Local Health Departments Characteristics Research Articles

Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities.

Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources. To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics. The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures. LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities-had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers. Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.

THE ROAD MAP STRATEGIST INITIATIVE: A NATIONWIDE EFFORT TO BUILD LOCAL PUBLIC HEALTH CAPACITY ON DEMENTIA

Abstract The Road Map Strategist Initiative is a nationwide effort to build local health department (LHD) capacity to address cognitive health and dementia. Through a collaboration between the Alzheimer’s Association and the National Association of County and City Health Officials (NACCHO), the initiative aims to make policy, systems, and environmental change, with a focus on health equity. Participating health departments receive funding, training, and technical assistance to establish a part-time Healthy Brain Initiative (HBI) Road Map Strategist, a public health professional serving as a system change agent. With support and education from the program sponsors, Road Map Strategists conduct a community health needs assessment, train LHD staff and leadership, and collaborate with community partners to implement and accelerate public health actions on dementia. Actions taken by the Road Map Strategists are informed by the Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia, The 2018-2023 Road Map. Presenters will share lessons learned from the first cohort of eight (8) LHDs during each stage of the initiative, with a focus on approaches used for Road Map implementation efforts in their communities. This session will share evaluation findings on successes and barriers for changing health department capacity to support local dementia efforts. Data from key indicators related to knowledge gain and capacity change will be shared, including the way LHD characteristics influenced success. The session will also cover effective approaches toward advancing health equity in dementia in local communities and plans for future iterations of the initiative.

United States local health department engagement in activities that support active transportation considerations in land use and transportation policies: Results of a national survey

Active transportation by walking or biking can improve health and quality of life. Public health official participation in transportation and land use policy-related decision-making is recommended to improve opportunities for active transportation. However, United States local health department (LHD) engagement in activities that support this decision-making is not well understood. The purpose of this study was to describe engagement in activities that support inclusion of active transportation in transportation and land use decision-making among small and midsize LHDs, identify LHD characteristics associated with engagement, and describe interest in training activities to increase engagement. Data are from a 2017 national probability cross-sectional survey of United States LHDs serving fewer than 500,000 residents that assessed departmental engagement in eleven activities related to ten cross-cutting capabilities that support engagement in transportation and land use decision-making (30.2% response rate). Negative binomial regression of 183 LHDs with complete data determined the relationship between LHD characteristics and engagement in activities. Survey weights were applied to generate nationally representative statistics. LHDs reported their engagement in eleven activities that support active transportation in land use and transportation decision-making as a major responsibility, secondary responsibility, or neither. Responses were summed to generate a score. LHDs reporting major responsibility varied by activity and ranged from 8.6% for data and assessment to 32.7% for public outreach to community. The distribution of engagement scores was skewed (mean = 6.2, variance = 34.7). Larger population size served, any staff working on active transportation issues, and contracting with an individual/organization on active transportation were significantly associated with greater engagement in activities related to land use and transportation decision-making that support active transportation. High interest in training or technical assistance for activities ranged from 12.2% for dedicated staffing to 42.8% for public outreach to community. These data demonstrate room for improvement in activities and capabilities supportive of active transportation in land use and transportation decision-making and modest but promising interest in assistance for greater engagement among LHDs.

Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards.

Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement. This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics. Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review. We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results. The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county. Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.

Training Networks of Local Health Departments: A Regional Assessment.

The public health system faces major challenges in 2020, including an aging workforce, reductions in funding, and 2 simultaneous major threats to public health-the coronavirus pandemic and racial injustice. To effectively harness promising new technologies and address these and other public health challenges ahead, public health professionals must be trained on evidence-based practices for protecting and improving public health. This project sought to understand the network of health departments and organizations that provide training in order to inform strategic efforts to fill training gaps and improve access to training for local health departments (LHDs), thereby strengthening the public health system. We conducted a Web-based survey of 501 LHDs in the 6 states constituting Region V of the Department of Health & Human Services. The survey focused on the training relationship between LHDs and state and national organizations that provide public health training, allowing for a social network analysis. We used data visualization and descriptive statistics to examine the network. Of 290 participating health departments (58% response rate), 248 had monthly or more frequent contact with at least 1 organization for the purpose of training. Altogether, the 248 LHDs were connected to 47 state-level organizations and 10 national-level organizations. In 5 of 6 states, more LHDs were connected to the state health department for training than to any other organization type. Universities, national nonprofits, and national membership organizations provided training to the fewest LHDs. Local health department characteristics did not have a clear relationship with its number of training connections. State health departments may benefit from the support of universities, national nonprofits, and national membership organizations by partnering to offer training or by recommending training from these organizations to LHDs. Additional qualitative information from local and state health departments would be useful to determine the best strategies for universities, national nonprofits, and national membership organizations to participate in training local practitioners to improve LHD capacity.

