Local Public Health Practitioners Research Articles

Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey.

Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).

Public Health Workforce Gaps, Impacts, and Improvement Strategies from COVID-19.

The public health workforce has been instrumental in protecting residents against population health threats. The COVID-19 pandemic has highlighted the importance of the public health workforce and exposed gaps in the workforce. Public health practitioners nationwide are still coming to understand these gaps, impacts, and lessons learned from the pandemic. This study aimed to explore Minnesota’s local public health practitioners’ perceptions of public health workforce gaps, the impacts of these workforce gaps, and the lessons learned in light of the COVID-19 pandemic. We conducted seven concurrent focus groups with members of the Local Public Health Association of Minnesota (LPHA; n = 55) using a semi-structured focus group guide and a survey of the local agencies (n = 70/72 respondents, 97% response rate). Focus group recordings were transcribed verbatim and analyzed using deductive and inductive coding (in vivo coding, descriptive coding), followed by thematic analysis. The quantitative data were analyzed using descriptive analyses and were integrated with the qualitative data. Participants indicated experiencing many workforce gaps, workforce gaps impacts, and described improvement strategies. Overall, many of the workforce gaps and impacts resulting from COVID-19 discussed by practitioners in Minnesota are observed in other areas across the nation, making the findings relevant to public health workforce nationally.

Increased pulmonary circulatory disease diagnosis risk associated with heatwave

Observational studies suggest that increased chronic obstructive pulmonary disease (COPD) risk is associated with prolonged, high ambient temperatures (i.e., heatwaves). Yet, reports of pulmonary circulatory disease (PCD) risk associated with heatwaves are elusive. Faced with evidence of a changing global climate, local public health practitioners must now assess disease risk associated with climate change phenomena in their communities. Determine the relative odds of pulmonary circulatory diagnosis among subjects admitted to hospital emergency departments (EDs) from 29 May 2012 to 3 August 2012 and subjects admitted to the ED during the same calendar days in 2011 in Douglas County, NE. A retrospective, observational, case-control design was used to estimate PCD diagnosis risk using conditional logistic regression. The estimated PCD diagnosis odds ratio was 4.35 (95% CI = 1.08 – 17.57). In Douglas County NE the risk of PCD diagnoses was higher in the ED population admitted from 28 May to 3 August 2012 than the ED population admitted during the same calendar days in 2011.

Mutation of Mycobacterium tuberculosis and Implications for Using Whole-Genome Sequencing for Investigating Recent Tuberculosis Transmission.

Tuberculosis (TB) control programs use whole-genome sequencing (WGS) of Mycobacterium tuberculosis (Mtb) for detecting and investigating TB case clusters. Existence of few genomic differences between Mtb isolates might indicate TB cases are the result of recent transmission. However, the variable and sometimes long duration of latent infection, combined with uncertainty in the Mtb mutation rate during latency, can complicate interpretation of WGS results. To estimate the association between infection duration and single nucleotide polymorphism (SNP) accumulation in the Mtb genome, we first analyzed pairwise SNP differences among TB cases from Los Angeles County, California, with strong epidemiologic links. We found that SNP distance alone was insufficient for concluding that cases are linked through recent transmission. Second, we describe a well-characterized cluster of TB cases in California to illustrate the role of genomic data in conclusions regarding recent transmission. Longer presumed latent periods were inconsistently associated with larger SNP differences. Our analyses suggest that WGS alone cannot be used to definitively determine that a case is attributable to recent transmission. Methods for integrating clinical, epidemiologic, and genomic data can guide conclusions regarding the likelihood of recent transmission, providing local public health practitioners with better tools for monitoring and investigating TB transmission.

Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation.

Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10728-021-00441-1.

1083-P: Diabetes and Social Determinants of Health: A Web-Based Interactive Module

Social determinants of health (SDoH), the conditions in which we live, learn, work, and play, have a profound impact on health and lead to health disparities in our communities. The Centers for Disease Control and Prevention (CDC) created an interactive SDoH module within the US Diabetes Surveillance System to explore these disparities in the context of diabetes burden and risk factors (Figure). The module was launched with the CDC Social Vulnerability Index (SVI), which was created to identify communities needing support during hazardous events. The index is composed of Census Bureau data on 15 variables, grouped into 4 themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. Percentile ranks are used to score areas from 0-1 on social vulnerability with 1 being the most vulnerable. SVI is available at the national level to compare counties across states and at the state level to compare counties within a state. In addition to SVI, CDC will scale this module to include other SDoH such as food insecurity, community walkability, and crime. Local, state, and federal public health practitioners may find this application useful for identifying disparities in SDoH and chronic disease and designing targeted interventions to reduce these disparities in the communities of greatest need. Disclosure S. R. Benoit: None. D. C. Shelton: None. Y. Wang: None. K. Batchu: None. K. M. Bullard: None. P. Cho: None. I. A. Hora: None. D. King: None. J. W. Reynolds: None. H. Xie: None. Y. Zhang: None. M. Aboneaaj: None.

