Local Health Departments’ Governance: A Visual Display Using LHD Shape Files

Analyses conducted for public health systems and services research (PHSSR) frequently include a variable that represents the relationship between state and local health departments (i.e., a governance category) in their analyses, either as an explanatory variable or a control variable. A number of organizations and researchers has categorized states according to governance, but the categorizations have been inconsistent across studies. This lack of agreement regarding governance category has been problematic for PHSSR. The Association of State and Territorial Health Officials (ASTHO) in conjunction with NORC at the University of Chicago and with input from the National Association of County and City Health Officials (NACCHO) conducted a study to systematically categorize state health agencies by their governance relationships with their local health departments (LHDs), using specific criteria. Based on a literature review, expert opinion, a survey, and follow-up telephone interviews in selected states, the relationships that exist between state and local health departments in each state were classified into four core categories: centralized, decentralized, shared and mixed. States’ systems were further classified based on a determination of what percentage of a state\u27s population is served by LHDs of each governance type, creating additional categories of largely centralized, largely decentralized and largely shared for those states where more than 75 percent of the population is served by that predominant governance structure. The classification system for LHDs developed by NACCHO defines the governance relationship of each LHD with the state health agency as local, state or shared. The presentation will include a map showing the classification of each state. A second map, developed using ARCGIS, will show the classification of each local health department based on NACCHO’s classification system. These new governance categories will be included in the data sets from ASTHO’s Profile survey and NACCHO’s Profile survey. These newly standardized state and local public health agency governance categorizations should help PHSSR by providing greater uniformity and validity across research studies

Use of Facebook by Local Health Departments: Posts, Frequency, and Purposes

Introduction: Online social media is one of the greatest advancements of 21st century after the telephone revolution of early ‘70s. Emailing pictures and videos have become obsolete and taken over by real time sharing to several friends. Similar to telephone and mobile phones, the use of Facebook is not confined to personal use. There is a great potential for public health professional at local health departments (LHDs) to utilize this popular platform to endorse health information, communicate with public, and support the agency work. Objective: To assess the usage of Facebook by LHDs, their level of activity on Facebook, and to identify the areas in which LHDs are focusing through Facebook. Method: We used data from the National Association of County and City Health Officials’ (NACCHO) 2013 Profile of LHD study, administered to 2,532 LHDs. A module consisting of questions based on social media usage completed by 505 LHDs determined that 167 LHDs use Facebook. We then followed the Facebook profiles of these 167 LHDs over a period of 4 months and transcribed the content information into a document. Finally we performed qualitative analysis on the transcripts to get our results. Result: LHDs which responded about their activity on Facebook on 2013 profile survey done by NACCHO were somewhat inconsistent in their presence itself. We were able to find only 101 LHDs with an active profile. Boulder County Health Department, Colorado was found to be the most popular based on the number of “likes” within the study period. In terms of content information, we found that tobacco usage and its effects were the most popular topic followed by inclement weather/ emergency preparedness and maternal and child health issues. Surprisingly, Ebola was the least mentioned topic by LHDs on Facebook. Conclusion: This analysis reflected the cross sectional standings of LHDs in using social media platforms in increasing awareness about many public health issues. Despite the extended reach of social media, our LHDs are not completely utilizing this platform in health promotion. Moreover, LHDs need to be updated with the current global concerns as well, along with the conventional public health issues

Local Health Departments’ (LHDs) Meaningful Use Readiness, General Informatics Capacity, Needs, and Barriers

This presentation was given at the CDC Public Health Informatics Annual Conference -- Engaging, Empowering, Evolving…Together

Local Health Department Funding Cuts and Impacts

This study sought to quantify the impact of the economic recession on the budgets, workforce, and programs of Local Health Departments (LHDs) across the United States. The National Association of County and City Health Officials (NACCHO) conducted two on-line surveys in 2008–2009; the first conducted in December of 2008 using census design, and the second in August 2009 using a nationally representative stratified sample of 990 LHDs. Trends found in the first two surveys will be compared with a third survey to be conducted in January 2010. Findings of the first two surveys demonstrate that across the country, LHDs experienced substantial reduction in budgets, employees, and public health activities and services. In 2009, 45 percent of LHDs reported cuts in their budget compared to the previous fiscal year; this is up from 27 percent in 2008. Job losses increased; in calendar year 2008 an estimated 7,000 LHD jobs were lost, while 8,000 staff positions were lost over six months in the first half of 2009 (January 1–June 30). In addition to staff lost through layoffs, an additional 12,000 LHD employees were subjected to reduced hours or mandatory furloughs in January–June 2009. From July 2008–June 2009, 55 percent of LHDs made cuts to important public health programs. As of July 2009, only 14 percent of LHDs had received funding from the American Reinvestment and Recovery Act. The findings from this study show that LHDs are severely strained by increasing budget and workforce cuts, to the point that they are being forced to eliminate or reduce vital programs that protect the public’s health. These pressures come even as LHDs are being called upon to take the lead in local H1N1 vaccination campaigns and as the demand for many different services has increased due to adverse economic conditions

