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Petrovskis A, Baquero B, Bekemeier B. Involvement of Local Health Departments in Obesity Prevention: A Scoping Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E345-E353. [PMID: 33729187 PMCID: PMC8781226 DOI: 10.1097/phh.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local health department (LHD) obesity prevention (OP) efforts, particularly by rural LHDs, are seemingly uncommon, in part, due to limited infrastructure, workforce capacity, accessible data, and available population-level interventions aimed at social determinants of health (SDOH). METHODS We conducted a scoping review to determine LHD roles in OP efforts and interventions. Inclusion criteria were articles including evidence-based OP and LHD leaders or staff. Articles were coded by type of LHD involvement, data use, intervention characteristics, use of an SDOH lens, and urban or rural setting. RESULTS We found 154 articles on LHD OP-52 articles met inclusion criteria. Typically, LHDs engaged in only surveillance, initial intervention development, or evaluation and were not LHD led. Data and SDOH lens use were infrequent, and interventions typically took place in urban settings. CONCLUSION LHDs could likely play a greater role in OP and population-level interventions and use data in intervention decision making. However, literature is limited. Future research should focus on LHD capacity building, including academic-public health partnerships. Studies should include rural populations, data, and SDOH frameworks addressing "upstream" factors.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Barbara Baquero
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Betty Bekemeier
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
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Padek MM, Mazzucca S, Allen P, Rodriguez Weno E, Tsai E, Luke DA, Brownson RC. Patterns and correlates of mis-implementation in state chronic disease public health practice in the United States. BMC Public Health 2021; 21:101. [PMID: 33504338 PMCID: PMC7840223 DOI: 10.1186/s12889-020-10101-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. METHODS A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman's correlation and multinomial logistic regression were used to assess factors in mis-implementation. RESULTS Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). CONCLUSION The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.
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Affiliation(s)
- Margaret M Padek
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Emily Rodriguez Weno
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Edward Tsai
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Center for Public Health System Science, Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis 1 Brookings Dr, St. Louis, MO, 63130, USA
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Sreedhara M, Goulding M, Valentine Goins K, Frisard C, Lemon SC. Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans. Front Public Health 2020; 8:580175. [PMID: 33392132 PMCID: PMC7775553 DOI: 10.3389/fpubh.2020.580175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Policy, systems, and environmental (PSE) approaches can sustainably improve healthy eating (HE) and physical activity (PA) but are challenging to implement. Community health improvement plans (CHIPs) represent a strategic opportunity to advance PSEs but have not been adequately researched. The objective of this study was to describe types of HE and PA strategies included in CHIPs and assess strategies designed to facilitate successful PSE-change using an established framework that identifies six key activities to catalyze change. Methods: A content analysis was conducted of 75 CHIP documents containing HE and/or PA PSE strategies, which represented communities that were identified from responses to a national probability sample of US local health departments (<500,000 residents). Each HE/PA PSE strategy was assessed for alignment with six key activities that facilitate PSE-change (identifying and framing the problem, engaging and educating key people, identifying PSE solutions, utilizing available evidence, assessing social and political environment, and building support and political will). Multilevel latent class analyses were conducted to identify classes of CHIPs based on HE/PA PSE strategy alignment with key activities. Analyses were conducted separately for CHIPs containing HE and PA PSE strategies. Results: Two classes of CHIPs with PSE strategies emerged from the HE (n = 40 CHIPs) and PA (n = 43 CHIPs) multilevel latent class analyses. More CHIPs were grouped in Class A (HE: 75%; PA: 79%), which were characterized by PSE strategies that simply identified a PSE solution. Fewer CHIPs were grouped in Class B (HE: 25%; PA: 21%), and these mostly included PSE strategies that comprehensively addressed multiple key activities for PSE-change. Conclusions: Few CHIPs containing PSE strategies addressed multiple key activities for PSE-change. Efforts to enhance collaborations with important decision-makers and community capacity to engage in a range of key activities are warranted.
