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. 2024 Dec;114(12):1335–1343. doi: 10.2105/AJPH.2024.307830

The Synergistic Health Threats of State Laws Targeting Marginalized Groups in the United States

Kristen Underhill 1, Valerie A Earnshaw 1, Kimberly M Nelson 1,✉
PMCID: PMC11540941  PMID: 39298696

Abstract

Discriminatory state laws have deleterious effects on the health of socially marginalized groups. Health care clinicians, institutions, researchers, and research funders have tended to view different discriminatory laws in isolation, focusing on particular issues or groups. In contrast, intersectionality calls attention to the overlapping and synergistic systems of oppression that discriminatory legislation promotes or upholds, warranting an integrated analysis of these laws.

In this analytic essay, we assess discriminatory state laws simultaneously and discuss their implications for health care clinicians, institutions, and researchers. We present a multifunctional model of law and population health that describes how discriminatory law affects health outcomes among marginalized groups. We then draw on publicly available legislation trackers to identify 30 states that have enacted legislation since 2020 that targets Black people and other people of color; lesbian, gay, bisexual, and queer people; transgender and nonbinary people; and women and other birthing people.

Finally, we call for a coordinated, multilateral, and forceful effort by health care professionals, institutions, researchers, and research funders to counter these laws and address their predictable health consequences. (Am J Public Health. 2024;114(12):1335–1343. https://doi.org/10.2105/AJPH.2024.307830)

State law in the United States has long played an active part—sometimes a starring role—in maintaining power imbalances by race, ethnicity, sexual orientation, gender identity, and sex. A new surge of discriminatory state legislation in the United States has diminished protections for marginalized social groups, including Black people and other people of color; lesbian, gay, bisexual, and queer (LGBQ) people; transgender people; and women and other people capable of pregnancy. Public health law theory posits that laws have direct and indirect consequences for population health,1 including the health of marginalized populations.2 A growing body of research has documented associations between laws that adversely target marginalized populations (i.e., discriminatory laws) and poorer health among members of those groups.3–5 Building on the legacies of early thinkers in intersectionality, such as bell hooks, Kimberlé Crenshaw, Pauli Murray, W.E.B. Du Bois, James McCune Smith, and members of the Black feminist Combahee River Collective, health inequities research recognizes linkages between discriminatory policies and health of multiply marginalized groups. An intersectionality framework suggests that these laws stem from, and contribute to, overlapping and synergistic systems of marginalization, including but not limited to racism, sexism, heterosexism, and cisgenderism.6 As these systems interact, discriminatory laws may target more than 1 group at a time or impact people at the intersections of multiple forms of oppression.6

These dynamics bolster a theory-driven prediction: when legislation adversely targets a marginalized group, we should anticipate health consequences for that group, for other marginalized groups, and for subgroups that experience multiple forms of structural disadvantage. This analysis considers recent laws targeting Black people and other people of color, LGBQ people, transgender people, and women and other people capable of pregnancy, as illustrative but not exhaustive examples of discriminatory legislation. Given that more than half of US people experience 1 or more of these forms of marginalization, recent discriminatory legislation demands a forceful response not only by policymakers and advocates but also by health care professionals, institutions, researchers, and research funders.

FROM DISCRIMINATORY LAWS TO HEALTH OUTCOMES

Legal epidemiologists have identified multiple pathways connecting law to health.1,7 Statutes, regulations, and judicial decisions result from complex social and political forces, which exert their own impacts on health and make it difficult to disaggregate the effects of law itself. Some studies therefore use law as an indicator of environment (e.g., a recent review identified 58 studies that use laws to indicate the presence or magnitude of structural stigma targeting LGBQ and transgender people8). Other studies focus on the direct and indirect health impacts of laws, which is our focus here. The health impacts of laws might be intended (e.g., laws restricting vaccine exemptions can reduce infectious disease outbreaks9) or unintended (e.g., COVID-19 lockdowns were associated with increased drug overdose deaths10).

The most prominent framework in public health law research proposes that law simultaneously exerts direct effects on behavior, direct effects on the social and built environment, and indirect effects on behavior via the environment, all of which cumulatively impact population health.1 This model also recognizes that law can shape social attitudes, including (de)stigmatizing social statuses,11 and these social attitudes have both direct and indirect impacts on population health.