The Impact of Economic Downturn on Local Public Health: Qualitative Data Analysis of Decision Drivers

In this study, we examine qualitative data pertaining to programmatic cuts in local health departments (LHDs) resulting from adverse economic conditions. These data include detailed information about the nature of public health services eliminated, anticipated impacts on the health of communities, and drivers of decision-making about which services, programs or activities to reduce as a result of budget loss. This study involves analysis of qualitative data from two waves of Economic Surveillance Surveys (ESS) of LHDs – the first conducted in August of 2009 and the second to be conducted in January of 2010. Both of the ESSs are based on nationally representative stratified random samples. We have used QSR NVivo to organize, code, and synthesize qualitative data. Our preliminary analyses of the 2009 ESS show that budget reductions lead to reduction or elimination of a wide variety of public health services and activities, including essential public health functions that are not provided by other agencies. Consequently, LHDs reported that they expected serious community health impacts, including spread of infectious disease, negative MCH outcomes, unintended pregnancies, undetected chronic disease and cancers, and spread of food-borne illness. The results from the 2010 survey will provide additional information about decision drivers in service reduction due to budget loss by LHDs. These findings add to the evidence-base and provide valuable insights to local health department leaders and local government officials in a general economic downturn for understanding expected relative impact to their agency. The LHD leaders will also benefit from qualitative details concerning service-reduction decisions and factors to consider when making such decisions. The findings may allow state and federal public health leaders to make better decisions about resource allocation, particularly at times when budgets are declining

Factors Associated with Recent Budget Reductions for Local Public Health Agencies

Research Objective: The general objective of this study is to examine the manner in which current economic downturn facing the country has impacted the budgets of local health departments (LHDs) around the country, and to identify factors instrumental in predicting the vulnerability of a LHD to experiencing budget cuts. Specific research objectives include: 1. To determine the proportion of LHDs that have had their budgets reduced compared to previous fiscal year; 2. To examine the extent to which LHD budgets have decreased over the past year; 3. To identify organizational characteristics that are associated with vulnerability to budget cut; and 4. To examine factors associated with level of reduction or increase in the LHD budgets. Study Design: This study involves analysis of linked data from two recent cross-sectional national surveys of LHDs conducted by NACCHO in late 2008 – the National Survey of LHD Budget Changes; and the 2008 National Profile of LHDs. Potential explanatory variables for the multivariate models include population size and degree of urbanization of jurisdiction, type of governance, funding mix (sources of LHD revenue), per capita LHD expenditures, type of services provided, and characteristics of the LHD’s top executive. We will use logistic regression to model the dichotomous variable representing whether or not LHD experienced a budget cut, as well as polytomous variable representing the extent of budget cut. Population Studied: The target population for the study is all local health departments in the country, defined as “an administrative or service unit of local or state government concerned with health, and carrying some responsibility for the health of a jurisdiction, smaller than the state.” The Profile survey was a complete census of all LHDs (2795 at the time of the survey), whereas the Budget-Cut Survey used predominantly census approach with exception of five states, where sampling was performed for only those groups of LHDs, for which the same contact person was listed for the entire group, and not separately for each LHD in the group. Principal Findings: Our preliminary analysis shows that 27% of LHDs experienced a decrease in budget in the current year compared with the prior year and this percentage shows considerable variation across states and categories of jurisdiction population. We expect to find a significant impact of several organizational characteristics on vulnerability for budget cuts. Conclusion: The proportion of LHDs experiencing budget reductions, and the level of reductions are substantial enough that it should draw attention of all stakeholders to the factors associated with vulnerability of LHDs, to be identified by our multivariate analyses. Implications For Policy, Delivery Or Practice: The findings of this study are very timely, given the current economic crisis. Identifying characteristics of local health departments that make them particularly vulnerable to budget cuts during an economic downturn will provide insights to leaders at all levels of the public health system. Local health department leaders and local government officials will be able to gauge the expected relative impact to their agency in a general economic downturn and consider whether changes to their structure, funding, or service mix might result in more stable funding levels in the future. A better understanding of the types of local health departments most severely impacted by an economic downturn may allow state and federal public health leaders to make better decisions about resource allocation, particularly at times when budgets are declining. Funding Source(s): CDC, Robert Wood Johnson Foundation Theme: Public Healt

