Local Health Department Activities Research Articles

The Cost of Providing the Foundational Public Health Services in Ohio.

To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre-COVID-19. Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019. Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans. In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre-COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state. A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.

An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship Behaviors

Introduction:Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors.Study design:This longitudinal, cluster-RCT compared the effectiveness of Dating Matters with standard of care across middle school. Standard of care was an evidence-based teen dating violence prevention curriculum (Safe Dates) implemented in eighth grade.Setting/participants:Forty-six middle schools in high-risk urban neighborhoods in four U.S. cities were randomized. Schools lost to follow-up were replaced with new schools, which were independently randomized (71% school retention). Students were surveyed in fall and spring of sixth, seventh, and eighth grades (2012–2016). The analysis sample includes students from schools implementing Dating Matters or standard of care for >2 years who started sixth grade in the fall of 2012 or 2013 and had dated (N=2,349 students, mean age 12 years, 49% female, and 55% black, non-Hispanic, 28% Hispanic, 17% other).Intervention:Dating Matters is a comprehensive, multicomponent prevention model including classroom-delivered programs for sixth to eighth graders, training for parents of sixth to eighth graders, educator training, a youth communications program, and local health department activities to assess capacity and track teen dating violence–related policy and data.Main outcome measures:Self-reported teen dating violence perpetration and victimization, use of negative conflict resolution strategies, and positive relationship skills were examined as outcomes. Imputation and analyses were conducted in 2017.Results:Latent panel models demonstrated significant program effects for three of four outcomes; Dating Matters students reported 8.43% lower teen dating violence perpetration, 9.78% lower teen dating violence victimization, and 5.52% lower use of negative conflict resolution strategies, on average across time points and cohorts, than standard of care students. There were no significant effects on positive relationship behaviors.Conclusions:Dating Matters demonstrates comparative effectiveness, through middle school, for reducing unhealthy relationship behaviors, such as teen dating violence and use of negative conflict resolution strategies, relative to the standard of care intervention.Trial registration:This study is registered at www.clinicaltrials.gov .

Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders.

The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions.

Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations. Employing the linked data sets of the 2012-2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care-sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016-August 2017. Multilevel regression showed that local health departments' provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care-sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments' direct provision of mental health preventive care could reduce 9% of the racial disparities. Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.

State and Local Health Department Activities Related to Abortion: A Web Site Content Analysis.

Context:Recent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged.Objective:To systematically investigate health department activities related to abortion.Methods:We searched state health department Web sites of the 50 states and District of Columbia using key words such as “abortion” and “pregnancy termination”. Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents.Setting:State and local health department Web sites.Participants:N/A.Results:On average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities.Conclusions:While most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.

Factors Perceived as Influencing Local Health Department Involvement in Mental Health.

Local health departments (LHDs) are potentially well positioned to implement population-based approaches to mental health promotion, but research indicates that most LHDs are not substantively engaged in activities to address mental health. Little is known about factors that influence if and how LHDs address population mental health. The objectives of this qualitative study were to (1) understand how LHD officials perceive population mental health; (2) identify factors that influence these perceptions and LHD activities to address population mental health; and (3) develop an empirically derived conceptual framework of LHD engagement in population mental health. Twenty-one semi-structured interviews were conducted with a purposive sample of LHD officials and analyzed using thematic content analysis in 2014-2015. Transcripts were double coded, inter-rater reliability statistics were calculated, and categories with κ ≥0.60 were retained. Respondents perceived mental health as a public health issue and expressed that it has emerged as a priority through community health needs assessment processes, such as those conducted for health department accreditation. However, most LHDs were not substantively engaged in population mental health activities because of limited resources, knowledge, data, and hesitancy to infringe upon the territory of local behavioral health agencies. LHDs and local behavioral health agencies had difficulty communicating and collaborating because of divergent perspectives and financing arrangements. LHD officials are eager to embrace population mental health, but resources, training and education, and systems-level changes are needed. Contemporary reforms to the structure and financing of the U.S. health system offer opportunities to address these challenges.

Implementation of Oral and Rectal Gonococcal and Chlamydial Nucleic Acid Amplification-Based Testing as a Component of Local Health Department Activities.

From January 1, 2014, to May 31, 2015, 452 individuals received extragenital nucleic acid amplification-based Neisseria gonorrhoeae and Chlamydia trachomatis testing through public health venues. Seventy-four individuals (16%) tested positive for Neisseria gonorrhoeae and/or Chlamydia trachomatis at an extragenital site and 40 (54%) would not have been effectively diagnosed and treated in the absence of extragenital testing.

