title: Developing the Evidence for Public Health Systems to Battle Vaccine Preventable Disease at the Local Level: Data Challenges and Strategies for Advancing Research.
abstract: Generally decreasing local health department (LHD) resources devoted to immunization programs and changes in LHD roles in immunization services represent major shifts in a core LHD service.
  
  
  
  Within a rapidly changing immunization landscape and emerging vaccine preventable disease outbreaks, our objective was to examine how LHD immunization expenditures are related to county-level immunization coverage and pertussis rates.
  
  
  
  We used a practice-based approach in which we collaborated with practice partners and uniquely detailed LHD immunization expenditure data. Our analyses modeled the ecologic relationship between LHD immunization expenditures and LHD system performance and health outcomes.
  
  
  
  This study was launched through a consortium of public health Practice-Based Research Network states as part of a suite of studies examining the relationship between various LHD service-related expenditures and health outcomes.
  
  
  
  We investigated and sought to include all LHDs in the states of Florida, New York (except New York City's LHD), and Washington.
  
  
  
  With LHD immunization expenditures as our independent variable, our outcomes were 1 year of jurisdiction-level rates of toddler immunization completeness, to measure immunization system performance, and 11 years of annual jurisdiction-level numbers of pertussis cases per 100 000 population, to measure related health outcomes.
  
  
  
  Immunization completeness and pertussis rates varied greatly, but our models did not produce significant results despite numerous analytic approaches and while controlling for other factors.
  
  
  
  While our study was part of a suite of studies using similar methods and producing significant results, this study was instead challenged by serious data limitations and highlighted the gap in consistent, standardized data that can support critically needed evidence regarding immunization rates and disease. With LHDs at the epicenter of reducing vaccine preventable disease, it is vital to utilize emerging opportunities to understand the nature of their efforts in immunization coverage and disease prevention.
authors: Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier and Ms Yip); University of Washington School of Public Health, Seattle, Washington (Drs Bekemeier and Kwan-Gett); and Department of Sociology, University of Washington, Seattle, Washington (Ms Pantazis).
authors: Betty
authors: B
authors: Bekemeier
authors: Athena
authors: A
authors: Pantazis
authors: Michelle Pui-Yan
authors: MP
authors: Yip
authors: Tao
authors: T
authors: Kwan-Gett
mesh_terms: D003695:Delivery of Health Care; D005431:Florida; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D007114:Immunization / Q000191:economics* / Q000379:methods; D017589:Immunization Programs / Q000191:economics / Q000379:methods; D009111:Local Government; D009518:New York; D011315:Preventive Medicine / Q000379:methods; D011634:Public Health / Q000191:economics* / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000639:trends; D014861:Washington