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Affiliation(s)
- Meera Sreedhara
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Melissa Goulding
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Karin Valentine Goins
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephenie C. Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Factors Facilitating or Hindering Use of Evidence-Based Diabetes Interventions Among Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:443-450. [PMID: 32732717 PMCID: PMC7196444 DOI: 10.1097/phh.0000000000001094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess facilitators, barriers, and capacities to use of evidence-based programs and policies (EBPPs) in local health departments (LHDs). DESIGN A qualitative study design was used to elicit a contextual understanding of factors. One-hour interviews were conducted among directors and diabetes/chronic disease practitioners from LHDs. A consensus coding approach was used to identify themes. SETTING AND PARTICIPANTS Twenty-four participants from 14 Missouri LHDs completed interviews. RESULTS Themes were identified as facilitators, barriers, or capacities that enhance EBPP use. Facilitators included awareness of EBPPs, leadership and supervisor support of EBPP use, and facilitators to increase capacity to implement EBPPs. Skills development, targeted messaging, and understanding of evidence-based decision-making (EBDM) terminology were needed. Barriers to EBPPs use were described at the individual, organizational, and interorganizational levels and included community buy-in, limited resources, relevance to partners, and time scarcity. Capacities included the ways LHDs learn about EBPPs, methods that influence the use of EBPPs, and resources needed to sustain EBPPs. Top ways to learn about EBPPs were in-person interactions. Staff meetings, meetings with decision makers, and relevant evidence influenced decision making. Resources needed were funding, organizational capacity, and partnerships. Directors' and practitioners' views differed on type of agency culture that promoted EBPP use, preferences for learning about EBPPs, ways to influence decisions, needs, and barriers to EBPPs. CONCLUSIONS These findings can inform future strategies to support uptake of EBPPs in diabetes and chronic disease control in LHDs. LHDs have a good understanding of EBPPs, but subtle differences in perception of EBPPs and needs exist between directors and practitioners. Investment in capacity building and fostering an organizational culture supportive of EBDM were key implications for practice. By investing in employee skill development, LHDs may increase agency capacity. Researchers should use preferred channels and targeted messaging to disseminate findings.
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Feng W, Martin EG. Fighting obesity at the local level? An analysis of predictors of local health departments' policy involvement. Prev Med 2020; 133:106006. [PMID: 32007526 DOI: 10.1016/j.ypmed.2020.106006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/13/2019] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
Obesity is a critical public health issue in the United States. Local health departments (LHDs) can play a crucial role in public health policy, and are well-positioned to address obesity in their communities. We assess the obesity policy involvement among LHDs across the United States and the factors associated with increased involvement. Data come from 1803 LHDs in the 2016 National Profile of Local Health Department survey, supplemented with county-level obesity prevalence and political ideology. Negative binomial regressions examined LHD and regional characteristics associated with the number of obesity policies with which LHDs were involved. Almost half (46.1%) of LHDs reported no involvement with local obesity policies. Several factors were associated with increased policy involvement: having local boards of health with advisory (IRR = 1.31, p < 0.05) or governance roles (IRR = 1.27, p < 0.01), larger workforces (IRR = 1.34, p < 0.001), accreditation (IRR = 1.40, p < 0.001), higher obesity prevalence (IRR = 1.03, p < 0.01), and being politically more liberal (IRR = 1.01, p < 0.05). Overall, the large number of LHDs with no or limited involvement in obesity policies is a missed opportunity for local action. A better understanding of LHD policy involvement, how organizational and political factors enable or constrain their actions, and how they can leverage their current authority is needed to help LDHs serve local needs.
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Affiliation(s)
- Wenhui Feng
- Department of Public Health and Community Medicine, Tufts University School of Medicine, United States of America.
| | - Erika G Martin
- Rockefeller College of Public Affairs & Policy, University at Albany-State University of New York, United States of America
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Porter KJ, Brock DJ, Estabrooks PA, Perzynski KM, Hecht ER, Ray P, Kruzliakova N, Cantrell ES, Zoellner JM. SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes. BMC Public Health 2019; 19:1273. [PMID: 31533683 PMCID: PMC6751747 DOI: 10.1186/s12889-019-7567-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies. Methods In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. Results Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. Conclusions In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health. Electronic supplementary material The online version of this article (10.1186/s12889-019-7567-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA.
| | - Donna Jean Brock
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Paul A Estabrooks
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Katelynn M Perzynski
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Erin R Hecht
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Pamela Ray
- Virginia Department of Health, New River Health District, 212 3rd Avenue, Radford, VA, 24141, USA
| | - Natalie Kruzliakova
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Eleanor S Cantrell
- Virginia Department of Health, Lenowisco Health District, 134 Roberts Street SW, Wise, VA, 24293, USA
| | - Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
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Humphries DL, Hyde J, Hahn E, Atherly A, O'Keefe E, Wilkinson G, Eckhouse S, Huleatt S, Wong S, Kertanis J. Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost. Front Public Health 2018; 6:115. [PMID: 29755964 PMCID: PMC5932147 DOI: 10.3389/fpubh.2018.00115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Forty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use. Objective To characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA). Methods We interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews. Results The findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models – independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population. Implications There are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.
