Table 1
Characteristics of the Survey Sample and Sampling Frame.
| Characteristics | Survey | Sampling Framea | ||
|---|---|---|---|---|
| n | Percent (95% CI) | n | Percent (95% CI) | |
| Degree of collaboration | ||||
| 0 collaborative activities | 116 | 18.8% (15.9%–22.1%) | – | – |
| 1 collaborative activity | 135 | 21.8% (18.8%–25.3%) | – | – |
| 2 collaborative activities | 114 | 18.4% (15.6%–21.7%) | – | – |
| 3 collaborative activities | 105 | 17.0% (14.2%–20.2%) | – | – |
| 4 collaborative activities | 148 | 23.9% (20.7%–27.5%) | – | – |
| Distance between LHD and nearest SPPH | ||||
| ≥84 miles | 154 | 24.9% (21.7%–28.5%) | 513 | 25.7% (23.8%–27.6%) |
| 48 to 83 miles | 155 | 25.1% (21.8%–28.7%) | 528 | 26.4% (24.5%–28.4%) |
| 24 to 47 miles | 152 | 24.6% (21.4%–28.2%) | 476 | 23.8% (22.0%–25.7%) |
| ≤23 miles | 157 | 25.4% (22.1%–29.0%) | 482 | 24.1% (22.3%–26.0%) |
| Missing | – | – | 1 | 0.1% (0.0%–0.4%) |
| Size of population served by LHD | ||||
| <100,000 | 438 | 70.9% (67.2%–74.3%) | 1,479 | 74.0% (72.0%–75.8%) |
| 100,000 to 399,999 | 132 | 21.4% (18.3%–24.8%) | 364 | 18.2% (16.6%–20.0%) |
| ≥400,000 | 48 | 7.8% (5.9%–10.2%) | 157 | 7.9% (6.7%–9.1%) |
| Number of LHD employees | ||||
| ≤10 | 163 | 26.4% (23.0%–30.0%) | 550 | 27.5% (25.6%–29.5%) |
| 11 to 24 | 142 | 23.0% (19.8%–26.5%) | 495 | 24.8% (22.9%–26.7%) |
| 25 to 68 | 148 | 23.9% (20.7%–27.5%) | 477 | 23.9% (22.0%–25.8%) |
| ≥69 | 147 | 23.8% (20.6%–27.3%) | 420 | 21.0% (19.3%–22.8%) |
| Missing | 18 | 2.9% (1.8%–4.6%) | 58 | 2.9% (2.2%–3.7%) |
| LHD executive’s education | ||||
| Bachelor’s Degree or Less | 253 | 40.9% (37.1%–44.8%) | 836 | 41.8% (39.7%–44.0%) |
| Master’s Degree | 283 | 45.8% (41.9%–49.7%) | 857 | 42.9% (40.7%–45.0%) |
| Doctorate | 82 | 13.3% (10.6%–16.0%) | 307 | 15.4% (13.8%–17.0%) |
| LHD executive has a MPH or DrPH | ||||
| Yes | 144 | 23.3% (20.1%–26.8%) | 421 | 21.1% (19.3%–22.9%) |
| No | 445 | 72.0% (68.3%–75.4%) | 1468 | 73.4% (71.4%–75.3%) |
| Missing | 29 | 4.7% (3.3%–6.7%) | 111 | 5.6% (4.3%–6.6%) |
| LHD has a formal agreement with a SPPH | ||||
| Yes | 232 | 37.5% (33.8%–41.4%) | – | – |
| No | 386 | 62.5% (58.6%–66.2%) | – | – |
| LHD employs ≥1 physician | ||||
| Yes | 222 | 35.9% (32.2%–39.8%) | 773 | 38.7% (36.5%–40.8%) |
| No | 270 | 43.7% (39.8%–47.6%) | 769 | 38.5% (36.3%–40.6%) |
| Missing | 126 | 20.4% (17.4%–23.8%) | 458 | 22.9% (21.1%–24.8%) |
| LHD employs ≥1 environmental health specialist | ||||
| Yes | 484 | 78.3% (74.8%–81.4%) | 1544 | 77.2% (75.3%–79.0%) |
| No | 74 | 12.0% (9.6%–14.8%) | 261 | 13.1% (11.6%–14.6%) |
| Missing | 60 | 9.7% (7.6%–12.3%) | 195 | 9.8% (8.5%–11.1%) |
| LHD employs ≥1 epidemiologist | ||||
| Yes | 173 | 28.0% (24.6%–31.7%) | 562 | 28.1% (26.2%–30.1%) |
| No | 298 | 48.2% (44.3%–52.2%) | 907 | 45.4% (43.2%–47.5%) |
| Missing | 147 | 23.8% (20.6%–27.3%) | 531 | 26.6% (24.7%–28.5%) |
| LHD employs ≥1 health educator | ||||
| Yes | 383 | 62.0% (58.1%–65.7%) | 1152 | 57.6% (55.4%–59.8%) |
| No | 138 | 22.3% (19.2%–25.8%) | 507 | 25.4% (23.5%–27.3%) |
| Missing | 97 | 15.7% (13.0%–18.8%) | 341 | 17.1% (15.5%–18.8%) |
| LHD employs ≥1 information systems specialist | ||||
| Yes | 158 | 25.6% (22.3%–29.2%) | 488 | 24.4% (22.6%–26.3%) |
| No | 313 | 50.6% (46.7%–54.5%) | 974 | 48.7% (46.5%–50.9%) |
| Missing | 147 | 23.8% (20.6%–27.3%) | 538 | 26.9% (25.0%–28.9%) |
[i] Notes: Sample N = 618; Sampling Frame N = 2,000.
a The 2013 National Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials served as the sampling frame.
