An Observational Study of the Association Between Exposure to Vacant Building Demolitions and Elevated Blood Lead Levels in Children Under Six in St Louis City.

CONTEXT: St Louis City has been demolishing vacant buildings at an increasing rate. Demolition can cause lead dust spread, and childhood lead exposure can have negative effects on cognition, growth, and development. Previous studies show an association between exposure to multiple demolitions and elevated blood lead levels (EBLLs) in children, but St Louis City does not monitor the effects of demolitions on children's blood lead levels. OBJECTIVES: The purpose of this study was to measure the association between exposure to demolitions and EBLLs in children younger than 6 years in St Louis City from 2017 to 2020. DESIGN/SETTING/PARTICIPANTS: We analyzed blood lead testing data for children 0 to 72 months of age (n = 22 192) and proximity to demolitions. Exposure was the presence of demolitions within 400 ft of a child's address in the 33 days before their first lead test. MAIN OUTCOME MEASURE: We used logistic regression to test the association between proximity to demolition and EBLLs (≥5 µg/dL). RESULTS: The percentage of children living in proximity to 1 or more demolitions was slightly higher among those with EBLLs (n = 21; 1.3%) than among those without EBLLs (n = 250; 1.2%). However, after adjusting for age, sex, year home was built, season, neighborhood socioeconomic percentile, and neighborhood racial composition, the odds of EBLLs were not significantly different for children exposed to 1 or more demolitions (OR = 0.82; 95% CI, 0.5-1.25) compared with exposed to zero demolitions. CONCLUSIONS: Although this study found no association between exposure to demolitions and EBLLs, results should be interpreted with caution, given numerous limitations. Given the consequences of childhood lead exposure, it is recommended that St Louis City conduct a similar analysis on demolitions conducted after 2020 using systematically collected demolition dates. Targeted testing or soil and air monitoring could also be informative.

Training Networks of Local Health Departments: A Regional Assessment.

OBJECTIVE: The public health system faces major challenges in 2020, including an aging workforce, reductions in funding, and 2 simultaneous major threats to public health-the coronavirus pandemic and racial injustice. To effectively harness promising new technologies and address these and other public health challenges ahead, public health professionals must be trained on evidence-based practices for protecting and improving public health. This project sought to understand the network of health departments and organizations that provide training in order to inform strategic efforts to fill training gaps and improve access to training for local health departments (LHDs), thereby strengthening the public health system. DESIGN/SETTING/PARTICIPANTS: We conducted a Web-based survey of 501 LHDs in the 6 states constituting Region V of the Department of Health & Human Services. The survey focused on the training relationship between LHDs and state and national organizations that provide public health training, allowing for a social network analysis. We used data visualization and descriptive statistics to examine the network. RESULTS: Of 290 participating health departments (58% response rate), 248 had monthly or more frequent contact with at least 1 organization for the purpose of training. Altogether, the 248 LHDs were connected to 47 state-level organizations and 10 national-level organizations. In 5 of 6 states, more LHDs were connected to the state health department for training than to any other organization type. Universities, national nonprofits, and national membership organizations provided training to the fewest LHDs. Local health department characteristics did not have a clear relationship with its number of training connections. CONCLUSIONS: State health departments may benefit from the support of universities, national nonprofits, and national membership organizations by partnering to offer training or by recommending training from these organizations to LHDs. Additional qualitative information from local and state health departments would be useful to determine the best strategies for universities, national nonprofits, and national membership organizations to participate in training local practitioners to improve LHD capacity.

Examining the extent and factors associated with interprofessional teamwork in primary care settings.

Despite growing emphasis on adopting team-based models of primary care to facilitate patient access to a diverse range of care providers, our understanding of team functioning within primary care teams remains limited. This study examined interprofessional teamwork within primary care practices (Family Health Teams [FHT] and Community Health Centers - [CHC]) in Ontario and explored team-level and organizational factors associated with interprofessional teamwork. Interprofessional teamwork was measured using the Collaborative Practice Assessment Tool (CPAT), which was completed by providers in each participating team. The CPAT responses of 988 providers representing on average 12 professions (sd = 2.1) across 66 teams (44 FHTs and 22 CHCs) were included in the analysis. The average CPAT score was 46.6 (sd = 2.5). CHCs had significantly higher CPAT scores than FHTs (mdiff = 1.7, p = .02). Using diverse communication mechanisms to share information, increasing quality improvement capacities, and age of practice, had a statistically significant positive association with CPAT scores. Increasing team size, using centralized administrative processes, a high level of information exchange, and having a mixed governance board were significantly negatively associated with CPAT score. Findings illustrate factors associated with interprofessional teamwork and offer insight into the comparative performance of two team-based primary care models in Ontario.

Impact of the affordable care act dependent coverage provision on young adult cancer patient insurance coverage by sociodemographic and economic characteristics.