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Affiliation(s)
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs, Bedford, MA, United States
| | - Ethan Hahn
- Yale School of Public Health, New Haven, CT, United States
| | - Adam Atherly
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, IL, United States.,Center for Health Services Research, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Elaine O'Keefe
- Yale School of Public Health, New Haven, CT, United States
| | | | - Seth Eckhouse
- Boston University School of Public Health, Boston, MA, United States
| | - Steve Huleatt
- West Hartford-Bloomfield Health District, Bloomfield, CT, United States
| | - Samuel Wong
- Framingham Health Department, Framingham, MA, United States
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Parks RG, Tabak RG, Allen P, Baker EA, Stamatakis KA, Poehler AR, Yan Y, Chin MH, Harris JK, Dobbins M, Brownson RC. Enhancing evidence-based diabetes and chronic disease control among local health departments: a multi-phase dissemination study with a stepped-wedge cluster randomized trial component. Implement Sci 2017; 12:122. [PMID: 29047384 PMCID: PMC5648488 DOI: 10.1186/s13012-017-0650-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners. METHODS/DESIGN This paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption. TRIAL REGISTRATION ClinicalTrial.gov, NCT03211832.
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Affiliation(s)
- Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Elizabeth A Baker
- Department of Behavioral Science & Health Education, College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
| | - Katherine A Stamatakis
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
| | - Allison R Poehler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Yan Yan
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, USA
| | - Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Hamilton, Ontario, Canada
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
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Five Community-wide Approaches to Physical Activity Promotion: A Cluster Analysis of These Activities in Local Health Jurisdictions in 6 States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:112-120. [PMID: 28492446 DOI: 10.1097/phh.0000000000000570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Local health departments (LHDs) have essential roles to play in ensuring the promotion of physical activity (PA) in their communities in order to reduce obesity. Little research exists, however, regarding the existence of these PA interventions across communities and how these interventions may impact community health. DESIGN In this exploratory study, we used cluster analysis to identify the structure of co-occurring PA interventions, followed by regression analysis to quantify the association between the patterns of PA interventions and prevalence of PA and obesity at a population level. SETTING Our study setting included local health jurisdictions in Colorado, Florida, Minnesota, New Jersey, Tennessee, and Washington. PARTICIPANTS Participating jurisdictions were those 218 local health jurisdictions (mostly counties) from which LHD leaders had provided data in 2013 for the Multi-Network Practice and Outcome Variation Examination Study. MAIN OUTCOME MEASURES We obtained unique public health activities data on PA interventions conducted in 2012 from 218 LHDs in 6 participating states. We categorized jurisdictions using cluster analysis, based on PA intervention approaches indicated by LHD leaders as available in their communities and then examined associations between categories and prevalence of obesity and of residents engaged in PA. RESULTS We identified 5 distinct PA intervention categories representing community-wide approaches-Comprehensive Approach, Built Environment, Personal Health, School-Based Interventions, and No Apparent Activities. Prevalence rates of obesity and PA among jurisdictions in the intervention clusters were significantly different from jurisdictions with No Apparent Activities, with more population-level approaches most significantly related to beneficial outcomes. CONCLUSION Our findings suggest the importance of standardized public health services data for generating evidence regarding health-related outcomes. The intervention categories we identified appear to reflect broad, local community-wide prevention approaches and demonstrated that population-level PA interventions can be testable and may have particularly beneficial relationships to community health. Widespread adoption of such standardized data depicting local public health prevention activity could support monitoring practice change, performance improvement, comparisons across communities that could reduce unnecessary variation, and the generation of evidence for public health practice and policy-making.
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The diffusion of evidence-based decision making among local health department practitioners in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:134-40. [PMID: 25136937 DOI: 10.1097/phh.0000000000000129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM. DESIGN, SETTING, AND PARTICIPANTS Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes. RESULTS Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers. CONCLUSIONS Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.
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Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 23:364-369. [PMID: 27798526 DOI: 10.1097/phh.0000000000000486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. OBJECTIVE To determine the cost-effectiveness of a minigrant program to increase PA among youth. DESIGN Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. SETTING Twenty counties in North Carolina. PARTICIPANTS A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. MAIN OUTCOME MEASURE Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. RESULTS Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. CONCLUSION If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.