Stigma—a social process emerging at the co-occurrence of labeling, stereotyping, separation, and discriminatory treatment within a power context—is a “fundamental cause” of health inequities affecting marginalized populations.12,13 We suggest that discriminatory laws are structural-level manifestations of stigma that are likely to impact public health through multiple pathways. Specifically, we illustrate 2 mutually reinforcing functions of law in Figure 1: compliance and expressive functions. In its compliance function, law requires, subsidizes, licenses, burdens, or prohibits behaviors (e.g., a “bathroom bill” prohibits transgender people from using gender-congruent public bathrooms). In its expressive function, law codifies values regarding what, and who, deserves attention, dignity, respect, autonomy, protection, and care. Furthermore, through its expressive function, law takes a position on whether it is appropriate and allowable to treat a specific social group differently—for instance, a bathroom bill expresses that it is appropriate to deny transgender people something that cisgender people have (i.e., access to public restrooms that accord with their gender identity).

FIGURE 1—

FIGURE 1—

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A Multifunctional Model of Discriminatory Law and Population Health

Note. This figure develops a logic model for public health law research to demonstrate 2 separate but linked functions of law. In its compliance function, law sets forth prohibitions, mandates, costs, and incentives for behavior. In its expressive function, law encodes messages about social values, which change or reinforce social norms. Laws work through both of these pathways to shape resources, social and built environments, behavioral options, and experiences for members of marginalized groups.

Both the compliance and expressive functions of law can lead to environmental and behavioral impacts, and these pathways are mutually reinforcing. We trace the compliance function first. Through the compliance function, discriminatory laws affect the environment by changing the options or resources available to a marginalized group (e.g., bathroom bills decrease the availability of gender-congruent public facilities for transgender individuals). The compliance function also affects behavior as people adjust to the legal change. Law can drive behavior among members of the marginalized population (e.g., bathroom bills require transgender people to avoid bathrooms or to use facilities where they may experience harassment, abuse, and unwanted disclosure). Law can also influence behavior by other actors (e.g., in states with bathroom bills, public facilities or bystanders enforce the exclusion of transgender people from gender-congruent facilities). Where laws operate to reduce access to resources, such as access to health care or economic opportunity, these mechanisms can inflict material deprivation and consequent harms experienced by the target population.

The expressive function of law also has environmental and behavioral impacts. Discriminatory laws affect social norms, which are part of the social environment. Because discriminatory laws license or require adverse treatment of a marginalized group, they express and elevate the social norm that it is appropriate to disadvantage group members (e.g., bathroom bills express support for treating transgender people with less dignity and regard than cisgender people). The expressive functions of discriminatory laws can also affect behaviors and experiences among the marginalized group and others. For people who are aware of the law (e.g., transgender people who learn that the legislature has barred them from gender-congruent public bathrooms), the enactment of a discriminatory statute is inherently stigmatizing, with corollary consequences for health, even if the law is not enforced. As the law is implemented, the expressive function also facilitates or provides for individual behaviors that label, separate, and discriminate against the targeted group (e.g., bathroom bills empower people to question or challenge bathroom users whose gender presentation does not match sex stereotypes). This, in turn, leads people in the targeted group to experience more discrimination, stress, and resource scarcity.

Because powerful social institutions and actors take direction from law, the expressive impacts of discriminatory laws can also spread throughout the social environment, “spilling over” beyond the specific prohibitions or requirements of the law. In this way, the expressive impacts of a discriminatory law can be even more powerful than the law’s compliance impacts. A bathroom bill in public facilities, for example, can encourage private facilities to enact or maintain similar policies (spilling over to a different setting), or it can support discrimination against cisgender people who do not conform to expected gender appearances (spilling over to a different group).14,15 It may be enforced more frequently against transgender individuals with additional marginalized identities, like transgender women or transgender people of color (intersectional harms against multiply marginalized groups). Because bathroom bills allow differential treatment of transgender individuals, they can be cited to support practices that exclude transgender people—or cisgender people who do not conform to gender stereotypes—in nonbathroom settings (spilling over to a different group and a different setting). A bill in one state can reduce political or popular support for gender-inclusive practices in neighboring towns across the state line (spilling over to a different jurisdiction). Bathroom bills also strengthen ideas of gender essentialism and “benevolent” sexism that are already linked to harmful outcomes for transgender people and cisgender women and girls.16

In these ways, the effects of a discriminatory law can reach beyond its intended population and jurisdiction, escalating the society-wide processes of labeling, stereotyping, separation, material deprivation, and discrimination that harm the health of devalued groups.13 And although laws are themselves the product of many different forces (e.g., politics, resources, procedural options, interest group pressures), increased stigma can foster a supportive public environment for future discriminatory legislation. Importantly, this multifunctional model of the health impacts of discriminatory law can apply to any nation, state, or municipality with laws that marginalize (or allow marginalization of) a social group.