Patterns of Cross-Sector Collaboration in Local Health Departments: A Cluster Analysis.

Local health departments (LHDs) are positioned to act as the community health strategist for their catchment area, which requires cross-sector collaboration. However, little research exists to understand how much and what types of cross-sector collaboration occur and its impact on LHD practice. Data from 490 LHDs who participated in the 2016 National Profile of Local Health Departments survey were analyzed to identify patterns of cross-sector collaboration among LHDs. In the survey, LHDs reported the presence of collaborative activities for each of 22 categories of organizations. Factor analysis was used to identify patterns in the types of organizations with which LHDs collaborate. Then, cluster analysis was conducted to identify patterns in the types of cross-sector collaboration, and cross-sectional analyses examined which LHD characteristics were associated with cluster assignment. LHDs collaborated most with traditional health care-oriented organizations, but less often with organizations focused on upstream determinants of health such as housing. Three distinct clusters represented collaboration patterns in LHDs: coordinators, networkers, and low-collaborators. LHDs who were low-collaborators were more likely to serve smaller populations, be unaccredited, have a smaller workforce, have a White top executive, and have a top executive without a graduate degree. These findings imply that public health practitioners should prioritize building bridges to a variety of organizations and engage in collaboration beyond information sharing. Furthermore, LHDs should prioritize accreditation and workforce development activities for supporting cross-sector collaboration. With these investments, the public health system can better address the social and structural determinants of health and promote health equity.

Local Health Department Interest in Implementation of a Jail-Based Human Papillomavirus Vaccination Program in Kansas, Iowa, Missouri, and Nebraska.

Local health departments (LHDs) play a vital role in community vaccination programs for human papillomavirus (HPV) infection, but little research has been done to assess LHD interest in cross-sectoral partnerships to vaccinate high-risk groups, specifically incarcerated persons. To describe factors associated with interest in a novel implementation strategy linking LHDs with jails in 4 Midwestern states to deliver HPV vaccine. Survey based on the Consolidated Framework for Implementation Research (CFIR) model given to LHD administrators. A modified Poisson relative risk regression was used to assess the relationship between independent variables and LHD interest in implementation of a jail-based HPV vaccination program. LHDs in Kansas, Missouri, Iowa, and Nebraska. From September 2017 to April 2018, two-thirds (237/344) of invited LHD administrators from the 4 states responded to the survey. LHD interest in implementation of a jail-based HPV vaccination program. Forty-five percent of LHDs were interested in learning more about implementing a jail-based HPV vaccination program, and 2% already offered or had plans to offer HPV vaccine in their jails. Barriers to implementation were cost (66%), inmates' short incarcerations (47%), and availability of medical staffing (43%). LHD characteristics associated with interest in implementation of a jail-based HPV vaccination program included "inner setting" CFIR variables, which capture the structural and cultural context for program implementation: 7 or more employees (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.24-3.95), perception of importance to provide HPV vaccine in jails (OR = 3.70; 95% CI, 2.00-6.84), and already providing any vaccines in jails (OR = 2.62; 95% CI, 1.18-5.80). Nearly half of LHDs in the region expressed interest in partnering with local entities to meet HPV vaccination needs of high-risk groups. Research on cross-sectoral partnerships and what these collaborations look like in practice is needed for public health impact.

Fighting obesity at the local level? An analysis of predictors of local health departments' policy involvement

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.

Performance and Priorities: A Cross-sectional Study of Local Health Department Approaches to Essential Public Health Services.

