title: State practitioner insights into local public health challenges and opportunities in obesity prevention: a qualitative study.
abstract: BACKGROUND
  The extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs' success in obesity prevention.
  
  
  METHODS
  From June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations.
  
  
  RESULTS
  Main themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process.
  
  
  CONCLUSIONS
  These findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state-local relationship, especially in centralized states.
authors.affiliation: Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63110. E-mail: kstamata@slu.edu.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Stamatakis
authors.affiliation: Washington University School of Medicine and the Prevention Research Center in St. Louis, Missouri.
authors.forename: Moira
authors.initials: M
authors.lastname: Lewis
authors.affiliation: Washington University School of Medicine and the Prevention Research Center in St. Louis, Missouri.
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Khoong
authors.affiliation: Washington State Department of Health, Tumwater, Washington.
authors.forename: Claire
authors.initials: C
authors.lastname: Lasee
mesh_terms: D019058:Community Networks; D006295:Health Resources; D006801:Humans; D009111:Local Government; D009765:Obesity / Q000517:prevention & control*; D011635:Public Health Administration; D015980:Public Health Practice; D014481:United States