DISCRIMINATORY LAWS AND INTERSECTIONALITY

Laws burdening different marginalized groups occur in every state, and they tend to cluster within states,17 in part because many jurisdictions maintain a fairly continuous orientation toward policy over time.18 Intersectionality—a framework rooted in Black feminist theory19,20—emphasizes that systems of oppression, including stigma, are interlocking and synergistic.6 Indeed, while methods for intersectionality health research are developing rapidly, systematic reviews now identify hundreds of studies documenting differential health burdens (e.g., chronic conditions, hypertension, sexually transmitted infections, suicidal ideation, substance use) among people who hold multiple socially marginalized identities.21,22 Applied to discriminatory law, intersectionality suggests that co-occurring discriminatory laws are likely to have differential and possibly compounding effects specifically on the health of multiply marginalized people. In any jurisdiction where laws burden multiple marginalized populations simultaneously, these policies can work in concert to harm the health of individuals and groups. For individuals who experience multiple forms of discrimination (e.g., Black cisgender women, Latine transgender men, sexual minoritized women) adverse state laws can interact to produce synergistic harms.23

Consider, for example, a North Dakota high-school student who identifies as a Black transgender girl. Since 2020, the state legislature has passed anti‒critical race theory and antitransgender laws, each targeting a different aspect of her social identity. She will experience direct consequences of each law—schools where educators cannot provide “instruction relating to critical race theory” (HB 1508 [2021]), health systems in which she cannot access gender-affirming care (HB 1254 [2023]), and an extracurricular environment where she cannot participate in student athletics (HB 1249 [2023]). These barriers can increase experiences of exclusion and isolation, while the laws convey a cumulative message that she is less valued. The laws also express and sanction the general principles that it is acceptable to withhold medical care from transgender people, limit social participation by transgender people, or forbid classroom instruction that recognizes structural racism or includes central intellectual contributions by Black people and other people of color. All of these dynamics can amplify stigma and discrimination as part of the general social environment.

There are at least 3 implications of applying an intersectionality framework to understanding how discriminatory laws impact health outcomes. First, as mentioned previously, individuals belonging to multiple marginalized groups may be targeted by multiple discriminatory laws. Second, discriminatory laws may target more than 1 marginalized group, shifting power and opportunities away from multiple groups simultaneously. For example, Legislative Bill 574 in Nebraska (2023) simultaneously bars health care providers from providing abortion beyond 12 weeks of gestational age and “gender-altering procedures” for individuals younger than age 19. At once, this law targets women and other birthing people, transgender people, and transgender people capable of pregnancy. In Florida, 1 provision of Senate Bill 266 (2023) bars public institutions of higher education from offering “general education core courses” that “distort significant historical events or include a curriculum that teaches identity politics … or is based on theories that systemic racism, sexism, oppression, and privilege are inherent in the institutions of the United States.” Another provision of the same law prohibits the use of state or federal funds for activities that “advocate for diversity, equity, and inclusion.” As a whole, the statute targets multiple (and multiply) marginalized populations, including Black people and other people of color, LGBQ people, transgender people, women and people capable of pregnancy, and groups at the intersections of all of these categories—all of whom are priority populations for diversity, equity, and inclusion initiatives.

Third, discriminatory laws may impact individuals differently depending on their social positions. For example, a nationwide abortion ban would greatly increase pregnancy-related mortality, but the new harms would not be equitably distributed; instead, modeling predicts that additional deaths would be concentrated among non-Hispanic Black birthing people—those at the intersection of marginalized social positions because of gender and race—mirroring longstanding racial disparities in maternal mortality.24 In these ways, discriminatory laws can disproportionately burden people who experience multiple sources of marginalization.