Despite a push for increased local public health capacity, no clear baseline for performance of local health departments (LHDs) exists. The objectives of this study were to quantify the self-reported performance of LHDs on the 10 Essential Public Health Services (EPHSs) and describe the relationships between performance and characteristics of LHDs. We used data on 2000 LHDs from the 2013 National Profile of Local Health Departments survey to develop principal components analysis-based scores to evaluate each LHD on the performance of EPHSs. Scores ranged from 0 to 100. LHDs that performed no activities within an EPHS had a score of 0, and LHDs that performed all activities within an EPHS had a score of 100. We explored the relationships between EPHS scores and LHD characteristics by using multivariate linear regression and cluster analysis. Performance scores varied greatly by LHDs and EPHSs; however, LHDs typically scored <50, indicating that they performed fewer than half of the activities evaluated. LHDs that served larger populations (vs smaller populations) and LHDs that had higher per-capita funding (vs lower per-capita funding) had higher EPHS scores. We identified 6 EPHS performance score-based LHD clusters, which suggests similarities in which EPHSs LHDs focused on. Our results suggest weaknesses in many LHDs' fulfillment of the EPHSs, particularly in low-population and low-funding settings. LHDs should be given the resources to increase capacity and ensure the EPHSs are met in communities.

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.

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.

Barriers and Facilitators to Collaboration Between Local Health Departments and Schools and Programs of Public Health – A Mixed-Methods Study

Collaboration between local health departments (LHDs) and schools and programs of public health (SPPH) have potential to improve public health practice, education and research. However, little is known about the barriers and facilitators to LHD and SPPH collaboration. The purpose of this paper is to identify and explore factors that affect the level of collaboration between LHDs and SPPH. A mixed-methods study was used. LHD characteristics associated with the degree of collaboration with SPPH were identified thorough a survey, and these and other factors were explored through group interviews with LHD practitioners and faculty from SPPH. Proximity, community size, organizational capacity, and goal and process clarity were all found to influence the degree of collaboration. This study highlights needs and opportunities for expanding collaboration between LHDs and SPPH.

Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA

ObjectiveThe nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently...

Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs.

The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.

Facilitating Partnerships With Community- and Faith-Based Organizations for Disaster Preparedness and Response: Results of a National Survey of Public Health Departments.

We identify characteristics of local health departments, which enhance collaborations with community- and faith-based organizations (CFBOs) for emergency preparedness and response. Online survey data were collected from a sample of 273 disaster preparedness coordinators working at local health departments across the United States between August and December 2011. Using multiple linear regression models, we found that perceptions of CFBO trust were associated with more successful partnership planning (β=0.63; P=0.02) and capacity building (β=0.61; P=0.01). Employee layoffs in the past 3 years (β=0.41; P=0.001) and urban location (β=0.41; P=0.005) were positively associated with higher ratings of resource sharing between health agencies and CFBOs. Having 1-3 full-time employees increased the ratings of success in communication and outreach activities compared with health departments having less than 1 full-time employee (β=0.33; P=0.05). Positive attitudes toward CFBOs also enhanced communication and outreach (β=0.16; P=0.03). Staff-capacity factors are important for quick dissemination of information and resources needed to address emerging threats. Building the trust of CFBOs can help address large-scale disasters by improving the success of more involved activities that integrate the CFBO into emergency plans and operations of the health department and that better align with federal-funding performance measures. (Disaster Med Public Health Preparedness. 2018;12:57-66).

Local Health Departments Tweeting About Ebola: Characteristics and Messaging.

The first imported US Ebola hemorrhagic fever case during the 2014 West Africa Ebola outbreak triggered an increase in online activity through various social media platforms, including Twitter. The purpose of our study was to examine characteristics of local health departments (LHDs) tweeting about Ebola, in addition to how and when LHDs were communicating Ebola-related messages. All tweets sent by 287 LHDs known to be using Twitter were collected from September 3 to November 2, 2014. Twitter data were merged with the 2013 National Association of County & City Health Officials Profile study to assess LHD characteristics associated with sending Ebola-related tweets. To examine the content of Ebola tweets, we reviewed all such tweets and developed a codebook including 4 major message categories: information giving, news update, event promotion, and preparedness. A time line tracking the trends in Ebola tweets was created by aligning daily tweets with major Ebola news events posted on the Centers for Disease Control and Prevention Ebola Web site. Approximately 60% (n = 174) of all LHDs using Twitter sent a total of 1648 Ebola-related tweets during the study period. Sending more tweets in general (odds ratio: 2.42; 95% confidence interval, 1.00-5.84) and employing at least 1 public information specialist (odds ratio: 2.61; 95% confidence interval, 1.14-5.95) significantly increased the odds that an LHD tweeted about Ebola. Of all the Ebola tweets collected, 78.6% were information giving, 22.5% were on preparedness, 20.8% were news updates, and 10.3% were event promotion tweets. A temporal analysis of Ebola tweets indicated 5 distinct waves, each corresponding with major Ebola news events. Twitter has become a communication tool frequently used by many LHDs to respond to novel outbreaks, but messaging strategies vary widely across LHDs. We recommend that LHDs increase tweet frequency during public health emergencies in order to ensure timely dissemination of critical information.