Rapid Behavioral Health Assessment Post-disaster: Developing and Validating a Brief, Structured Module.

To develop and validate a brief, structured, behavioral health module for use by local public health practitioners to rapidly assess behavioral health needs in disaster settings. Data were collected through in-person, telephone, and web-based interviews of 101 individuals affected by Hurricanes Katrina (n = 44) and Sandy (n = 57) in New Orleans and New Jersey in April and May 2018, respectively. Questions included in the core module were selected based on convergent validity, internal consistency reliability, test–retest reliability across administration modes, principal component analysis (PCA), question comprehension, efficiency, accessibility, and use in population-based surveys. Almost all scales showed excellent internal consistency reliability (Cronbach’s alpha, 0.79–0.92), convergent validity (r > 0.61), and test–retest reliability (in-person vs. telephone, intra-class coefficient, ICC, 0.75–1.00; in-person vs. web-based ICC, 0.73–0.97). PCA of the behavioral health scales yielded two components to include in the module—mental health and substance use. The core module has 26 questions—including self-reported general health (1 question); symptoms of posttraumatic stress disorder, depression, and anxiety (Primary Care PTSD Screen, Patient Health Questionnaire-4; 8 questions); drinking and other substance use (Alcohol Use Disorders Identification Test-Concise, AUDIT-C; Drug Abuse Screening Test, DAST-10; stand-alone question regarding increased substance use since disaster; 14 questions); prior mental health conditions, treatment, and treatment disruption (3 questions)—and can be administered in 5–10 minutes through any mode. This flexible module allows practitioners to quickly evaluate behavioral health needs, effectively allocate resources, and appropriately target interventions to help promote recovery of disaster-affected communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10900-021-00966-5.

Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States.

Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States.

Participatory systems mapping for localised evidence and decision-making: helminth control, SSA

Abstract Background Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making. Methods We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts. Results Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented. Conclusions An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners. Key messages Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

Measurement of Social Processes at the Neighborhood Level in Baltimore City.

Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n=793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.

Using Preparedness Exercise Tools to Train Public Health Teams to Address Access and Functional Needs During Emergencies in Rural Appalachia.

Local public health agencies are a critical component of communities' ability to respond to and manage emergencies. This article outlines one public health agency's process for developing an all-inclusive, all-hazards public health plan to guide preparedness activities. The plan is interactive and searchable to enable it to be applied practically during an emergency. The new plan was developed using a collective action approach and is consistent with the whole community framework. It represents the perspectives of people with access and functional needs and better prepares local emergency management and response teams to anticipate these needs during emergencies. We created both a tabletop exercise and a full-scale exercise to train public health practitioners on the plan contents, as well as an exercise planning and implementation workbook that includes agendas, sample exercises, sample slides, and supporting documentation. These materials provide specific suggestions for supporting people with access and functional needs during emergency mitigation, preparedness, response, and recovery. In October 2017, more than 110 people participated in the tabletop exercise as part of the annual staff training at our local health department. One year later, we delivered a full-scale exercise. Nearly all relevant staff (95%) participated in both exercises, and 98% of participants reported that they had greater knowledge and resilience in mitigating and responding to public health emergencies as a result of their participation. We aim to include additional community members in future exercises to assure the plan meets everyone's needs. The current plan has increased the confidence level of local public health practitioners in responding to emergencies.

Trends of Early Marriage in Developing Countries: A Systematic Review

Background: Early marriage is being increasingly recognized globally as a fundamental violation of human rights and a major obstacle to sustainable development. Early marriage occurs globally to varying degrees, especially in developing countries. The purpose of this article was to identify the determinants and impact of early marriage in developing countries.Method: A systematic search for studies published from 2014 up to 2019 was conducted via Scopus, Proquest, Elsevier, Science Direct, Sage Journal, SpringerLink and EBSCO. A total of 10 studies met the inclusion criteria. These were independently extracted by two reviewers.Result: Education and place of residence were the most commonly studied determinants of early marriage. Only a few of them reported results concerning the age difference between the spouses, access to media information and self-efficiency. Early marriage has a relationship with both the mother's and child's health. However, the significance of these associations was often small or inconsistent.Conclusion: This review summarizes the best available evidence for local policymakers and public health practitioners so then they can consider incorporating these findings into the development of intervention protocols for the prevention of early marriage.