NEW WAVE(S) OF DISCRIMINATORY US LEGISLATION

Between January 1, 2020, and January 1, 2024, 30 US states enacted laws that adversely target 1 or more of the following groups: Black people and other people of color, LGBQ people, transgender people, and women and other people with the capacity for pregnancy (Table 1). Twenty-five of these states passed laws targeting more than 1 stigmatized group. We selected these 4 marginalized groups as illustrative for our analysis, although similar efforts could, and should, illuminate laws affecting additional marginalized populations, such as immigrants, incarcerated individuals, people with disabilities, and people living in poverty. We do not focus on the causes of law, but we note that this time encompasses important political shifts, including a new presidential administration, increased polarization in state legislatures, and changes in the composition of federal courts that evaluate the constitutionality of state laws.

TABLE 1—

Example State Laws That Target Marginalized Groups in the United States, Enacted January 1, 2020‒January 1, 2024

State Black People and Other People of Color LGBQ People Transgender People Women and Other People With the Capacity for Pregnancy
Alabama … HB 322 SB 184 Ala Code §26-23H-4
Arizona SB 2906 SB 1399 HB 1138 Ariz Rev Stat Ann §36-2326
Arkansas SB 627 SB 294 HB 1156 Ark Code Ann §5-61-401 et seq.
Florida HB 241 HB 1557 HB 1557 Fla Stat §390.0111
Georgia HB 1084 SB 226 SB 140 Ga Code Ann §16-12-141
Idaho HB 377 HB 190 HB 71 Idaho Code Ann §18-622
Indiana HB 1447 HB 1608 HB 1041 Ind Code Ann §16-34-2-1
Iowa HF 802 SF 496 HF 2416 SF 496
Kansas … … HB 2238 HB 2184
Kentucky SB 1 SB 150 SB 83 Ky Rev Stat Ann §311.722
Louisiana … SB 7 SB 44 La Rev Stat Ann §40:1061
Mississippi SB 2113 SB 2346 HB 1125 Miss Code Ann §41-41-45
Missouri SB 15 … SB 49 Mo Rev Stat §188.017
Montana … HB 303 SB 99 HB 303
Nebraska … … LB 574 LB 574
New Hampshire HB 2 … … …
North Carolina SL 2023-62 SL 2023-106 HB 808 NC Sess Laws 2023-14
North Dakota HB 1508 HB 1111 HB 1254 SB 1250
Ohio … … … Ohio Rev Code Ann §2919.195(A)
Oklahoma HB 1775 HB 3092 SB 615 Okla Stat tit 63, §1-731.4
Pennsylvania … … … HB 611
South Carolina HB 4100 … H4608 S 474
South Dakota HB 1012 … SB 46 SD Codified Laws §22-17-5.1
Tennessee SB 623 … HB 1895 SB 1257
Texas HB 3979 HB 900 SB 14 Tex Health & Safety Code Ann §170A.001 et seq.
Utah SB 55 SB 55 HB 11 Utah Code Ann §76-7a-201
Virginia HB 127 … … …
West Virginia … … HB 2007 W Va Code §16-2R-3
Wisconsin … … … Wis Stat §940.04
Wyoming … … SF 133 HB 152
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Our synthesis includes laws that were passed by the state legislature and signed by the governor or that had a governor’s veto overridden. We include “trigger” laws that took effect after the Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization, laws that pre-empted localities from passing protective ordinances, and laws that were enacted but struck down by courts or reversed. We adopt the classifications applied by legislation trackers, which use varying methodologies. For example, some but not all trackers include laws that are facially neutral but susceptible to discriminatory application (e.g., laws that allow religious objections to adoption placements can be used to discriminate against LGBQ couples). Some laws are specific to health care practice (e.g., restrictions on gender-affirming care), while others focus on other domains (e.g., laws that bar schools from enforcing the use of students’ preferred pronouns). Our tables are therefore illustrative rather than comprehensive, and Table 1 includes the trackers we used and an example citation for each category of law. Where any tracker classified a law as discriminatory to a group of interest, we included it. Relying on publicly available trackers has inherent limitations. They can be simultaneously underinclusive (i.e., failing to find or classify relevant laws) and overinclusive (i.e., including laws with a vague or attenuated relationship to the populations of interest). Strengths, however, are that this method saves resources, making it feasible to monitor multiple types of law simultaneously; public trackers are accessible and therefore drive advocacy, practice, and conversations about law; and our model of expressive impacts involves public perceptions of law, for which public trackers are instructive.