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Cohen SA, Cook SK, Kelley L, Foutz JD, Sando TA. A Closer Look at Rural-Urban Health Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors. J Rural Health 2016; 33:167-179. [PMID: 27557442 DOI: 10.1111/jrh.12207] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/10/2016] [Accepted: 07/05/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity affects over one-third of older adults in the United States. Both aging and obesity contribute to an increased risk for chronic disease, early mortality, and additional health care utilization. Obesity rates are higher in rural areas than in urban areas, although findings are mixed. The objectives of this study are to assess potential nonlinearity in the association between rurality and obesity, and to evaluate the potential for socioeconomic status and geographic area to moderate the associations between rurality and obesity. METHODS Using a representative sample of adults aged 65 and above from the Behavioral Risk Factor Surveillance System, obesity (BMI ≥ 30 kg/m2 ) was modeled against the primary exposure of rural-urban status, as measured by the Index of Relative Rurality. Binary logistic regression models were used to estimate the odds of obesity by rurality both as a continuous variable and by decile of rurality. Models were then stratified by per-capita income and state to assess potential moderation by these factors. RESULTS The prevalence of obesity in older adults was highest in intermediate rurality areas (OR in rurality decile #5 1.134, 95% CI: 1.086-1.184) and lowest in the most rural and most urban areas. Obesity was highest in low- and middle-income areas, regardless of rural-urban status. In high-income areas, obesity among older adults was highest in areas of intermediate rurality and lowest in the most rural areas (OR 0.726, 95% CI: 0.606-0.870) and more urban areas, showing a J-shaped association. There were substantial differences in the associations between rurality and obesity in older adults among states. CONCLUSION Associations between rurality and obesity varied by degree of rurality, socioeconomic status, and geography. Therefore, traditional "one-size-fits-all" approaches to reducing rural-urban health disparities in older adults may be more effective if tailored to the area-specific rural-urban gradients in health.
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Affiliation(s)
- Steven A Cohen
- Health Studies Program, Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island
| | - Sarah K Cook
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Lauren Kelley
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Julia D Foutz
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Trisha A Sando
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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Spruijt-Metz D, Hekler E, Saranummi N, Intille S, Korhonen I, Nilsen W, Rivera DE, Spring B, Michie S, Asch DA, Sanna A, Salcedo VT, Kukakfa R, Pavel M. Building new computational models to support health behavior change and maintenance: new opportunities in behavioral research. Transl Behav Med 2015; 5:335-46. [PMID: 26327939 PMCID: PMC4537459 DOI: 10.1007/s13142-015-0324-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static "snapshots" of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloud-enabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing "gold standard" measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a "knowledge commons," which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.
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Affiliation(s)
- Donna Spruijt-Metz
- />University of Southern California, 635 Downey Way, Suite 305 Building Code: VPD 3332, Los Angeles, CA 90089-3332 USA
| | | | | | | | | | - Wendy Nilsen
- />National Institutes of Health, Bethesda, MD USA
| | | | | | | | - David A. Asch
- />Wharton School, University of Pennsylvania, Philadelphia, PA USA
| | - Alberto Sanna
- />Scientific Institute Hospital San Raffaelle, Milano, Italy
| | | | | | - Misha Pavel
- />VTT Technical Research Centre of Finland, Espoo, Finland
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Leider JP, Castrucci BC, Harris JK, Hearne S. The Relationship of Policymaking and Networking Characteristics among Leaders of Large Urban Health Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9169-80. [PMID: 26258784 PMCID: PMC4555272 DOI: 10.3390/ijerph120809169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The relationship between policy networks and policy development among local health departments (LHDs) is a growing area of interest to public health practitioners and researchers alike. In this study, we examine policy activity and ties between public health leadership across large urban health departments. METHODS This study uses data from a national profile of local health departments as well as responses from a survey sent to three staff members (local health official, chief of policy, chief science officer) in each of 16 urban health departments in the United States. Network questions related to frequency of contact with health department personnel in other cities. Using exponential random graph models, network density and centrality were examined, as were patterns of communication among those working on several policy areas using exponential random graph models. RESULTS All 16 LHDs were active in communicating about chronic disease as well as about use of alcohol, tobacco, and other drugs (ATOD). Connectedness was highest among local health officials (density = .55), and slightly lower for chief science officers (d = .33) and chiefs of policy (d = .29). After accounting for organizational characteristics, policy homophily (i.e., when two network members match on a single characteristic) and tenure were the most significant predictors of formation of network ties. CONCLUSION Networking across health departments has the potential for accelerating the adoption of public health policies. This study suggests similar policy interests and formation of connections among senior leadership can potentially drive greater connectedness among other staff.
