention efforts, CDM developed and implemented a yearly web-based survey that tracked: implementation of state practices related to enforcement of underage drinking laws; state programs (including educational programs) for youth, parents, and caregivers; information on state interagency collaborations to prevent underage drinking; and estimates of state expenditures on underage drinking initiatives. The survey yielded an annual response rate of 100 percent (all states and the District of Columbia responding).

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Health Policy
Evaluation of HHS Delivery System Reform Efforts and Affordable Care Act (ACA) Provisions, HHS/PSC/SAS/DAM/Office of the Secretary

Under the guidance of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services (HHS), the research team (consisting of staff from CDM and its subcontractor) conducted an Evaluation of HHS Delivery System Reform Efforts and Affordable Care Act (ACA) Provisions. This project measured the effects of the implementation of a wide range of new programs designed to drive improvements in the organization and delivery of health care services under the ACA. The CDM Team specified a general conceptual model of health systems change that recognized that observed changes in outcomes are influenced by: the components and incentives of specific delivery reform initiatives, the characteristics of organizations participating in those initiatives, and the broader competitive market and local policy environments within which those organizations operate.

This evaluation provided HHS with recommendations on a coordinated evaluation plan to tie results from the numerous Medicare, Medicaid, and Dual Eligible delivery system reform initiatives and ACA provisions into an overall model of health system change. The ultimate objective of the ACA delivery reform initiative was to slow the rate of health spending, improve the value of services delivered, and drive changes in the delivery system that would facilitate ongoing performance improvement, not only for Medicare and Medicaid beneficiaries, but also for the overall system.