From an intersectional perspective, the most common pattern was for states to pass legislation targeting every 1 of the 4 groups of interest (either separately or in the same statute), which occurred in 14 states. The next most common patterns occurred in states that passed laws targeting transgender people and women (4 states); laws targeting Black people and other people of color, transgender people, and women and other people capable of pregnancy (4 states); and laws targeting LGBQ people, transgender people, and women and other people capable of pregnancy (3 states). Three states passed legislation targeting women and other people capable of pregnancy but were not identified as targeting other groups; 2 states passed legislation targeting Black people and other people of color but not other groups. Sixteen of the 30 states passed at least 1 law that simultaneously targeted more than 1 of the 4 identified groups in the same bill or statute (Table 2).

TABLE 2—

Example State Laws That Simultaneously Target Multiple Marginalized Groups in the United States, Enacted January 1, 2020‒January 1, 2024

State Law Year Black People and Other People of Color LGBQ People Transgender People Women and Other People Capable of Pregnancy
Alabama HB 322 2022 X X
Arizona HB 2161 2022 X X X X
Arizona SB 1399 2022 X X X
Arizona HB 2439 2022 X X X
Arkansas SB 294 2023 X X X X
Arkansas HB 1615 2023 X X
Florida HB 1069 2023 X X X X
Florida SB 266 2023 X X X X
Florida SB 1382 2023 X X X
Florida S 1580 2023 X X X
Florida HB 7 2022 X X X
Florida HB 1557 2022 X X X
Georgia SB 226 2023 X X X
Indiana HB 1608 2023 X X
Iowa SF 496 2023 X X X X
Kentucky SB 150 2023 X X
Louisiana SB 7 2023 X X
Louisiana HB 61 2023 X X
Louisiana HB 77 2023 X X
Louisiana SB 162 2023 X X
Mississippi SB 2346 2023 X X
Montana HB 303 2023 X X X
Nebraska LB 574 2023 X X
North Carolina SL 2023-106 2023 X X
North Dakota HB 1205 2023 X X X
North Dakota HB 1111 2023 X X X
Oklahoma SB 404 2023 X X
Oklahoma HB 3092 2022 X X X X
Texas HB 900 2023 X X
Utah SB 97 2023 X X
Utah SB 55 2022 X X X X
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These patterns identify how recent discriminatory legislation has proceeded simultaneously on multiple fronts, and how lawmaking acts to burden the same groups repeatedly across jurisdictions. Where a state has recently passed laws discriminating against transgender individuals, laws burdening women and other birthing people are also likely in that state. And where one state legislature passes a new law burdening LGBQ people, other states may follow. Across states, we note that populations at the intersections of the chosen marginalized groups, such as LGBQ people of color or transgender people capable of pregnancy, are repeatedly exposed to the unique and synergistic consequences of these laws.

A CALL FOR ACTION THROUGH PRACTICE AND RESEARCH

Across many US states, discriminatory legislation is rolling back dignity, opportunities, and material resources for marginalized groups. We have illustrated this point with reference to 4 marginalized populations, although additional analyses could and should include many other groups (e.g., incarcerated people, disabled people, immigrants). Drawing on extensive previous work in legal epidemiology, the health consequences of stigma, and intersectionality, we predict that exposure to discriminatory legislation is likely to produce deleterious health outcomes for marginalized group members.12 We therefore view this constellation of laws as a concerted force that threatens the health of multiple marginalized groups. Because more than half of US people experience 1 or more sources of marginalization, there is an urgent need for a coordinated, multilateral effort that counters these laws and addresses their likely health consequences. Legislators, legislative staff, advocacy groups, and political processes are integral to this response, but health care clinicians, institutions, and researchers also have a critical role to play. Indeed, intersectionality praxis, which Bowleg has labeled the “fourth wave” of intersectionality within public health, compels health care clinicians, institutions, and researchers to act.20

Much of health care research and practice focuses on 1 population or issue at a time. Where discriminatory laws affect specific groups or legal questions, targeted responses are essential. Marginalized populations have differences in social, economic, and political exclusion; historical context; care needs; and structural health risks, and they have diverse pathways toward equity and justice. Health care stakeholders have also foregrounded laws that directly restrict health care practice, such as laws that penalize providers of abortion or gender-affirming care.