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Affiliation(s)
- Jonathon P Leider
- Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310E Bethesda, Maryland, MD 20814, USA.
| | - Brian C Castrucci
- Beaumont Foundation, 7501 Wisconsin Avenue, Suite 1310E Bethesda, Maryland, MD 20814, USA.
| | - Jenine K Harris
- Brown School, Center for Public Health Systems Science, Washington University in St. Louis, Missouri, MO 63130, USA.
| | - Shelley Hearne
- Director, Big Cities Health Coalition, National Association of County and City Health Officials, 1100 17th Street, NW, Seventh Floor, Washington, DC 20036, USA.
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Lessons learned from a collaborative field-based collection of physical activity data using accelerometers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 20:251-8. [PMID: 23518592 DOI: 10.1097/phh.0b013e3182893b9b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Recent improvements in the accuracy and availability of accelerometers present an opportunity to increase the validity of physical activity assessment. While use of these devices is now pervasive among researchers, accelerometers have not been widely used by community-based public health practitioners. OBJECTIVE To present a case example of field-based data collection using accelerometers with youth. METHOD A collaborative research team, including state- and county-level public health practitioners and university researchers, collected accelerometer data from 1313 youth, aged 9 to 14 years, in 20 North Carolina counties. RESULTS This case example highlights some considerations for how to improve communication and streamline data collection logistics within a multidisciplinary research team. It demonstrates that a collaborative model can make objective physical activity evaluation feasible in community settings with limited resources. CONCLUSIONS Lessons learned by our research team about coordinating the logistics of accelerometer use and scheduling a large-scale data collection in multiple sites can be adapted by other researchers and community-based practitioners who aim to evaluate physical activity using accelerometers or other mobile data collection devices.
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Porterfield DS, Rogers T, Glasgow LM, Beitsch LM. Measuring public health practice and outcomes in chronic disease: a call for coordination. Am J Public Health 2015; 105 Suppl 2:S180-8. [PMID: 25689196 PMCID: PMC4355715 DOI: 10.2105/ajph.2014.302238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/04/2022]
Abstract
A strategic opportunity exists to coordinate public health systems and services researchers' efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice.
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Affiliation(s)
- Deborah S Porterfield
- Deborah S. Porterfield, Todd Rogers, and LaShawn M. Glasgow are with RTI International, Research Triangle Park, NC. Deborah S. Porterfield is also with the School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee
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Castrucci BC, Rhoades EK, Leider JP, Hearne S. What gets measured gets done: an assessment of local data uses and needs in large urban health departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21 Suppl 1:S38-48. [PMID: 25423055 PMCID: PMC4243790 DOI: 10.1097/phh.0000000000000169] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The epidemiologic shift in the leading causes of mortality from infectious disease to chronic disease has created significant challenges for public health surveillance at the local level. OBJECTIVE We describe how the largest US city health departments identify and use data to inform their work and we identify the data and information that local public health leaders have specified as being necessary to help better address specific problems in their communities. DESIGN We used a mixed-methods design that included key informant interviews, as well as a smaller embedded survey to quantify organizational characteristics related to data capacity. Interview data were independently coded and analyzed for major themes around data needs, barriers, and achievements. PARTICIPANTS Forty-five public health leaders from each of 3 specific positions-local health official, chief of policy, and chief science or medical officer-in 16 large urban health departments. RESULTS Public health leaders in large urban local health departments reported that timely data and data on chronic disease that are available at smaller geographical units are difficult to obtain without additional resources. Despite departments' successes in creating ad hoc sources of local data to effect policy change, all participants described the need for more timely data that could be geocoded at a neighborhood or census tract level to more effectively target their resources. Electronic health records, claims data, and hospital discharge data were identified as sources of data that could be used to augment the data currently available to local public health leaders. CONCLUSIONS Monitoring the status of community health indicators and using the information to identify priority issues are core functions of all public health departments. Public health professionals must have access to timely "hyperlocal" data to detect trends, allocate resources to areas of greatest priority, and measure the effectiveness of interventions. Although innovations in the largest local health departments in large urban areas have established some methods to obtain local data on chronic disease, leaders recognize that there is an urgent need for more timely and more geographically specific data at the neighborhood or census tract level to efficiently and effectively address the most pressing problems in public health.