Abbreviations: LHD, Local Health Department; SPPH, School or Program of Public Health; MPH, Master of Public Health; DrPH, Doctor of Public Health.
Table 2
Association Between Local Health Department Characteristics and the Degree Of Collaboration.
| Local Health Department Characteristics | OR | 95% CI | AOR | 95% CI |
|---|---|---|---|---|
| Distance between LHD and nearest SPPH | ||||
| ≥84 miles | – | – | – | – |
| 48 to 83 miles | 1.15 | 0.77–1.71 | 0.87 | 0.57–1.34 |
| 24 to 47 miles | 2.18** | 1.45–3.26 | 1.18 | 0.76–1.85 |
| ≤23 miles | 7.76** | 5.06–11.89 | 3.79* | 2.31–6.20 |
| Size of population served by LHD | ||||
| ≤99,999 | – | – | – | – |
| 100,000 to 399,999 | 3.50** | 2.43–5.03 | 0.86 | 0.52–1.43 |
| ≥400,000 | 28.66** | 13.48–60.94 | 3.00* | 1.13–7.94 |
| Number of LHD employees | ||||
| ≤10 | – | – | – | – |
| 11 to 24 | 0.94 | 0.63–1.41 | 0.76 | 0.48–1.19 |
| 25 to 68 | 2.91** | 1.95–4.35 | 1.58 | 0.96–2.60 |
| ≥69 | 9.91** | 6.39–15.37 | 2.23* | 1.15–4.34 |
| LHD has a formal agreement with a SPPH | ||||
| No | – | – | – | – |
| Yes | 6.92** | 5.03–9.52 | 5.50** | 3.89–7.78 |
| LHD executive’s education | ||||
| ≤Bachelor’s | – | – | – | |
| Master’s | 2.98** | 2.19–4.06 | 1.30 | 0.88–1.90 |
| Doctorate | 5.96** | 3.69–9.62 | 1.09 | 0.60–1.97 |
| LHD executive has a MPH or DrPH | ||||
| No MPH or DrPH | – | – | – | – |
| MPH or DrPH | 3.17** | 2.23–4.49 | 1.50 | 0.98 –2.29 |
| LHD employs ≥1: | ||||
| Physician | 3.08** | 2.21–4.91 | 1.10 | 0.74–1.63 |
| Environmental Health Specialist | 3.80** | 2.46–5.87 | 1.54 | 0.92–2.52 |
| Epidemiologist | 4.04** | 2.79–5.85 | 1.64* | 1.01–2.67 |
| Health Educator | 3.62** | 2.51–5.21 | 1.53* | 1.00–2.32 |
| Information systems specialist | 3.47** | 2.38–5.05 | 1.31 | 0.82–2.10 |
[i] Notes: N = 618. Multiple imputation was used to create 30 imputed datasets.
* P < 0.05. ** P < 0.001.
Abbreviations: OR, odds ratio; AOR, adjusted odds ratio; CI, confidence interval; LHD, local health department; SPPH, school or program of public health; MPH, Master of public health; DrPH, Doctor of Public Health.
Table 3
Characteristics of the Group Interview Participants.
| Group Interview | Participants | Populationa | Distance | Degree of Collaborationb | Type of SPPH | Geographic Location | |
|---|---|---|---|---|---|---|---|
| LHD | SPPH | ||||||
| One | 2 | 1 | ≈400,000 | ≈75 | 4 (high) | SPH | Midwest |
| Two | 2 | 2 | ≈300,000 | >5 | 4 (high) | SPH & Medical School | South |
| Three | 3 | 1 | ≈1,000,000 | >5 | 4 (high) | SPH | South |
| Four | 1 | 1 | ≈1,000,000 | ≈100 | 1 (low) | SPH | South |
| Five | 1 | 1 | ≈15,000 | ≈50 | 1 (low) | MPH Program | Midwest |
| Six | 3 | 2 | ≈30,000 | ≈100 | 4 (high) | SPH | Midwest |
| Seven | 2 | 1 | ≈80,000 | >5 | 4 (high) | BPH Program | Midwest |
| Eight | 1 | 1 | ≈25,000 | ≈100 | 1 (low) | MPH Program | Midwest |
[i] Notes:
a The LHD population was rounded to the nearest thousand to support confidentiality.
b The degree of collaboration was based on the number of collaborative strategies used by LHDs. The survey measured four collaborative strategies. The sample was limited to LHDs with four or one collaborative strategy.
Abbreviations: LHD, local health department; SPPH, school or program of public health; SPH, school of public health, MPH Program, Master of Public Health Program, BPH, Bachelor of Public Health Program.