Although particularized responses to laws that burden specific populations and clinical services are imperative, relying solely on a compartmentalized response also has drawbacks. An issue-by-issue view can overlook the acute damage that laws can do to people who simultaneously hold more than 1 marginalized social position. Indeed, systematic reviews now identify hundreds of studies documenting differential health burdens (e.g., chronic conditions, sexually transmitted infections, suicidal ideation, substance use) among people who experience multiple forms of social marginalization.21,22 Moreover, these seemingly distinct discriminatory laws co-occur in ways that shift power and opportunity away from multiple marginalized groups simultaneously. Viewing specific populations or issues in isolation can obscure how multiple laws work together to shape environment, behavior, and health outcomes. A wider, intersectional lens can capture opportunities for collaboration, harnessing the much-needed power and strength of groups experiencing a common set of legislative threats. Indeed, intersectionality, Bowleg notes, “is fundamentally a resistance project” that demands action,20(p89) such as efforts to mitigate legislative threats, to work with policymakers to reshape existing laws, and to prevent the passage of harmful new laws. These movements should also recognize and defer to leaders, advocacy efforts, expertise, and priorities from within multiply marginalized groups.

The skills and political capital of clinicians and institutions can be formidable forces in the response to discriminatory laws. First, clinicians in every specialty have patients experiencing the burdens of these laws, whether they be direct (e.g., inability to access gender-affirming care) or indirect (e.g., increased discrimination attributable to not being able to use a gender-congruent bathroom). Clinicians should therefore prepare to identify and treat potential increases in psychological and physical harms among marginalized patients. Second, health care institutions and clinicians can develop practice norms that resist multiple forms of discrimination. These include promoting structural competency25; providing staff and provider training in equity-oriented, person-centered care that addresses historical and contemporary discrimination26,27; hiring, supporting, and retaining providers and staff from marginalized communities; and enforcing hospital and clinic policies that support equitable treatment and accountability. We note that many health care providers are navigating an unprecedented and uncertain landscape of sanctions, including criminal penalties, licensing consequences, or fines for providing certain forms of care (e.g., abortion, gender-affirming care); providers will need to decide the best-available course of action depending on where they practice.

Third, health care institutions and clinicians—particularly in privately organized health care systems, as is common in the United States—wield expertise, influence, and material resources, which generate political capital. Given the health consequences that are likely to follow discriminatory legislation, health care institutions and clinicians can use their political influence to oppose not only laws restricting medical practice but also discriminatory legislation in other areas (e.g., laws banning transgender students from school athletics). Because discriminatory legislation is likely to exacerbate health inequities among marginalized groups, clinicians and health care institutions have a professional interest in opposing these damaging laws.

Health research on state laws can also be more powerful when it recognizes how laws intersect, including how this intersection impacts subgroups facing multiple forms of discrimination simultaneously. Legal epidemiological methods should be used to track and systematically map discriminatory laws that are likely to impact population health and should focus on linkages between these laws and health outcomes.28 Furthermore, researchers should collect demographic information that allows the identification of diverse subgroups, the study of multiple laws, and the ways that laws’ compliance and expressive functions influence environment, behavior, and health. Research funders can support this work by prioritizing projects that consider the interplay among state laws, stigma, and health among marginalized groups.

Discriminatory laws undermine the autonomy and health of marginalized people, to the advantage of dominant social groups. A coordinated threat demands a collective and intersectional response, and the clinicians, institutions, and researchers that care for marginalized patients have compelling reasons to join this work.

ACKNOWLEDGMENTS

This work is supported by the National Institutes of Mental Health (R01MH119892, Principal Investigator: Nelson).

 We are grateful to Hannah Knapp-Broas for assistance compiling data from public legislation trackers.

 Note. The content of this publication is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

CONFLICTS OF INTEREST

The authors have no conflicts to report.

HUMAN PARTICIPANT PROTECTION

Human participant protection was not required because this work did not involve human participants.

See also State Laws Targeting Marginalized Groups, pp. 1322–1364.

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