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Affiliation(s)
- Brian C Castrucci
- de Beaumont Foundation, Bethesda, Maryland (Mr Castrucci and Dr Leider); and National Association of County and City Health Officials, Washington, District of Columbia (Dr Hearne)
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Sekhobo JP, Edmunds LS, Dalenius K, Jernigan J, Davis CF, Giddings M, Lesesne C, Kettel Khan L. Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations. Prev Chronic Dis 2014; 11:E181. [PMID: 25321632 PMCID: PMC4208999 DOI: 10.5888/pcd11.140152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007. METHODS We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System. RESULTS Early childhood obesity prevalence declined in all study neighborhoods from 2004-2006 to 2008-2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004-2006 to 15.3% in 2008-2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn. CONCLUSION The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.
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Affiliation(s)
- Jackson P Sekhobo
- Division of Nutrition, New York State Department of Health, 150 Broadway, Menands, NY 12204. E-mail:
| | | | - Karen Dalenius
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mark Giddings
- New York State Department of Health, Albany, New York
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Lebel A, Kestens Y, Clary C, Bisset S, Subramanian SV. Geographic variability in the association between socioeconomic status and BMI in the USA and Canada. PLoS One 2014; 9:e99158. [PMID: 24932774 PMCID: PMC4059636 DOI: 10.1371/journal.pone.0099158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/12/2014] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Reported associations between socioeconomic status (SES) and obesity are inconsistent depending on gender and geographic location. Globally, these inconsistent observations may hide a variation in the contextual effect on individuals' risk of obesity for subgroups of the population. This study explored the regional variability in the association between SES and BMI in the USA and in Canada, and describes the geographical variance patterns by SES category. METHODS The 2009-2010 samples of the Behavioral Risk Factor Surveillance System (BRFSS) and the Canadian Community Health Survey (CCHS) were used for this comparison study. Three-level random intercept and differential variance multilevel models were built separately for women and men to assess region-specific BMI by SES category and their variance bounds. RESULTS Associations between individual SES and BMI differed importantly by gender and countries. At the regional-level, the mean BMI variation was significantly different between SES categories in the USA, but not in Canada. In the USA, whereas the county-specific mean BMI of higher SES individuals remained close to the mean, its variation grown as SES decreased. At the county level, variation of mean BMI around the regional mean was 5 kg/m2 in the high SES group, and reached 8.8 kg/m2 in the low SES group. CONCLUSIONS This study underlines how BMI varies by country, region, gender and SES. Lower socioeconomic groups within some regions show a much higher variation in BMI than in other regions. Above the BMI regional mean, important variation patterns of BMI by SES and place of residence were found in the USA. No such pattern was found in Canada. This study suggests that a change in the mean does not necessarily reflect the change in the variance. Analyzing the variance by SES may be a good way to detect subtle influences of social forces underlying social inequalities.
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Affiliation(s)
- Alexandre Lebel
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Graduate School of Land Management and Regional Planning, Laval University, Quebec City, Quebec, Canada
| | - Yan Kestens
- CHUM Research Center, Montreal, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Christelle Clary
- CHUM Research Center, Montreal, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Sherri Bisset
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Faculty of Nursing Science, Laval University, Quebec City, Quebec, Canada
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Roth C, Foraker RE, Payne PRO, Embi PJ. Community-level determinants of obesity: harnessing the power of electronic health records for retrospective data analysis. BMC Med Inform Decis Mak 2014; 14:36. [PMID: 24886134 PMCID: PMC4024096 DOI: 10.1186/1472-6947-14-36] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/30/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Obesity and overweight are multifactorial diseases that affect two thirds of Americans, lead to numerous health conditions and deeply strain our healthcare system. With the increasing prevalence and dangers associated with higher body weight, there is great impetus to focus on public health strategies to prevent or curb the disease. Electronic health records (EHRs) are a powerful source for retrospective health data, but they lack important community-level information known to be associated with obesity. We explored linking EHR and community data to study factors associated with overweight and obesity in a systematic and rigorous way. METHODS We augmented EHR-derived data on 62,701 patients with zip code-level socioeconomic and obesogenic data. Using a multinomial logistic regression model, we estimated odds ratios and 95% confidence intervals (OR, 95% CI) for community-level factors associated with overweight and obese body mass index (BMI), accounting for the clustering of patients within zip codes. RESULTS 33, 31 and 35 percent of individuals had BMIs corresponding to normal, overweight and obese, respectively. Models adjusted for age, race and gender showed more farmers' markets/1,000 people (0.19, 0.10-0.36), more grocery stores/1,000 people (0.58, 0.36-0.93) and a 10% increase in percentage of college graduates (0.80, 0.77-0.84) were associated with lower odds of obesity. The same factors yielded odds ratios of smaller magnitudes for overweight. Our results also indicate that larger grocery stores may be inversely associated with obesity. CONCLUSIONS Integrating community data into the EHR maximizes the potential of secondary use of EHR data to study and impact obesity prevention and other significant public health issues.