Prevalence and correlates of local health department activities to address mental health in the United States

Mental health has been recognized as a public health priority for nearly a century. Little is known, however, about what local health departments (LHDs) do to address the mental health needs of the populations they serve. Using data from the 2013 National Profile of Local Health Departments – a nationally representative survey of LHDs in the United States (N=505) – we characterized LHDs' engagement in eight mental health activities, factors associated with engagement, and estimated the proportion of the U.S. population residing in jurisdictions where these activities were performed. We used Handler's framework of the measurement of public health systems to select variables and examined associations between LHD characteristics and engagement in mental health activities using bivariate analyses and multilevel, multivariate logistic regression. Assessing gaps in access to mental healthcare services (39.3%) and implementing strategies to improve access to mental healthcare services (32.8%) were the most common mental health activities performed. LHDs that provided mental healthcare services were significantly more likely to perform population-based mental illness prevention activities (adjusted odds ratio: 7.1; 95% CI: 5.1, 10.0) and engage in policy/advocacy activities to address mental health (AOR: 3.9; 95% CI: 2.7, 5.6). Our study suggests that many LHDs are engaged in activities to address mental health, ranging from healthcare services to population-based interventions, and that LHDs that provide healthcare services are more likely than others to perform mental health activities. These findings have implications as LHDs reconsider their roles in the era of the Patient Protection and Affordable Care Act and LHD accreditation.

Local Health Department Activities to Ensure Access to Care

Local health departments (LHDs) can play an important role in linking people to personal health services and ensuring the provision of health care when it is otherwise unavailable. However, the extent to which LHDs are involved in ensuring access to health care in its jurisdictions is not well known. To provide nationally representative estimates of LHD involvement in specific activities to ensure access to healthcare services and to assess their association with macro-environment/community and LHD capacity and process characteristics. Data used were from the 2010 National Profile of Local Health Departments Study, Area Resource Files, and the Association of State and Territorial Health Officials' 2010 Profile of State Public Health Agencies Survey. Data were analyzed in 2012. Approximately 66.0% of LHDs conducted activities to ensure access to medical care, 45.9% to dental care, and 32.0% to behavioral health care. About 28% of LHDs had not conducted activities to ensure access to health care in their jurisdictions in 2010. LHDs with higher per capita expenditures and larger jurisdiction population sizes were more likely to provide access to care services (p <0.05). There is substantial variation in LHD engagement in activities to ensure access to care. Differences in LHD capacity and the needs of the communities in which they are located may account for this variation. Further research is needed to determine whether this variation is associated with adverse population health outcomes.

Coordinating Research and Practice: Challenges Testing Messages to Increase Medical Reserve Corps Participation in Local Health Department Activities

Local health departments (LHDs) increasingly depend on volunteers, often Medical Reserve Corps (MRC) volunteers, to assist with a variety of functions. While LHDs have extensive lists of volunteers, only about 10% are actively involved in LHD activities. Psychological literature has shown that well-designed messages can motivate behavior among individuals. Key to this theory is the concept of "framing," defined as the influence the characterization of an issue can have on its understanding. Research has been conducted on how to frame and disseminate both political and public health messages to alter individual behavior. We aimed to design and test appropriate evidence-based messages to increase volunteer participation rates in LHD flu clinics. After inviting over 900 MRC units to participate during the 2011-2012 influenza season, five were able to collect and report data to the research team. Using a randomized trial design, we tested messages among the five participating MRC units consisting of a total of 2,020 volunteers. Chi Square analysis showed no difference in attendance between those who received either of the test messages versus the control message (p=.305). Our small sample size of MRC units likely biased our sample and reduced the external validity of our study. Our experience in conducting research with MRC coordinators and volunteers highlights the challenges of conducting research with practitioners who lack the time, infrastructure and resources necessary to work with researchers. There is a strong need for more supportive infrastructure for conducting research with practitioners.

Where is obesity prevention on the map?: distribution and predictors of local health department prevention activities in relation to county-level obesity prevalence in the United States.

The system of local health departments (LHDs) in the United States has the potential to advance a locally oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. This study examines the extent to which LHDs across the United States have responded to local levels of obesity by examining the association between jurisdiction-level obesity prevalence and the existence of obesity prevention programs. Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n = 2300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. Two thousand three hundred local health department jurisdictions defined with respect to county boundaries. Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. Likelihood of having obesity prevention activities and association with area-level obesity prevalence. The existence of obesity prevention activities was not associated with the prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. This article identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance.

