Community Health Improvement Plans Research Articles

Examining the Priorities of Local Health Departments in California: A Mixed Methods Study.

Prioritization is an essential task of local health departments (LHDs). We examined the alignment of priorities reported in Community Health Needs Assessments (CHNA) priorities align with priorities in the Community Health Improvement Plans (CHIP). We report factors that influence the choice of priorities and the alignment of the priorities. A mixed method study design. California. CHNA and CHIP documents were sought for all 58 counties. Interviews were conducted with 19 state and local public health officials. The priorities in the CHNA and the CHIP were coded as i) only in the CHNA, ii) only in the CHIP, or iii) in both the CHNA and the CHIP. The interviewees were asked to share their experiences related to issue prioritization and decision-making in public health agencies. The interviews were coded and thematically analyzed to identify barriers and facilitators of the prioritization process. The alignment between the needs prioritized in CHNA and the priorities targeted in CHIP was 35%. The interviews identify reasons for the misalignment, including a need to include priorities in the CHNA even though LHDs are not able to address them, political factors that influence the selection of priorities, and a lack of discretionary funding or capacity/expertise within the agency or its community partners to respond to the needs identified. The lack of discretionary funding was particularly acute for smaller (rural) LHDs (CMSP) and resulted in their often having to focus on priorities where there was state or federal funding. LHDs face numerous challenges in aligning the priorities reported in the CHNA and the priorities they focus upon in the CHIP. LHDs should consider using a formal, transparent, and evidence-based approach to setting aligning. Future research should focus on developing a formal decision-making process that is appropriate for local public health decision-making.

Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022.

This study aimed to assess the quality of community health assessments (CHA) and community health improvement plans conducted by Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs) in Kentucky. Quality assessment of CHAs and community health improvement plan documents using criteria adapted from Pennel et al (2015). PHAB-accredited LHDs in Kentucky. Seventeen CHAs and community health improvement plan documents from PHAB-accredited LHD. Quality scores based on 17 evaluation criteria, including stakeholder involvement, data examination, plan feasibility, and LHD-hospital collaboration. The study found significant variation in the quality of CHAs and community health improvement plan documents. The highest scores were for partner involvement, data examination, and plan feasibility. The lowest scores were for LHD-hospital collaboration, use of evidence-based strategies, and plan evaluation. No community variables significantly predicted overall report scores. The quality of CHAs and community health improvement plan documents varies among Kentucky LHDs, highlighting the need for more robust guidance and standardized criteria. Strengthening hospital-LHD collaboration and focusing on evidence-based strategies can improve public health outcomes. Enhancing CHAs and community health improvement plan processes through legislative changes, better guidance, and improved collaboration between hospitals and LHD can lead to more effective public health interventions and outcomes.

Local Public Health Strategies for Addressing Social Determinants of Health-Analysis of Recent Community Health Improvement Plans.

The Public Health 3.0 (PH3.0) framework encourages local health departments (LHDs) to address the social determinants of health (SDOHs) that impact health equity. This study sought to understand how often LHDs are working to address SDOH, which SDOHs are most often being addressed, as well as the mix of strategies that have been proposed to address this work. We reviewed recent Community Health Improvement Plans (CHIPs) to analyze the current involvement of LHDs in addressing SDOH. CHIPs published from 2020. Accredited LHDs from across the United States (n=80). We developed a qualitative guidebook to characterize CHIP strategies based on the SDOH domain they addressed and the strategic mechanism they proposed. Across our entire sample, CHIPs were roughly 1.5 times more likely to address Health Care Access than Food Insecurity and Access to Healthy Food (65%), Neighborhood Infrastructure (61%), or Affordable Housing (65%), and they were 3 to 4 times more likely to address Health Care Access than Safe Housing (23%), Education Access and Quality (31%), or Economic Stability (24%). Across all major domains, a few concerned policy changes and a handful focused on improving systems or developing the built environment. Most strategies focused on service provision through events or the education of the public and professionals on health-related topics. The results of this study demonstrate that not all SDOHs are addressed equally by LHDs within their CHIPs. There is significant variation in how SDOHs are addressed along at 2 dimensions: first, in the likelihood that a CHIP addresses the domain and, second, in the mechanism by which each domain is addressed. Practically, the list of strategies we documented from the 80 CHIPs included in our sample may serve as the basis for strategies that other communities may wish to consider when addressing SDOH.

Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments.

We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps' What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a "WWFH intervention" rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.

