title: The impact of local environmental health capacity on foodborne illness morbidity in Maryland.
abstract: OBJECTIVE
  We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level.
  
  
  METHODS
  We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs).
  
  
  RESULTS
  Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness.
  
  
  CONCLUSIONS
  Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness.
authors.affiliation: Food Safety and Inspection Service, US Department of Agriculture, Washington, DC, USA. joanna.zablotsky-kufel@fsis.usda.gov
authors.forename: Joanna S
authors.initials: JS
authors.lastname: Zablotsky Kufel
authors.forename: Beth A
authors.initials: BA
authors.lastname: Resnick
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fox
authors.forename: John
authors.initials: J
authors.lastname: McGready
authors.forename: James P
authors.initials: JP
authors.lastname: Yager
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
mesh_terms: D018563:Disease Notification / Q000592:standards; D005511:Food Handling / Q000592:standards; D005513:Food Inspection / Q000191:economics / Q000592:standards*; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008396:Maryland / Q000453:epidemiology; D012147:Restaurants / Q000592:standards; D000078329:Workforce