How Legal Epidemiology Datasets Can Strengthen Health Outcome Research

The Policy Impacting Public Health (PIPH) for LGBTQIA+ Populations Project brings together researchers from Saint Louis University School of Law’s Center for Health Law Studies, Pacific University, and Wayne State University to examine how laws shape health outcomes. This collaborative, data-driven effort uses legal epidemiology to track and analyze laws affecting LGBTQIA+ communities nationwide, advancing Saint Louis University’s commitment to rigorous scholarship that informs health equity and justice

The Need for Data

There is a proliferation of laws impacting the lives of LGBTQIA+ people. Existing research on health outcomes consistently shows longstanding social and health inequities for LGBTQIA+ people. And laws contribute to and create the conditions for these inequities by affecting social norms, access to care, and protection from discrimination. In order to study these relationships, health outcomes researchers who examine the ways stigma and discrimination impact health have called for additional information on laws, particularly enforcement mechanisms. Currently, comparing legal changes to health outcomes is challenging, and this project seeks to make that easier.

What is the PIPH Project?

PIPH is a multidisciplinary research team from the law, social work, and school psychology fields dedicated to creating accurate, usable longitudinal legal epidemiological datasets of state laws affecting LGBTQIA+ populations by subject (What is Legal Epidemiology?). As we introduce others to the work of PIPH, we wanted to pause for a moment and discuss why we committed to this project and how we hope it can play a part in LGBTQIA+ health equity moving forward. We – Professor Walter-McCabe, Dr. Kinney, and Dr. Kiperman-Hibner – independently had interest in understanding what laws look like across states for LGBTQIA+ people, and while our paths crossed at different times, we formally aligned around the time Dobbs came into effect. We joined forces in response to an urgent need for a systematic understanding of how laws directly impacting LGBTQIA+ people have changed across the United States. Over the years, we have collaborated with students who learn how to code laws and, we hope, are inspired to share their knowledge of legal epidemiology in their future careers.

We are happy to announce the release of our first legal epidemiology dataset on conversion therapy ban laws. This dataset is the first in a series examining laws that are potential structural determinants of health for LGBTQIA+ populations. The PIPH datasets capture multiple datapoints (enforcement mechanisms, exemptions, and preemptions) for state laws in the 50 U.S. states and the District of Columbia for use by a broad audience, including health outcomes researchers who need legal datapoints coded for use in their studies. This work builds on the work of others who have tracked laws impacting LGBTQIA+ populations (Movement Advancement Project) by adding a longitudinal component, comprehensively tracking state-level statutes, regulations, and executive orders across the effective dates.

Why We Need Legal Epidemiology

PIHP’s goal is to equip researchers, advocates, and activists for LGBTQIA+ rights with information on laws around the country that directly impact LGBTQIA+ people in a concise, systematic manner using legal epidemiology. Our datasets expand opportunities to measure the impact of policy on LGBTQIA+ populations by creating policy variables to pair with existing datasets, such as the Behavioral Risk Factors Youth Surveillance System (BRFYSS) and the U.S. Transgender Survey (USTS). With legal epidemiological data, nuanced analysis is possible across states and time. For example, it is possible to compare anxiety scores among elementary school students who live in states with or without conversion therapy bans or compare scores in one state before a ban was put in place versus after. Incorporate legal epidemiology into your dataset, to analyze macro-level factors, learn their impact on mental health outcomes for LGBTQIA+ groups, and facilitate advocacy and justice for the LGBTQIA+ people that many of us serve. 

What’s Next?

As we look ahead, the PIPH Project will continue building this body of work by developing new datasets that track other areas of law shaping LGBTQIA+ health. The next datasets, focused on gender-affirming medical care bans for transgender and nonbinary youth and medical shield laws, are already underway. As with the conversion therapy dataset, these will be longitudinal, capturing how laws change over time, how they are enforced, and what those details mean for people’s lives. Each new release brings us closer to a more complete picture of how the legal environment functions as a structural determinant of health.

This project has always been collaborative at its heart. Our work has been shaped by feedback from partners and national experts and supported by dedicated student researchers who helped bring the data to life. We hope to keep that spirit of collaboration going and welcome input from anyone interested in using legal epidemiology in their own research or advocacy or who has ideas for future topics.

Our hope is that these datasets will not only make research more precise but also make the connections between policy and health harder to ignore. When we can see how laws evolve and who they protect or exclude, we gain tools to challenge inequities and advance justice for LGBTQIA+ people in every community.

The first dataset on conversion therapy laws is now available. We invite you to explore it, share it, and use it to help deepen understanding of how law and policy shape the health and well-being of LGBTQIA+ communities.

Co-Investigators

Heather Walter-McCabe,  J.D., M.S.W.  (she/her)
Associate professor, Saint Louis University School of Law, Center for Health Law Studies
Email: heather.waltermccabe@slu.edu 

M. Killian Kinney, Ph.D., M.S.W.  (they/them)
Assistant professor and MSW Advanced Standing associate program director, Pacific University, Claire Argow Social Work Program
Email: kkinney@pacificu.edu 

Sarah Kiperman-Hibner, Ph.D., Ed.S. (she/her)
Associate professor, Wayne State University, Center for Health and Community Impact
Email: sarah.kiperman@wayne.edu