Community Health Improvement Plans and Physical Activity Implementation Strategies: Findings From a Cross-Sectional Survey of US Local Health Departments.

Community Health Improvement Plans (CHIPs) are a foundational public health practice conducted by every accredited health department in the United States. Community Health Improvement Plans may impact community-wide physical activity (PA) by implementing large-scale interventions. However, no studies have evaluated whether, or how, CHIP goals focusing on increasing PA are implemented. This study aims to understand CHIP PA goals, implementation strategies, and implementation outcomes of CHIP nationally. This study was a cross-sectional online survey of CHIP implementation. A random sample of accredited local health departments nationally. Local health departments (N = 44) were invited to participate in this study. Constructs from Proctor's Model of Implementation Research and implementation strategies were the main outcomes assessed. Most CHIPs included PA goals (72.7%). Goals most commonly focused on changing built environment and infrastructure (25.9%), increasing education and awareness (22.2%), increasing PA programming (18.5%), and partnering with health care (18.5%). Common implementation strategies used were designing and evaluating their CHIPs (72.7%) and developing relationships with stakeholders (72.7%). Respondents reported that CHIPS were able to be adopted, acceptable for the community, and feasible. Community Health Improvement Plans were also reported to be safe, yet respondents reported effectiveness lower than other constructs. Participants reported that individual-level PA was unlikely to change due to their CHIP (mean = 3.39, SD = 1.12). Overall, it seems that communities are choosing easily adopted, appropriate, feasible, and safe interventions that may be less effective over those that may produce large-scale improvement in PA behavior. Future research needs to be conducted on the process of CHIP implementation and the potential long-term outcomes. Community Health Improvement Plans may serve as a powerful tool to improve population health if implemented effectively.

Population-level predictors of sexually transmitted infection rate changes in Missouri: an ecological study

BackgroundSexually transmitted infection rates continue to increase across the US, further developing health disparities and economic burdens of disease, especially as migration occurs. In this study, we aim to assess the relationship between STI rates and population-level variables from 2008 to 2017 at the county level in Missouri.MethodsTwo data sources were used: STI rates of chlamydia, gonorrhea, syphilis, HIV reported to Missouri DHSS and ACS 1-year county population estimates. Linear regression models and ANOVA tests were conducted in SPSS for each STI from year-to-year and 2008–2017. Covariates included in the analyzes were county-level income, employment rate, race, ethnicity, age, and percent poverty. Further, Akaike Information Criterion tests were performed to indicate the best predictor models and averaged standardized beta values.ResultsSignificant relationships among STI rates and population growth were identified. Chlamydia, syphilis, and HIV were positively associated with population growth from 2008 to 2017 (β = 0.15; β = 0.01; β = 0.05, respectively). Gonorrhea was negatively associated with population growth (β = − 0.02) but positively associated with unemployment rates (β = 0.01) highlighting the need to address population growth, as well as other variables in a population.ConclusionsThere seems to be a positive relationship among population change and rates of STIs. As populations change, rates of STIs change. Moving forward, quantitative work should be conducted in various states and the nation to understand this relationship in different contexts. Future studies should be qualitative word focused on county health departments and community health improvement plans. Lastly, public policy should be implemented to buffer the impact of migration on health outcomes.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study.

Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention. This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted. Local public health departments in a US Midwestern state participated in the project. Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews. Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement. Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants. Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans. Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.

Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize?

This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. State and local health departments. Nationally representative population of state and local governmental public health workers. Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.

How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity.

Introduction:Healthy People establishes national goals and specific measurable objectives to improve the health and well-being of the nation. An overarching goal of Healthy People 2030 is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.” To inform Healthy People 2030 health equity and health disparities content and products, the US Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with NORC at the University of Chicago, conducted a review of peer-reviewed and gray literature to examine how health equity is defined, conceptualized, and measured by public health professionals.Methods:We reviewed (1) peer-reviewed literature, (2) HHS and other public health organization Web sites, and (3) state and territorial health department plans. We also conducted targeted searches of the gray literature to identify tools and recommendations for measuring health equity.Results:While definitions of health equity identified in the scan varied, they often addressed similar concepts, including “highest level of health for all people,” “opportunity for all,” and “absence of disparities.” Measuring health equity is challenging; however, strategies to measure and track progress toward health equity have emerged. There are a range of tools and resources that have the potential to help decision makers address health equity, such as health impact assessments, community health improvement plans, and adapting a Health in All Policies approach. Tools that visualize health equity data also support data-driven decision making.Discussion:Using similar language when discussing health equity will help align and advance efforts to improve health and well-being for all. Healthy People objectives, measures, and targets can help public health professionals advance health equity in their work. HHS ODPHP continues to develop Healthy People tools and resources to support public health professionals as they work with cross-sector partners to achieve health equity.

