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.