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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

Stamatakis, Katherine A. PhD, MPH; Leatherdale, Scott T. PhD; Marx, Christine M. MA; Yan, Yan MD, PhD; Colditz, Graham A. MD, DrPH; Brownson, Ross C. PhD

Journal of Public Health Management and Practice: September/October 2012 - Volume 18 - Issue 5 - p 402–411
doi: 10.1097/PHH.0b013e318221718c
Original Articles

Context: 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.

Objective: 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.

Design: 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.

Setting: Two thousand three hundred local health department jurisdictions defined with respect to county boundaries.

Participants: Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments.

Main Outcome Measures: Likelihood of having obesity prevention activities and association with area-level obesity prevalence.

Results: 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.

Conclusions: 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.

This study examines the extent to which local health agencies appear to be addressing obesity prevention in their jurisdictions by examining the association between the existence of obesity prevention programs, jurisdiction level obesity prevalence, and other organizational characteristics.

Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri (Drs Stamatakis, Yan, Colditz, and Brownson and Ms Marx); Department of Population Studies and Surveillance, Cancer Care Ontario, Toronto, Ontario, Canada (Dr Leatherdale); and Prevention Research Center in St Louis, George Warren Brown School of Social Work, St Louis, Missouri (Dr Brownson).

Correspondence: Katherine A. Stamatakis, PhD, MPH, Division of Public Health Sciences, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 660 S Euclid, Campus Box 8109, St Louis, MO 63110 (

This study was supported by NIH/NCRR Washington University-ICTS Grant Numbers KL2 RR024994 and UL1RR024992 and by Cooperative Agreement Number U48/DP000060 from the Centers for Disease Control and Prevention, Prevention Research Centers Program. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR, NIH, or the Centers for Disease Control and Prevention.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.