Poorer health suffered by lesbian, gay, and bisexual (LGB) populations may be associated with public policies. We collected the laws that in 2013 prohibited discrimination based on sexual orientation from 50 United States (US) states, the District of Columbia (Washington, DC or DC), and the 30 most populous US metropolitan areas. To facilitate future research, we coded certain aspects of these laws to create a dataset. We generated descriptive statistics by jurisdiction type and tested for regional differences in state law using Chi-square tests. Sixteen (31.4 per cent) states prohibited discrimination by all employers based on sexual orientation, 25 states (49.0 per cent) in public employment, 18 states (35.3 per cent) in government contracting, and 21 states (41.2 per cent) in private employment. Twenty-one states prohibited discrimination (41.2 per cent) in housing practices (selling and renting), and 17 (33.3 per cent) in public accommodations. Local (county/city) laws prohibiting discrimination were less common. State laws differed significantly by US census region - West, Midwest, Northeast, and South. Future analyses of these data could examine the impact of these laws on various outcomes, including health among LGB populations.
Despite benefits to sharing data among public health programs, confidentiality laws are often presumed to obstruct collaboration or data sharing. We present an overview of the use and release of confidential, personally identifiable information as consistent with public health interests and identify opportunities to align data-sharing procedures with use and release provisions in state laws to improve program outcomes. In August 2013, Centers for Disease Control and Prevention staff and legal researchers from the National Nurse-Led Care Consortium conducted a review of state laws regulating state and local health departments in 50 states and the District of Columbia. Nearly all states and the District of Columbia employ provisions for the general use and release of personally identifiable information without patient consent; disease-specific use or release provisions vary by state. Absence of law regarding use and release provisions was noted. Health departments should assess existing state laws to determine whether the use or release of personally identifiable information is permitted. Absence of direction should not prevent data sharing but prompt an analysis of existing provisions in confidentiality laws.
Purpose.-Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis. Methods.-We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state-and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses and hurdle models were used for county-level models. Bivariate analyses (P<0.25) were used to select variables for adjusted models. Results.-In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 β=1.24; 95%CI=0.28-2.20; 2015 β=1.19; 95%CI=0.42-1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P<0.05). Conclusions.-Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual-level across different subpopulations and various STDs. Our findings also suggest that more research is needed to further evaluate potential associations between policies and STDs. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM.
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