摘要：Objectives. We assessed whether local health departments (LHDs) were conducting obesity prevention programs and diabetes screening programs, and we examined associations between LHD characteristics and whether they conducted these programs. Methods. We used the 2005 National Profile of Local Health Departments to conduct a cross-sectional analysis of 2300 LHDs nationwide. We used multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results. Approximately 56% of LHDs had obesity prevention programs, 51% had diabetes screening programs, and 34% had both. After controlling for other factors, we found that employing health educators was significantly associated with LHDs conducting obesity prevention programs (OR = 2.08; 95% CI = 1.54, 2.81) and diabetes screening programs (OR = 1.63; 95% CI = 1.23, 2.17). We also found that conducting chronic disease surveillance was significantly associated with LHDs conducting obesity prevention programs (OR = 1.66; 95% CI = 1.26, 2.20) and diabetes screening programs (OR = 2.44; 95% CI = 1.90, 3.15). LHDs with a higher burden of diabetes prevalence were more likely to conduct diabetes screening programs (OR = 1.20; 95% CI = 1.11, 1.31) but not obesity prevention programs. Conclusions. The presence of obesity prevention and diabetes screening programs was significantly associated with LHD structural capacity and general performance. However, the effectiveness and cost-effectiveness of both types of programs remain unknown. The prevalence of obesity among US adults doubled between 1980 and 2004, and the 2005–2006 National Health and Nutrition Examination Survey found that more than 72 million US adults were obese. 1 – 3 Obesity contributes to many chronic conditions, including type 2 diabetes, hypertension, stroke, heart disease, certain cancers, and arthritis. 1 Of these conditions, type 2 diabetes, the sixth-leading cause of death in the United States, 4 may be most closely linked to obesity. 5 The prevalence of diagnosed diabetes among Americans increased from 2.5% in 1980 to 5.5% in 2005. 6 In 2007, approximately 17.9 million Americans had diagnosed diabetes, and approximately 5.7 million had undiagnosed diabetes. 7 The public health system has traditionally focused on the prevention and control of infectious diseases. However, improved sanitation and hygiene and the wide adoption of antibiotic use and vaccination have made infectious diseases less common. Conversely, chronic diseases, such as heart disease, cancer, and diabetes, have become more prevalent. 8 , 9 Chronic diseases now account for 7 of 10 US deaths. 10 Thus, public health agencies, including local health departments (LHDs), may be expected to play an expanded role in chronic disease prevention and control, in addition to their traditional role in infectious disease prevention and their recently enhanced role in disaster and emergency response. 11 For example, New York City has started a mandatory registry of glycosylated hemoglobin values. 12 There is a need to better understand the public health system's responses to chronic diseases (e.g., obesity and diabetes). Although many studies have examined characteristics of LHDs and their public health practices, 13 – 21 little is known about these departments' obesity and diabetes prevention activities. 22 To fill this gap, we assessed whether LHDs in the United States were conducting obesity prevention programs and diabetes screening programs. We used a conceptual framework developed by an expert panel and the Public Health Practice Program Office of the Centers for Disease Control and Prevention 23 to examine the characteristics of LHDs that conducted these programs and to discover associations between those characteristics and whether LHDs conducted the programs.
