title: State Size and Government Level Matter Most: A Structural Equation Model of Local Health Department Policy Behaviors.
abstract: OBJECTIVE
  To explore relationships between local health department policy behaviors, levels of government activity, policy focus areas, and selected health department characteristics.
  
  
  METHODS
  Cross-sectional analysis of secondary data from the 2013 National Association of County & City Health Officials (NACCHO) Profile Survey.
  
  
  METHODS
  Local health departments throughout the United States.
  
  
  METHODS
  A total of 2000 local health departments responding to the 2013 Profile Survey of Local Health Departments. Survey data were gathered by the NACCHO.
  
  
  METHODS
  Secondary analysis of reported policy behaviors for the 2013 NACCHO Profile Survey. A structural equation model tested effects on and between state population size, rurality, census region and policy focus, and the latent variables of policy behavior formed from a confirmatory factor analysis.
  
  
  METHODS
  Policy behaviors, levels of government activity (local, state, and federal), policy focus areas, and selected local health department characteristics.
  
  
  RESULTS
  The majority (85.1%) of health departments reported at least one of the possible policy behaviors. State population size increased the probability of local policy behavior, and local behavior increased the probability of state policy behavior. State size increased the likelihood of federal policy behavior and the focus on tobacco, emergency preparedness, and obesity/chronic disease. However, the more rural a state was, the more likely policy behavior was at the state and federal levels and not at local levels. Specific policy behaviors mattered less than the level of government activity.
  
  
  CONCLUSIONS
  Size of state and rurality of health departments influence the government level of policy behavior.
authors.affiliation: Rural Center for AIDS/STD Prevention (Dr Meyerson), Department of Applied Health Science, School of Public Health (Dr Meyerson), and Department of Epidemiology and Biostatistics, School of Public Health (Dr Sayegh), Indiana University-Bloomington; and Center for HPV Research, Indiana University School of Medicine, Bloomington (Dr Meyerson).
authors.forename: Beth E
authors.initials: BE
authors.lastname: Meyerson
authors.forename: M Aaron
authors.initials: MA
authors.lastname: Sayegh
mesh_terms: D003430:Cross-Sectional Studies; D006291:Health Policy; D006801:Humans; D009111:Local Government; D013219:State Government; D011795:Surveys and Questionnaires; D014481:United States; D014492:United States Public Health Service / Q000706:statistics & numerical data / Q000639:trends*