Can Mini Grant Programs Address Community Health Improvement Plans in Rural Areas? A Local Evaluation

Can Mini Grant Programs Address Community Health Improvement Plans in Rural Areas? A Local Evaluation

Results From a National Mixed-Methods Study Exploring Community Health Improvement Implementation: An Opportunity to Strengthen Public Health Systems Through Collective Action.

There are multiple calls for public health agency role and workforce transformation to increase capacity to orchestrate cross-sectoral partnerships that set and implement strategies addressing the structural and social determinants of health. Mobilizing for Action through Planning and Partnerships (MAPP) may be one tool for collective action to improve population health and equity. However, little is known about the Action Cycle in MAPP and implementation of resulting community health improvement plans. To explore the characteristics of MAPP users who completed the MAPP Action Cycle and factors that facilitated or inhibited implementation activities during this phase. We used a sequential participatory mixed-methods design involving 2 phases of data collection. The first data collection phase included a Web-based survey using Qualtrics. The second data collection phase included qualitative key-informant interviews and focus groups. A national public health and health care advisory group informed the evaluation throughout the entire process to ground the process in practice and experience. This study showed that some MAPP participants do not conduct implementation activities as defined by the MAPP Action Cycle and of those who do, implementation activity varies by participant experiences conducting MAPP and accreditation status. The MAPP users who completed 3 or more rounds of MAPP were more likely to align and integrate MAPP within their agencies as well as organize a collaborative implementation process with partners. More resources and skills in planning that facilitate long-range partnerships were noted as key to implementation. Opportunity remains to improve implementation in MAPP. National leaders should explore and build capacity and infrastructure within public health agencies and with their partners to create a system of readiness and an infrastructure that support implementation over time.

Assessing Local Public Health Agency Alignment With Public Health 3.0: A Content Analysis of Illinois Community Health Improvement Plans.

Public Health 3.0 described the need for public health agencies and the public health workforce to transform and obtain new skills and approaches to address the social determinants of health (SDOH) through cross-sectoral partnerships and collective action. To assess the current state of local health departments' Public Health 3.0 alignment through interventions and initiatives documented in community health improvement plans (CHIPs). We conducted a content analysis of Illinois CHIPs from July to November 2020. A coding framework aligned with Public Health 3.0 concepts was developed on the basis of constructs from the literature, faculty expertise, and preliminary reviews of the CHIPs. Two researchers deductively coded for health priorities and interventions in Microsoft Excel 2016 and calculated the number of CHIPs in which each code appeared. Ninety CHIPs representing 98 counties across the state were analyzed; 2 CHIPs were excluded because of a lack of strategies. Our content analysis found that 13% (n = 12) of CHIPs had explicit priorities related to SDOH and 12% (n = 11) included interventions that addressed socioeconomic factors. Ten percent (n = 9) of CHIPs proposed multilevel multicomponent interventions. Eighty-nine percent (n = 80) of CHIPs included community-level interventions, and 53% (n = 48) of CHIPs included policy, systems, and environmental strategies focused on specific health content. The majority of CHIPs (96%; n = 86) had at least 1 partnership strategy. Thirty-two percent (n = 29) of CHIPs mentioned the use of an evidence-based strategy. Our content analysis found opportunities to improve Illinois public health agencies' Public Health 3.0 capacities and capability. Findings are limited to this data source and definitions of the Public Health 3.0 attributes, leaving room for practice and research opportunities to develop operational definitions of Public Health 3.0; capacity building to improve the public health workforce readiness; and research and evaluation to measure improvements.

Community Health Improvement Plans: An Analysis of Approaches Used by Local Health Departments.

