title: Adequacy of state capacity to address noncommunicable disease clusters in the era of environmental public health tracking.
abstract: OBJECTIVE
  We sought to assess the capacity of state public health agencies to address noncommunicable disease clusters (NCCs) and to develop recommendations to enhance agencies' NCC response capacity.
  
  
  METHODS
  We conducted an inventory of state public health agency Web sites and administered a Web-based survey of state health agency personnel to examine NCC capacity with respect to responsibility and authority, scope, protocols, trends in NCC investigations, and desired assistance.
  
  
  RESULTS
  Twenty-six of the state agency Web sites listed an NCC contact, and 12 mentioned a cluster response team. Thirty-seven states completed the Web-based survey, all addressed cancer clusters, and 30 also responded to other NCCs, such as multiple sclerosis, amyotrophic lateral sclerosis, and autism.
  
  
  CONCLUSIONS
  NCCs are of key concern to communities, and all of the survey respondents indicated that citizen reports were an impetus for investigations; yet, state-level capacity to address NCCs was inconsistent and disjointed. State agency personnel were committed to responding to NCC inquiries but were hampered by lack of personnel, resources, and prescribed protocols, as well as inadequate interagency communication. We offer recommendations to address these challenges.
authors.affiliation: Michigan Public Health Institute, Okemos, Mich 48304, USA. njuzych@med.wayne.edu
authors.forename: Nadia Shalauta
authors.initials: NS
authors.lastname: Juzych
authors.forename: Beth
authors.initials: B
authors.lastname: Resnick
authors.forename: Robin
authors.initials: R
authors.lastname: Streeter
authors.forename: Julie
authors.initials: J
authors.lastname: Herbstman
authors.forename: Joanna
authors.initials: J
authors.lastname: Zablotsky
authors.forename: Mary
authors.initials: M
authors.lastname: Fox
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D016000:Cluster Analysis; D004782:Environmental Health; D004812:Epidemiologic Methods; D006801:Humans; D020407:Internet; D015980:Public Health Practice; D013219:State Government; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology