Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA 98195, USA.
J Public Health Manag Pract. 2013 Mar-Apr;19(2):153-61. doi: 10.1097/PHH.0b013e318252ee41.
Local health departments (LHDs) are expected to address health disparities. Little is known, however, about what factors influence the activities used by an LHD in addressing health disparities. The objective of this study was to examine factors such as an LHD's leader, jurisdiction, and organizational characteristics that could be considered to influence the approaches used within LHDs to address health disparities.
We used a cross-sectional, 2-level, mixed linear model with secondary LHD data nested within states. National data were used, depicting activities conducted by LHDs.
The sample consisted of the 2332 LHDs that responded to the National Association of County and City Health Officials's 2008 National Profile of LHDs Survey.
The activities used by LHDs in addressing health disparities were depicted as respondents indicating that they had employed 0 to 8 types of the activities listed in the Profile Survey in relation to addressing disparities.
Local health departments significantly vary in the number of types of activities used in addressing health disparities. Significant associations exist between more types of health disparities activities used by LHDs and LHDs having a "top executive" with more education, clinical training, and/or less than 5 years of experience as the LHD's top executive. Local health departments with a jurisdiction that is urban, with a higher percentage of black residents, with a higher percentage of Hispanic residents, with higher per capita LHD expenditures, and/or that has conducted a community health assessment in last 3 years were also significantly associated with higher numbers of types of health disparities activities used.
Local context and the characteristics of an LHD's top executive appear to be important factors related to the activities used to address health disparities across LHDs. A focus on the competencies and development of LHD leaders may be important in promoting LHD engagement in a wider range of approaches toward reducing disparities.
地方卫生部门（LHD）被期望解决健康差异问题。然而，人们对影响 LHD 解决健康差异所采用的活动的因素知之甚少。本研究的目的是研究 LHD 的领导者、管辖范围和组织特征等因素，这些因素可能会影响 LHD 内部用于解决健康差异的方法。
我们使用了横断面、2 级、混合线性模型，将州内嵌套的二级 LHD 数据进行了嵌套。使用了全国性数据，描绘了 LHD 开展的活动。
该样本由 2332 个回应国家协会县和城市卫生官员 2008 年国家 LHD 概况调查的 LHD 组成。
LHD 用于解决健康差异的活动被描绘为受访者表示他们在解决差异方面采用了 0 到 8 种列于概况调查中的活动类型。
LHD 在解决健康差异方面采用的活动类型数量存在显著差异。LHD 使用的健康差异活动类型与 LHD 拥有接受过更多教育、临床培训和/或担任 LHD 最高行政职务不到 5 年的“最高行政长官”以及更多类型的健康差异活动之间存在显著关联。管辖范围为城市、黑人和西班牙裔居民比例较高、人均 LHD 支出较高、或在过去 3 年内进行过社区健康评估的 LHD，也与使用更多类型的健康差异活动显著相关。
地方环境和 LHD 最高行政长官的特征似乎是与 LHD 之间用于解决健康差异的活动相关的重要因素。关注 LHD 领导者的能力和发展可能对于促进 LHD 参与更广泛的方法来减少差异非常重要。
