title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Two thousand three hundred local health department jurisdictions defined with respect to county boundaries.
  
  
  METHODS
  Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments.
  
  
  METHODS
  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.
authors: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA. stamatakisk@wustl.edu
authors: Katherine A
authors: KA
authors: Stamatakis
authors: Scott T
authors: ST
authors: Leatherdale
authors: Christine M
authors: CM
authors: Marx
authors: Yan
authors: Y
authors: Yan
authors: Graham A
authors: GA
authors: Colditz
authors: Ross C
authors: RC
authors: Brownson
mesh_terms: D002391:Catchment Area, Health; D019058:Community Networks; D055317:Evidence-Based Practice; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006287:Health Planning Guidelines; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D054624:Health Status Disparities; D006801:Humans; D007373:Interinstitutional Relations; D009111:Local Government; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D015397:Program Evaluation; D011635:Public Health Administration; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology