April 10, 2026
This week’s newsletter discusses cases concerning tobacco preemption, conversion therapy laws, and birthright citizenship. You can find all of our previous newsletters archived here.
Preemption of Local Tobacco Regulation
In City of Columbus et al. v. State of Ohio and Ohio Department of Health et al. (Docket No. 2025-1057, Supreme Court of Ohio), Columbus and twenty other cities are challenging an Ohio state law that seeks to preempt all current and future local regulations of tobacco products. On December 12, 2022, Columbus passed an ordinance authorizing its Department of Health to enforce the city's tobacco laws and health code, establish a system of civil penalties including fines and license revocation for violations, and ban the sale of flavored tobacco products. The ordinance cites the need to protect children from the harmful and addictive effects of flavored tobacco products and noted that these products “disproportionately impact the 85% of African American smokers and 36% of LGBTQ smokers who smoke menthol as a result of targeted marketing practices.”
Two days after passing the ordinance, the Ohio Legislature passed a bill (H.B. 513) that prohibited all local regulations of tobacco products. The governor vetoed the bill. Then in June 2023, the Ohio Legislature passed a budget bill prohibiting local regulation of tobacco products, and the governor again vetoed this portion of the bill. However, the Legislature voted to override the governor's second veto, making this portion of the bill now law.
The current law (Ohio Rev. Code § 9.681) states that “the regulation of tobacco products and alternative nicotine products is a matter of general statewide concern that requires statewide regulation…No political subdivision may enact, adopt, renew, maintain, enforce, or continue in existence any charter provision, ordinance, resolution, rule, or other measure that conflicts with or preempts any policy of the state regarding the regulation of tobacco products or alternative nicotine products.” The law further states that this preemption includes taxes, fees, or charges on tobacco products and lowering or raising the age requirement provided for in state law regarding sales of these products.
On April 9, 2024, the Plaintiffs filed a complaint to challenge the constitutionality of the state law, seeking a temporary restraining order, a preliminary injunction, permanent injunctive relief, and a declaratory judgment. On April 19, the trial court granted the Plaintiffs’ request and then ruled in May 2024 that the state preemption law was unconstitutional and granted Plaintiffs a permanent injunction. The court found the law violated the Home Rule Amendment in Article XVIII of the Ohio Constitution, which states that municipalities shall have authority to exercise all powers of local self-government and can “adopt or enforce within their limits such local police, sanitary and other similar regulations, as are not in conflict with general laws.” The state appealed the decision to the Tenth District Court. On July 8, 2025, the appeals court affirmed the lower court decision, stating that the Home Rule Amendment was adopted to allow municipalities to do precisely the sort of legislating they did by passing local ordinances to protect residents from tobacco-related illness and death. The court also stated that if the state's statute was enforced as written, cities would lose the power to enforce tobacco laws, both criminal and civil, limiting their ability to keep city parks free of tobacco or invalidating zoning of convenience stores that sell tobacco products.
The state appealed to the Supreme Court of Ohio, which agreed in October 2025 to accept the case. No hearings have been scheduled yet.
Conversion Therapy Laws
On March 31, 2026, the United States Supreme Court issued an 8-1 ruling in Chiles v. Salazar (Docket No. 24-539), holding that the U.S. Court of Appeals for the Tenth Circuit failed to apply the appropriate First Amendment scrutiny to Colorado's Minor Conversion Therapy Law (MCTL) as it applied to talk therapy provided by licensed counselors. The MCTL, enacted in 2019, prohibited licensed mental health professionals from engaging in any practice or treatment, including talk therapy, aimed at changing the sexual orientation or gender identity of clients under the age of 18. Kaley Chiles, a licensed counselor in Colorado, who describes her practice as “faith-informed,” sued state officials arguing that the law violated her First Amendment rights by penalizing the expression of particular therapeutic viewpoints. The Tenth Circuit upheld the law, finding that it regulated professional conduct and only incidentally burdened speech.