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Affiliation(s)
- Caryn Roth
- Department of Biomedical Informatics, College of Medicine, 250 Lincoln Tower 1800 Cannon Drive, 43210 Columbus, OH, USA
| | - Randi E Foraker
- Division of Epidemiology, College of Public Health; The Ohio State University, Columbus, OH, USA
| | - Philip RO Payne
- Department of Biomedical Informatics, College of Medicine, 250 Lincoln Tower 1800 Cannon Drive, 43210 Columbus, OH, USA
| | - Peter J Embi
- Department of Biomedical Informatics, College of Medicine, 250 Lincoln Tower 1800 Cannon Drive, 43210 Columbus, OH, USA
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Stamatakis KA, Lewis M, Khoong EC, Lasee C. State practitioner insights into local public health challenges and opportunities in obesity prevention: a qualitative study. Prev Chronic Dis 2014; 11:E39. [PMID: 24625363 PMCID: PMC3958145 DOI: 10.5888/pcd11.130260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs' success in obesity prevention. METHODS From June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations. RESULTS Main themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process. CONCLUSIONS These findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state-local relationship, especially in centralized states.
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Affiliation(s)
- Katherine A Stamatakis
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63110. E-mail:
| | - Moira Lewis
- Washington University School of Medicine and the Prevention Research Center in St. Louis, Missouri
| | - Elaine C Khoong
- Washington University School of Medicine and the Prevention Research Center in St. Louis, Missouri
| | - Claire Lasee
- Washington State Department of Health, Tumwater, Washington
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Naghshizadian R, Rahnemai-Azar AA, Kella K, Weber MM, Calin ML, Bibi S, Farkas DT. Patient perception of ideal body weight and the effect of body mass index. J Obes 2014; 2014:491280. [PMID: 25614830 PMCID: PMC4295128 DOI: 10.1155/2014/491280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/17/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Despite much effort, obesity remains a significant public health problem. One of the main contributing factors is patients' perception of their target ideal body weight. This study aimed to assess this perception. METHODS The study took place in an urban area, with the majority of participants in the study being Hispanic (65.7%) or African-American (28.0%). Patients presented to an outpatient clinic were surveyed regarding their ideal body weight and their ideal BMI calculated. Subsequently they were classified into different categories based on their actual measured BMI. Their responses for ideal BMI were compared. RESULTS In 254 surveys, mean measured BMI was 31.71 ± 8.01. Responses to ideal BMI had a range of 18.89-38.15 with a mean of 25.96 ± 3.25. Mean (±SD) ideal BMI for patients with a measured BMI of <18.5, 18.5-24.9, 25-29.9, and ≥30 was 20.14 ± 1.46, 23.11 ± 1.68, 25.69 ± 2.19, and 27.22 ± 3.31, respectively. These differences were highly significant (P < 0.001, ANOVA). CONCLUSIONS Most patients had an inflated sense of their target ideal body weight. Patients with higher measured BMI had higher target numbers for their ideal BMI. Better education of patients is critical for obesity prevention programs.
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Affiliation(s)
- Rozhin Naghshizadian
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Amir A. Rahnemai-Azar
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Kruthi Kella
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Michael M. Weber
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Marius L. Calin
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Shahida Bibi
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
| | - Daniel T. Farkas
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA
- *Daniel T. Farkas:
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Local health department assurance of services and the health of California's seniors. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:550-61. [PMID: 23838898 DOI: 10.1097/phh.0b013e31828e25e5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING Fifty-seven California counties. PARTICIPANTS 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.
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