Mapping the Multidisciplinary Field of Public Health Services and Systems Research

Public health services and systems research (PHSSR) is the field of study charged with evaluating the public health system. PHSSR currently lacks a clear identity integrating the many theories, approaches, and disciplines contributing to the field. Experts in PHSSR were consulted to identify 11 key published PHSSR studies. With these articles as a starting point, a newly developed citation data collection system was used to collect a sample of 2986 documents connected to the key articles through citation linkages. Data were collected in October 2009. Citation network methods and latent position cluster modeling were used to examine the network of documents. A subset of 108 documents comprising the backbone of the network was identified through main-path analysis. Four unique clusters were identified within the main path. The core cluster consisted of older articles focused on local health department activities, partnerships, and effectiveness. The three non-core clusters focused on public health law, behavioral interventions, and national performance standards. Although all non-core clusters cited the core, there was little crosstalk among the non-core clusters, a pattern consistent with multidisciplinary fields. PHSSR appears to be a multidisciplinary field with research happening in silos across different research areas. Developing transdisciplinary research connections across PHSSR is necessary to meet national PHSSR goals.

The Operational Definition of a Functional Local Public Health Agency

In 2002, the National Association of County and City Health Officials embarked on a quest to clarify, in a uniform way, the functions of governmental local public health agencies. Over the next 3 years, a diverse group of local health department officials and their partners developed an Operational Definition of a Functional Local Health Department, which included 45 standards matched to the 10 Essential Services. These standards serve as the first comprehensive and uniform articulation of local health department activities for which 250 prototype metrics have subsequently been developed. This article articulates the historical and policy significance of the Operational Definition, the methodological development of the recently published prototype metrics, and presents ideas for use of the metric tool especially in light of current accreditation and quality improvement initiatives.

Roles and opportunities for local health departments in managed care markets.

Managed care organizations (MCOs) are increasing their share of many local markets and are increasingly providing services to newly insured populations and Medicaid eligibles. Local health departments (LHDs) in these markets must determine what strategies they wish to pursue in this new health care environment. Possible roles are identified (from public health services only to a full range of services). LHDs are encouraged to use their strategic advantages to contract with MCOs to serve geographic, socioeconomic, and cultural populations that differ from those that MCOs are accustomed to serve. Accreditation guidelines of the National Committee for Quality Assurance are summarized and their relationship to LHD activities discussed.

Roles for State-Level Local Health Liaison Officials in Local Public Health Surveillance and Capacity Building

In 27 state health agencies, local health liaison units or officials (LHLOs) are formally assigned responsibility for fostering a close working relationship between the state health agency and local health departments (LHDs). Yet in most other states, other agency staff carry out these responsibilities informally. Even where formal LHLOs exist, the assigned functions and specific activities vary, with little consistency across states other than serving as a potential or, in most cases, a real and vital linkage between LHDs and the state agency. This linkage places the LHLO in a unique position to have extensive knowledge, data, and information on LHD activities and to play an important role in assessing and improving local public health practice. This report examines aspects of the LHLO-LHD relationship in terms of potential LHLO roles in LHD practice surveillance and capacity building. Surveys of LHLOs and LHDs indicate that both support the development of surveillance tools to measure LHD effectiveness as a means to enhance capacity building efforts. Although LHLOs may not know or have the specific information immediately available to assess local public health practice for LHDs in their state, they report being able to obtain the information if necessary and with sufficient time. Further, LHDs are willing to share information concerning local public health practice with their state health department, particularly with their state LHLO. These findings suggest that LHLOs could be extensively involved in surveillance strategies beyond merely collecting and aggregating information provided by LHDs.

Local Health Department Activities in Heart Disease Control

.,99 cable-disease control and their contributions to this effort have been well documented. Success in controlling communicable diseases stimulated interest in prevention, a concept recognized in ancient times but which required scientific knowledge to become a reality. A number of leaders in the late nineteenth and early twentieth centuries were urging that more attention be given to preventive medicine. Some recommended that the principles of prevention be applied to a broad range of diseases and conditions, including cancer, heart disease, nutritional deficiencies, and others (1). A number of years and much research were required, however, before this broadened application could occur. Even when the evidence was overwhelming that the chronic diseases deserved priority in public health practice, there was reluctance to expand beyond the basic functions which had come to be accepted for local health departments. Political decisions, attitude of the private sector, financial limitations, and lack of aggressiveness on the part of public health professionals were factors in this situation. In 1950 the American Public Health Association adopted the following policy statement on services and responsibilities oflocal health departments: "As a result of advancing medical knowledge and public health practice, there has been a sharp decrease in morbidity and mortality from infectious diseases, particularly in infancy and childhood and the early years of adult life. Because of the marked changes in the age distribution of the population and in the spectrum of our health problems, the theory and practice of public health has expanded to include not only prevention of

Should an occupational health program be included in local health department activities.

Should an Occupational Health Program Be Included in Local Health Department Activities William L. Wilson CopyRight https://doi.org/10.2105/AJPH.49.3.355 Published Online: August 29, 2011