The U.S. Supreme Court reversed the Tenth Circuit’s decision and remanded the case back to that court for further analysis. Justice Gorsuch, writing for the majority, held that Colorado's law regulates speech based on viewpoint by permitting counselors to support clients pursuing gender transition while prohibiting counselors from assisting clients who wish to align their identity with their biological sex. Because the law was not neutral as to the content of speech, the Supreme Court said it was subject to strict scrutiny, the most demanding standard of constitutional review. The majority strongly signaled the law would be unlikely to survive that standard of review on remand. Justices Kagan and Sotomayor concurred separately, emphasizing the ruling's narrowness and noting that a viewpoint-neutral law regulating professional speech would raise different and harder questions. Justice Jackson was the sole dissenter, warning that the decision “threatens to impair States’ ability to regulate the provision of medical care in any respect” and risks “grave harm to Americans’ health and wellbeing."
Importantly, this ruling is not a verdict on whether conversion therapy is safe or effective. The research is clear that conversion therapy causes real harm and is linked to depression, anxiety, and suicidal ideation in young people. Research by The Trevor Project has found that LGBTQ+ youth who underwent conversion therapy were more than twice as likely to report having attempted suicide. Despite the Court’s finding that Colorado’s approach to regulating conversion therapy is unconstitutional, patients who are harmed by it may have other legal options, including claims of medical malpractice, consumer fraud, and intentional infliction of emotional distress.
Colorado is one of more than 20 states with laws restricting conversion therapy, and this decision puts states’ ability to rely on scientific and medical consensus to protect minors at serious risk. The ramifications of the ruling for the regulation of professional speech may also soon be felt in a pair of pending medical free speech cases, including Kory v. Bonta and Stockton v. Brown. These cases are both challenging state medical boards’ authority to discipline physicians for COVID-19 “misinformation.”
Birthright Citizenship
On April 1, 2026, the Supreme Court heard oral argument in Trump v. Barbara, a landmark challenge to President Trump’s Executive Order 14160 which purported to end birthright citizenship for children born in the United States to undocumented immigrants and temporary visa holders, a policy estimated to affect over 150,000 births annually. After the Supreme Court’s June 2025 ruling in Trump v. CASA limited the power of district courts to issue nationwide injunctions, the ACLU filed a class action on behalf of all children who would be affected. A federal court in New Hampshire certified the class and issued a preliminary injunction, and the Supreme Court granted certiorari in December 2025.
The central legal question is whether the executive order complies with the Fourteenth Amendment's Citizenship Clause, which grants citizenship to all persons “born or naturalized in the United States, and subject to the jurisdiction thereof” and with the federal statute that codifies it. The Trump administration argues that “subject to the jurisdiction thereof” requires a showing of “direct and immediate allegiance” to the United States, which they claim undocumented immigrants and temporary visitors cannot demonstrate. The government drew on Elk v. Wilkins, 112 U.S. 94 (1884) and 19th-century commentators to argue that the longstanding interpretation of birthright citizenship misreads the Fourteenth Amendment.
Oral argument lasted more than two hours and President Trump attended in person, becoming the first sitting president ever to observe Supreme Court oral arguments. During arguments, a majority of justices appeared skeptical of the administration’s position. Several justices pressed Solicitor General D. John Sauer on U.S. v. Wong Kim Ark, 169 U.S. 649 (1898) – the Court’s leading precedent on birthright citizenship – and questioned whether consideration of the government’s concerns about the modern-day consequences of birthright citizenship should factor into how the 14th Amendment is interpreted today.
The public health implications of a ruling in the administration’s favor would be significant. Children denied citizenship status would likely lose eligibility for Medicaid, CHIP, and other federally funded health programs. Maternal and child health outcomes could deteriorate as immigrant families delay or forgo prenatal and postnatal care out of fear that documentation status will be used against them and their children.
The newsletter will provide a fuller discussion of this case once a ruling is issued.
National Public Health Week
April 6-12 is National Public Health Week: a moment to recognize the work and accomplishments of all public health professionals and renew our commitment to action. At a time when there seems to be endless obstacles: funding cuts threatening vital programs and organizations, long-standing initiatives being upended by government action, and established science facing unprecedented scrutiny and skepticism, the work of those on the front lines has never been more important. We are deeply grateful for the people that continue to lead and advocate for strong, evidence-based policies. Thank you to the researchers, health care workers, and public health professionals who continue to work every day to protect and improve the health of our communities.
For more information on priority issues and resources to take action, visit the American Public Health Association’s website on National Public Health Week.
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