The Public Health Accreditation Board requires accredited local health departments (LHDs) to complete community health improvement plans (CHIPs). Evidence suggests that participatory planning frameworks, cross-sector collaboration, social determinants of health (SDOHs), and steering organizations are integral to effective public health planning. However, little is known about the degree to which LHDs incorporate these aspects during the CHIP process. To describe the use of planning methods, SDOHs, cross-sector partnerships, and steering organizations during the CHIP development process among nationally accredited LHDs and to identify whether LHD jurisdictional size or region is associated with differences in use. The most recent CHIPs from 93% of all nationally accredited LHDs (n = 195) were qualitatively reviewed and numerically coded for each of the planning components to calculate frequency and degree of use. Differences in use of each component by LHDs' jurisdictional size and region were tested using the chi-square test. Use of CHIP planning frameworks, SDOH inclusion, cross-sector partnerships, and steering organizations. One-half of LHDs (53%) reported use of Mobilizing for Action through Planning and Partnerships, but nearly one-fourth of LHDs did not use any planning framework. LHDs with a large jurisdictional size (>500 000) were significantly more likely to include SDOHs to a high degree than LHDs with mid- (100 000-499 999) to small- (<99 999) jurisdictional size (P < .01). Similarly, large LHDs were more likely to include cross-sector partners except for the category community members, which were rarely (10%) included. Mid-sized LHDs were more likely to lead the CHIP steering committee (61%) than small (29%) and large (9%) LHDs (P < .01). Differences in use of the 4 components by region were less significant. Jurisdictional size, rather than region, was more strongly associated with LHD approaches to CHIP development. More studies are needed to determine how differences influence CHIP implementation and impact.

Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans.

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.

Partnering on the Social Determinants of Health With the Community Health Improvement Matrix.

The research goal was to describe local health department community health improvement plans and hospital implementation strategies, assessing the extent to which they address the social determinants of health. In 2014, we used a grounded theory approach to conceptualize the extent of social determinant efforts in a purposive sample of improvement plans and implementation strategies (N = 12) taken from the community health assessment database pilot project (N = 502). We developed the Community Health Improvement Matrix (CHIM), categorizing public health activities according to target and prevention levels. In 2016, we surveyed NACCHO's Performance Improvement Workgroup (N = 9) using CHIM categories. In 2017, we tested the interrater reliability of the CHIM through an analysis of stories in 30 states (N = 101). We shared the CHIM in conferences, trainings, and focused conversations. The CHIM provides a framework for local public health partners to work together to address social determinants.

Hospital Collaboration with Local Health Departments on Community Health Improvement Activities: Is the Whole More Effective Than the Sum of Its Parts?

We examined the effect of nonprofit hospital (NFP) and local health department (LHD) collaboration in local health planning on drug‐induced mortality. NFPs must provide certain types of community benefit (CB) in order to keep their tax‐exempt status. The IRS reported that NFPs spent over $60 billion on CB activities in 2011. Despite the magnitude of spending, there is little evidence as to whether this spending leads to tangible improvements in population health. Traditionally, NFPs dedicated most of their CB dollars to charity care, health professions education, and research. While these areas of spending are beneficial to the community, they represent a partial fulfillment of the CB requirement per the IRS. NFPs are also expected to improve the overall health of the communities they serve by providing health care and prevention activities outside its four walls. Section 9007 of the PPACA, part of the IRS CB requirement, is a regulatory approach that steers NFPs toward providing community health activities that fall outside its acute care focus. It required NFPs to submit a triennial community health needs assessment (CHNA) and an implementation strategy. A few states have leveraged Section 9007 to encourage collaboration between NFPs and LHDs. New York (NY) is the only state that has required NFPs and LHD to collaborate on all three of the following key local health planning activities: CHNA, joint selection of health priorities, and joint implementation of initiatives to address health priorities.We estimated a difference‐in‐differences model using hospital and county data collected before and after hospitals targeted drug use in their community health improvement implementation strategy in 2013. We used robust standard errors clustered on county to calculate the p‐value. As a robustness check, we also used permutation tests to calculate the p‐value. We implemented several sensitivity and falsification tests. The study’s outcome is county‐level drug‐induced mortality per 100,000 residents.Our sample included 220 counties of which 22 were in NY and 198 were control counties.We found that NY’s requirement to collaborate on all three local health planning activities led to a decrease in drug‐induced mortality of approximately 7 deaths per 100,000 population compared with hospitals that did not collaborate with local health departments. This represents a 35% decrease in drug‐induced mortality rate based on the 2016 US national rate.Our findings support the hypothesis that the NY policy, with its requirement for NFP and LHD collaboration, is associated with a decrease in drug‐induced mortality when drug use is jointly prioritized. The requirement for NFP and LHD collaboration is the cornerstone of the NY policy.This finding may be of particular relevance to states that are moving in a similar direction as NY; for instance, Maryland’s Local Health Improvement Coalitions and Maine’s Shared Community Health Needs Assessment. Ohio recently enacted regulation that is virtually identical to NY which mandated all hospitals to collaborate with their LHDs on community health assessment and improvement plans by 2020. Moving forward, it will be key to monitor whether these states experience a similar effect as observed in NY.Agency for Healthcare Research and Quality.

