We measured the impact of the 2008-2010 economic recession on local health departments (LHDs) across the United States. Between 2008 and 2010, we conducted 3 Web-based, cross-sectional surveys of a nationally representative sample of LHDs to assess cuts to budgets, workforce, and programs. By early 2010, more than half of the LHDs (53%) were experiencing cuts to their core funding. In excess of 23 000 LHDs jobs were lost in 2008-2009. All programmatic areas were affected by cuts, and more than half of the LHDs had to reduce or eliminate at least 1 programmatic area. The capacity of LHDs to provide core public health services was undermined by the economic recession.
Objectives
We assessed the use of administrative-evidence based practices (A-EBPs) among managers of programs in chronic diseases (CD), environmental health (EH), and infectious diseases (ID) from a sample of local health departments (LHDs) in the U.S.
Design
Program managers completed a survey consisting of six sections (biographical data, use of A-EBPs, diffusion attributes, use of resources, and barriers to, and competencies in, evidence-based public health (EBPH)) with a total of 66 questions.
Participants
The survey was sent electronically to 168 program managers in CD, 179 in EH, and 175 in ID, representing 228 LHDs. The survey had previously been completed by 517 LHD Directors.
Measures
The use of A-EBPs was scored for 19 individual A-EBPs, across the five A-EBP domains, and for all domains combined. Individual characteristics were derived from the survey responses, with additional data on LHDs drawn from linked NACCHO Profile survey data. Results for program managers were compared across the three types of programs and to responses from the previous survey of LHD directors. The scores were ordered and categorized into tertiles. Unconditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), comparing individual and agency characteristics for those with the highest third of A-EBPs scores to those with the lowest third.
Results
The 332 total responses from program managers represented 196 individual LHDs. Program managers differed (across the three programs, and compared to LHD Directors) in demographic characteristics, education, and experience. The use of A-EBPs varied widely across specific practices and individuals, but the pattern of responses from directors and program managers was very similar for the majority of A-EBPs.
Conclusions
Understanding the differences in educational background, experience, organizational culture, and performance of A-EBPs between program managers and LHD directors is a necessary step to improving competencies in EBPH.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.