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

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.