Healthy Eating Policy Strategies in Community Health Improvement Plans: A Cross-Sectional Survey of US Local Health Departments.

Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy food environments are included in CHIPs nationally and relationships between LHD characteristics and participation in plans including such policies. To determine the proportion of US LHDs who participated in development of a CHIP containing healthy eating policy strategies and assess the association between LHD characteristics and inclusion of any healthy eating policy strategy in a CHIP. A cross-sectional national probability survey. Of the 209 US LHDs (serving populations <500 000) (response rate: 30.2%), 176 LHDs with complete data on CHIP status, outcomes, and covariates were eligible for analysis. Thirteen healthy eating policy strategies were organized into 3 categories: increasing availability/identification of healthy foods, reducing access to unhealthy foods, and improving school food environments. Strategies and categories were identified from literature and public health recommendations. In total, 32.2% of LHDs reported inclusion of 1 or more healthy eating policy strategies in a CHIP. The proportion of departments reporting specific strategies ranged from 20.8% for school district policies to 1.1% for sugar-sweetened beverage taxes. Local health departments serving 25 000 to 49 999 residents (odds ratio [OR]: 5.00; 95% confidence interval [CI]: 1.71-14.63), 100 000 to 499 999 residents (OR: 3.66; 95% CI: 1.12-11.95), pursuing national accreditation (OR: 4.46; 95% CI: 1.83-10.83), or accredited (OR: 3.22; 95% CI: 1.08-9.63) were more likely to include 1 or more healthy eating policy strategies in a CHIP than smaller LHDs (<25 000) and LHDs not seeking accreditation, respectively, after adjusting for covariates. Few LHDs serving less than 500 000 residents reported CHIPs that included a policy-based approach to improve food environments, indicating room for improvement. Population size served and accreditation may affect LHD policy engagement to enhance local food environments.

Erratum: Sreedhara et al (2019).

In the article M Sreedhara, K Valentine Goins, C Frisard, MC Rosal, SC Lemon. Stepping up active transportation in community health improvement plans: Findings from a national probability survey of local health departments. J Phys Act Health. 2019;16(9):772-779, https://doi.org/10.1123/jpah.2018-0623, the copyright was assigned to Human Kinetics, Inc. The authors subsequently obtained Open Access distributed under the terms of the Creative Commons Attribution License CC BY NC ND 4.0, which reverted copyright back to the authors. This online version of this article has been corrected.

Stepping Up Active Transportation in Community Health Improvement Plans: Findings From a National Probability Survey of Local Health Departments.

Local health departments (LHDs) are increasingly involved in Community Health Improvement Plans (CHIPs), a collaborative planning process that represents an opportunity for prioritizing physical activity. We determined the proportion of LHDs reporting active transportation strategies in CHIPs and associations between LHD characteristics and such strategies. A national probability survey of US LHDs (<500,000 residents; 30.2% response rate) was conducted in 2017 (n = 162). LHDs reported the inclusion of 8 active transportation strategies in a CHIP. We calculated the proportion of LHDs reporting each strategy. Multivariate logistic regression models determined the associations between LHD characteristics and inclusion of strategies in a CHIP. Inverse probability weights were applied for each stratum. 45.6% of US LHDs reported participating in a CHIP with ≥1 active transportation strategy. Proportions for specific strategies ranged from 22.3% (Safe Routes to School) to 4.1% (Transit-Oriented Development). Achieving national accreditation (odds ratio [OR] = 3.67; 95% confidence interval [CI], 1.11-12.05), pursuing accreditation (OR = 3.40; 95% CI, 1.25-9.22), using credible resources (OR = 5.25; 95% CI, 1.77-15.56), and collaborating on a Community Health Assessment (OR = 4.48; 95% CI, 1.23-16.29) were associated with including a strategy in a CHIP after adjusting for covariates. CHIPs are untapped tools, but national accreditation, using credible resources, and Community Health Assessment collaboration may support strategic planning efforts to improve physical activity.