title: Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010.
abstract: OBJECTIVE
  In collaboration with Public Health Practice-Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates.
  
  
  METHODS
  We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York.
  
  
  RESULTS
  While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York.
  
  
  CONCLUSIONS
  Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking.
authors.affiliation: Betty Bekemeier, Michelle Pui-Yan Yip, and Greg Whitman are with the Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle. Tao Kwan-Gett is with the Department of Health Services, University of Washington School of Public Health, Seattle. Matthew D. Dunbar is with the Center for Studies in Demography and Ecology, University of Washington, Seattle.
authors.forename: Betty
authors.initials: B
authors.lastname: Bekemeier
authors.forename: Michelle Pui-Yan
authors.initials: MP
authors.lastname: Yip
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Dunbar
authors.forename: Greg
authors.initials: G
authors.lastname: Whitman
authors.forename: Tao
authors.initials: T
authors.lastname: Kwan-Gett
mesh_terms: D003457:Cryptosporidiosis / Q000453:epidemiology / Q000517:prevention & control; D059022:Food Safety; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D006506:Hepatitis A / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D009111:Local Government; D009518:New York; D011635:Public Health Administration / Q000191:economics*; D012499:Sanitation / Q000191:economics*; D014861:Washington