Acceptability and utilization of evidence for decision-making: helminth control, sub-Saharan Africa

Abstract Background Public health practitioners are part of a larger global health system, responsible for the implementation of disease-specific health interventions, largely financed by external actors through a variety of mechanisms. Emphasis on the need for evidence-informed decision-making often includes rhetoric for the localization of this approach to assist practitioners in resource allocation. In practice its realisation is challenging. This research addresses the following: what are the evidence needs of local public health practitioners? How acceptable are, for example, modeled disease estimates? What decision-making processes occur for implementation? How do evidence and decision-making processes interact? Methods Examining mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths (STH) in the African Great Lakes region (Kenya, Malawi, Tanzania and Uganda), we use qualitative approaches to collect data, including a series of 4 workshops with district- and national-level MoH personnel, key informant interviews and e-survey questionnaires from a sample of relevant local and global organisations including NGOs. Coded data are analysed thematically. Results Preliminary results provide important insights into the sources, types and format of evidence which local public health practitioners find acceptable and useful for decision-making when implementing disease control measures. Conclusions A variety of factors influence local level decision-making with implications for policy aimed at disease control, such as MDA for schistosomiasis and STH, and global health policy and practice more broadly. First, processes of decision-making at different localities are heterogenous and evidence needs of local practitioners are not well understood. Second, evidence development and knowledge synthesis on health interventions are rarely linked in ways that feedback and respond to local implementation, decision-making practices and public health practitioners. Key messages Evidence needs of local public health practitioners need to be accounted for when producing and synthesising evidence. Multiple factors influence local level decision-making with implications for public health disease control policy.

Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama.

Alabama's Maternal, Infant, and Early Childhood Home Visiting-funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Practice-Based Evidence Supporting Healthy Eating and Active Living Policy and Environmental Changes.

Policy and environmental strategies have been recommended as evidence-based strategies to improve opportunities for healthy eating and active living. A cohort of 6 coalitions in Colorado representing 5 communities was funded to implement policy and environmental strategies that support healthy eating and active living. Coalitions prioritized built environment to support active living and healthy food and beverage strategies. Built environment coalitions prioritized the adoption of policies and implementation of infrastructure enhancements to improve access to walking, biking, and other physical activity at the institutional, regional, county, and/or municipal levels. Healthy food and beverage coalitions aimed to support the consumption of healthy foods and beverages in government settings, hospitals, and other public venues via policy, practice, or procedural changes. Built environment coalitions implemented change at 61 sites by implementing 16 policies and plans and 44 environmental changes. Healthy food and beverage coalitions implemented changes at 66 sites by passing 31 policies and plans and 44 environmental and practice changes. It is estimated that more than 70 000 individuals were likely exposed to these policy and environmental changes. All community coalitions were successful in driving policy and environmental changes to promote healthy eating and active living. This program contributes to the practice-based evidence to demonstrate that with funding and resources, local public health coalitions and practitioners can drive policy and environmental changes in their communities. Providing funding to a dedicated coalition or group of partners can give coalitions the resources they need to drive these changes.

Health literacy, depression, and stress among Chinese immigrants in South Korea.

This study examined health literacy, depression, and stress in Chinese immigrants living in South Korea, and analyzed factors related to these outcomes. This is a cross-sectional, descriptive study. Participants were 128 adult Chinese immigrants living in the Jung-gu District of Seoul, South Korea. The majority of the participants were women and in their 40s; had a high school diploma; and were employed and married. Most had lived in Korea for 5-10years. Outcome variables were health literacy, depression, and immigrant stress; independent variables were sociodemographic characteristics, language proficiency, health, and behavioral factors. Hierarchical multiple regression models based on the conceptual framework were tested. The major factor influencing health literacy was perceived economic status (p=0.021). The factors related to depression were life satisfaction in China (p=0.032), life satisfaction in Korea (p=0.040), and stress perception in everyday life (p=0.001). As the number of immigrants rises, there is increasing demand for public-health-center-based health promotion programs for immigrants. It is recommended that local public health practitioners, including public health nurses, closely analyze the characteristics of their community and immigrants, and develop and implement customized programs accordingly.

A cross-country study of mis-implementation in public health practice

BackgroundMis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP).MethodsA cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue.ResultsWe found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program’s effectiveness or evidence-base—or lack thereof—were rarely reasons for program continuation and termination.ConclusionsDecisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.

Making a Living in Governmental Public Health: Variation in Earnings by Employee Characteristics and Work Setting.