Assessing Gaps in Maternal and Child Health Safety Net

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health

Are We Out of the Woods Yet? Impact of Economic Recession on Local Health Departments’ (LHDs) Budget, Workforce, and Program Cuts

Objectives: The primary objective of this study is to examine trends in LHDs’ funding, workforce, and program cuts from 2008–2011 in the context of an economic recession. Data: The study analyzes data from multiple waves of a survey, specially designed and conducted by the National Association of County and City Health Officials (NACCHO) to measure impact of recession on local public health agencies. Findings: The proportion of LHDs that reported reduced budget in current year than previous year increased from 27 percent in December 2008 to 45 percent in July 2009. In January 2010, 38 percent (53 percent, if one-time funding is excluded) of LHDs reported cuts in their budget compared to the previous fiscal year. Preliminary results of the recent survey closing in November 2010 show that the proportion of LHDs with budget cuts has actually increased to 43 percent. Fifty-four percent of LHDs would have had lower budgets if they excluded one-time funding such as H1N1 and American Recovery and Reinvestment Act (ARRA). The final results of the study will also include data from the fifth wave of the survey, to be conducted in 2011, highlighting trends of jobs lost and programs/services reduced or eliminated by LHDs during the time period under study. The results will also highlight variation in these trends by size of the LHDs, their governance structure, geographic location, and other important infrastructural characteristics. Conclusions: LHDs are severely strained by increasing budget and workforce cuts, to the point that they are being forced to eliminate or reduce vital programs that protect the public’s health. There is no indication that impact of recession is subsiding. Implications: The study findings will improve understanding of the practice community, researchers and the funding agencies about impact of recession on public health agencies’ budgets, staff and programs. Results will provide empirical evidence to policy makers and funding agencies in support of their decisions for resource allocation

Risk Factors for Childhood Blindness in Punjab, Pakistan

In this matched pair case-control study, we examined the risk factors associated with visual impairment among children aged 10 years or younger. Data were collected in 2010 from two hospitals in Lahore Pakistan, Punjab Institute of Preventive Ophthalmology (PIPO) - Mayo Hospital, and The Children\u27s Hospital. The study consisted of 260 participants, 130 each in case and control groups. Using a structured questionnaire, data were collected from the parents and the guardians who accompanied the children to the hospital. Monocular and binocular visual acuity (VA) was measured using a typical Snellen chart. Expected risk variables were categorized into six groups: Socio economic background, family history, clinical observations, prenatal conditions, postnatal conditions, and environmental conditions. The results indicate that children with rural residence, from cousin marriages, and of a father with a habit of smoking cigarettes had elevated risk of being visually impaired. The risk of visual impairment was also higher for children with certain congenital anomalies, and those with certain conditions including retinal dystrophies, cataract, glaucoma, and cerebral palsy (CP). Further, premature birth and lack of vitamin A in the mother’s diet were significant risk factors of visual impairment. Some other factors were not statistically significant predictors of blindness among children in our study. These factors included father’s occupation, grandparents’ history of blindness, and retinopathy of prematurity (RoP). Our study findings imply that policy makers and public health practitioners should consider raising awareness about proper nutrition, promoting prenatal care, preventing premature births, and eliminating indoor smoking to eventually reduce the risk of childhood blindness in Pakistan. Public health agencies should consider providing counseling about cousin marriages, and concomitant risk factors such as congenital anomalies, and risk of blindness

College Students’ Knowledge, Attitudes, and Behaviors Regarding Low-Carbohydrate Diets

Poor dietary practices often result in weight gain and increase the potential risk for chronic diseases. As students transition to college, their new found independence and lack of parental supervision provides opportunities to indulge in calorie-rich foods and alcoholic beverages that result in weight gain. In an attempt to combat the weight gain, they resort to strategies they consider “quick-fixes” and one such practice is the adoption of fad diets of which several are popular today. This study focuses on university students’ knowledge, attitudes, and behaviors regarding low carbohydrate diets. Data were collected through a self-administered survey of 672 students enrolled in Healthful Living courses at a mid-size university in Southeast Georgia. Analysis was performed to generate summary statistics of the sample and to determine factors affecting: (1) avoidance of carbohydrates, (2) purchase of low carbohydrate food products, and (3) participation in diets, with special interest on low carbohydrate diets (i.e., Atkins, South Beach, and Sugar Busters diets). Results of our logistic regression analysis show that factors significantly affecting carbohydrate avoidance include: gender (