Electronic Health Records and Meaningful Use in Local Health Departments: Updates From the 2015 NACCHO Informatics Assessment Survey.

Electronic health records (EHRs) are evolving the scope of operations, practices, and outcomes of population health in the United States. Local health departments (LHDs) need adequate health informatics capacities to handle the quantity and quality of population health data. The purpose of this study was to gain an updated view using the most recent data to identify the primary storage of clinical data, status of data for meaningful use, and characteristics associated with the implementation of EHRs in LHDs. Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, which used a stratified random sampling design of LHD populations. Oversampling of larger LHDs was conducted and sampling weights were applied. Data were analyzed using descriptive statistics and logistic regression in SPSS. Forty-two percent of LHDs indicated the use of an EHR system compared with 58% that use a non-EHR system for the storage of primary health data. Seventy-one percent of LHDs had reviewed some or all of the current systems to determine whether they needed to be improved or replaced, whereas only 6% formally conducted a readiness assessment for health information exchange. Twenty-seven percent of the LHDs had conducted informatics training within the past 12 months. LHD characteristics statistically associated with having an EHR system were having state or centralized governance, not having created a strategic plan related to informatics within the past 2 years throughout LHDs, provided informatics training in the past 12 months, and various levels of control over decisions regarding hardware allocation or acquisition, software selection, software support, and information technology budget allocation. A focus on EHR implementation in public health is pertinent to examining the impact of public health programming and interventions for the positive change in population health.

Health Departments' Engagement in Emergency Preparedness Activities: The Influence of Health Informatics Capacity.

Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs' informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved emergency preparedness. We used the 2013 National Profile of LHDs study to perform Poisson regression of emergency preparedness activities. Only 38.3% of LHDs participated in full-scale exercises or drills for an emergency in the 12 months period prior to the survey, but a much larger proportion provided emergency preparedness training to staff (84.3%), and/or participated in tabletop exercises (76.4%). Our multivariable analysis showed that after adjusting for several resource-related LHD characteristics, LHDs with more of the 6 information systems still tend to have slightly more preparedness activities. In addition, having a designated emergency preparedness coordinator, and having one or more emergency preparedness staff were among the most significant factors associated with LHDs performing more emergency preparedness activities. LHDs might want to utilize better health information systems and information technology tools to improve their activity level in emergency preparedness, through improved information dissemination, and evidence collection.

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.

Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.

Cross-Jurisdictional Resource Sharing in Changing Public Health Landscape

Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environment. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency. This research examines the extent of cross-jurisdictional resource sharing among LHDs, the programmatic areas and organizational functions for which LHDs share resources, and LHD characteristics associated with resource sharing. Data from the National Association of County & City Health Officials' 2013 National Profile of LHDs were used. Descriptive statistics and multinomial logistic regression were performed for the 5 implementation-oriented outcome variables of interest, with 3 levels of implementation. More than 54% of LHDs shared resources such as funding, staff, or equipment with 1 or more other LHDs on a continuous, recurring basis. Results from the multinomial regression analysis indicate that economies of scale (population size and metropolitan status) had significant positive influences (at P ≤ .05) on resource sharing. Engagement in accreditation, community health assessment, community health improvement planning, quality improvement, and use of the Community Guide were associated with lower levels of engagement in resource sharing. Doctoral degree of the top executive and having 1 or more local boards of health carried a positive influence on resource sharing. Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.