This article examines factors related to earnings in the context of the governmental public health system's urgent need to recruit and retain trained public health workers as many in the existing workforce move toward retirement. This article characterizes annualized earnings from state and local public health practitioners in 2017, using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded in fall/winter 2017 to more than 100 000 state and local public health practitioners in the United States. The response consisted of 47 604 public health workers for a response rate of 48%.We performed descriptive statistics, bivariate analyses, and interval-based regression techniques to explore relationships between annualized earnings, supervisory status, gender, years of experience, highest degree (and whether it was a public health degree), job classification, race/ethnicity, union/bargaining unit, paid as salary or hourly wage, setting, and region. Higher supervisory status, higher educational attainment, white non-Hispanic race/ethnicity, male gender, salaried employment, bargaining unit (labor union) position, certain geographic regions, having a clinical/laboratory/other scientific position, and working in either a state health agency (SHA) or a large local health department (LHD) setting are all associated with higher salary. Having a public health degree versus a degree in another area did not appear to increase earnings. Being a person of color was associated with earning $4000 less annually than white peers (P < .001), all else being equal. The overall regression model showed a gender wage gap of about $3000 for women (P = .018). Supervisors, clinical and laboratory staff, public health sciences staff, and union staff also earned more than their counterparts. As multiple factors continue to shape the public health workforce, including increasing racial/ethnic diversity, continued retirements of baby boomers, and the growth of bachelor's-level public health education, researchers should continue to monitor the gender and racial/ethnic pay gaps. This information should help the field of governmental public health as it endeavors to rebuild its capacity while current workers, many at the highest level of leadership, move on to retirement or other jobs. Public health leaders must prioritize equitable pay across gender and race/ethnicity within their own departments as they build their organizations' capacity to achieve health equity.

The Modern Profile of Tuberculosis: Developing the TB Social Survey to understand contemporary social patterns in tuberculosis.

Social disparities in tuberculosis have been documented for decades, yet to date there has not been a comprehensive study to examine the contemporary causes of these disparities. Local public health departments, and particularly public health nursing staff are charged with delivering directly observed therapy to individuals with tuberculosis disease. As a result of the frequency and duration of treatment, practitioners delivering therapy are often well-acquainted with the lives and challenges of their constituents. Thus, through these practitioners there exists a deep repository of knowledge on the drivers of social disparities in tuberculosis disease. Partnering with local public health departments, we developed a survey instrument aimed at understanding the social profile of individuals with tuberculosis disease in metropolitan Detroit, Michigan. We discuss the development and implementation of the survey instrument as well as challenges in developing partnerships between academic researchers and local public health practitioners. This study can serve as a framework for both academic researchers and public health practitioners interested in addressing social disparities in infectious disease.

Adiposity and incident diabetes within 4 years of follow-up: the Guangzhou Biobank Cohort Study.

Whether different adiposity measures predict incident diabetes differentially in general Chinese populations is unclear. We investigated this in Chinese people aged 50+ years in the Guangzhou Biobank Cohort Study. Waist circumference and BMI were measured at baseline, and fasting glucose was measured at both baseline and follow-up examinations. Incident diabetes was defined as fasting glucose ≥ 7.0 mmol/l, glucose after 2-h oral glucose tolerance test ≥ 11.1 mmol/l, and/or self-reported physician-diagnosed diabetes during the follow-up period. Of 15 752 people without diabetes at baseline from 2003 to 2008, 1779 (11.3%) developed incident diabetes during the follow-up from 2008 to 2012 (mean = 3.6 years, sd = 1.0). After mutually adjusting each other and adjusting for other potential confounders, waist circumference showed a higher predictive value than BMI. The odds ratio (OR) (95% confidence interval (CI) was 1.50 (95% CI 1.37-1.64) for a 1 sd increment in waist circumference and 1.21 (95% CI 1.11-1.33), for a 1 sd increment in BMI. Similarly, after mutual adjustment, abdominal obesity was associated with an almost twofold odds of incident diabetes (OR 1.93, 95% CI 1.71-2.17), which was higher than that for general obesity (OR 1.76, 95% CI 1.50-2.06). The area under receiver operating characteristic curve (AUC) for waist circumference was higher than that for BMI [AUC = 0.676 (95% CI 0.660-0.686) vs. 0.665 (95% CI 0.651-0.678), P = 0.02]. Abdominal obesity predicted incident diabetes in older people better than general obesity. Our findings may be an early warning signal for local government or public health practitioners to develop and investigate more effective intervention programmes for diabetes, and should also be disseminated to the public to pay more attention to this important public health issue.