PURPOSE: To evaluate the impact of the Affordable Care Act Dependent Care Provision by sociodemographic and economic characteristics in young adult cancer patients. METHODS: The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) 18 database were queried for young adult cancer cases diagnosed during 2007-2014. Using a difference-in-differences approach, we examined insurance coverage in different subgroups of policy-eligible 19-25 year-olds versus policy-ineligible 27-29 year-olds from the pre- (2007-2009) to post- (2011-2014) Dependent Care Provision period. RESULTS: Across subgroups and study populations, insurance coverage increased significantly following the Provision enactment in the policy-eligible versus policy-ineligible group across most subgroups (range in NCDB: 1.83 to 6.38% for low and mid-low education areas, respectively; range in SEER: 1.43 to 6.18 for Non-Hispanic Others and Hispanics, respectively). Heterogenous impacts were observed by sex with a larger impact in males (NCDB: 5.14%, 95% CI 3.59-6.69; SEER: 4.46, 2.12-6.8) than females (NCDB: 2.51%, 95% CI 1.39-3.62; SEER: 2.50, 0.82-4.18). We observed no other statistical evidence for Dependent Care Provision subgroup heterogeneity except for a smaller impact in individuals from low education areas in NCDB. CONCLUSIONS: Our results indicate a positive Dependent Care Provision impact on insurance coverage in young adults with cancer across subgroups, with evidence for a smaller impact in females relative to males and in low relative to high education areas.

Cost-Related Nonadherence and Mortality in Patients With Chronic Disease: A Multiyear Investigation, National Health Interview Survey, 2000-2014.

INTRODUCTION: Prescription costs are rising, and many patients with chronic illnesses have difficulty paying for prescriptions. Missing or delaying medication because of financial concerns is common; however, the effects of cost-related nonadherence (CRN) on patient outcomes have not been described. Our objective was to determine if CRN is associated with higher all-cause and disease-specific mortality among patients living with diabetes and cardiovascular disease in a representative sample of US adults. METHODS: We ascertained CRN, vital status, and cause of death for 39,571 patients with diabetes, 61,968 patients with cardiovascular disease, and 124,899 patients with hypertension in the 2000 through 2014 releases of the National Health Interview Survey. We used adjusted Cox proportional hazards models to estimate associations between CRN and all-cause mortality and CRN and disease-specific mortality. RESULTS: On average, 15% of the sample reported CRN in the year before interview. After adjusting for confounders, CRN was associated with 15% to 22% higher all-cause mortality rates for all conditions (diabetes hazard ratio [HR] = 1.18; 95% CI, 1.1-1.3; cardiovascular disease [CVD] HR = 1.15; 95% CI, 1.1-1.2; hypertension HR = 1.22; 95% CI, 1.2-1.3). Relative to no CRN, CRN was associated with 8% to 18% higher disease-specific mortality rates (diabetes HR = 1.18; 95% CI, 1.0-1.4; CVD HR = 1.09; 95% CI, 1.0-1.2; hypertension HR = 1.08; 95% CI, 0.9-1.3). CONCLUSION: Relative to full adherence, CRN is associated with higher mortality rates for patients with diabetes, cardiovascular disease, and hypertension, although associations may have weakened since 2011. Policies that increase prescription affordability may decrease mortality for patients experiencing CRN.

Network influences on the development and implementation of active transportation policies in six U.S. cities.

Many communities have prioritized policy and built environment changes to promote active transportation (AT). However, limited information exists on the partnerships and processes necessary to develop and implement such policy and environmental changes, particularly among organizations in non-health sectors. Within the transportation sector, metropolitan planning organizations (MPOs) are increasingly recognized as organizations that can support AT policies. This study examined inter-organizational relationships among MPOs and their partners working to advance AT policies in six U.S. cities. In fall 2015, an average of 22 organizations in each city participated in an online survey about partnerships with MPOs and other organizations developing and implementing AT policies. Measures included organizational characteristics and relational attributes including: level of AT policy collaboration, information transmission, resource sharing, and perceived decisional power. Descriptive network analysis and exponential random graph modeling were used to examine organizational attributes and relational predictors associated with inter-organizational collaboration in each network. MPOs served as collaborative intermediaries, connecting other organizations around AT policies, in half of the cities examined. Organizations in each city were more likely to collaborate around AT policies when partners communicated at least quarterly. In half of the cities, the probability of AT policy collaboration was higher when two agencies exchanged resources and when organizations had perceived decisional authority. Network analysis helped identify factors likely to improve partnerships around AT policies. Results may contribute to best practices for collaboration among researchers, practitioners, policymakers, and advocates across diverse sectors seeking to promote population-level physical activity.

Examining the Reproducibility of 6 Published Studies in Public Health Services and Systems Research.

OBJECTIVE: Research replication, or repeating a study de novo, is the scientific standard for building evidence and identifying spurious results. While replication is ideal, it is often expensive and time consuming. Reproducibility, or reanalysis of data to verify published findings, is one proposed minimum alternative standard. While a lack of research reproducibility has been identified as a serious and prevalent problem in biomedical research and a few other fields, little work has been done to examine the reproducibility of public health research. We examined reproducibility in 6 studies from the public health services and systems research subfield of public health research. DESIGN: Following the methods described in each of the 6 papers, we computed the descriptive and inferential statistics for each study. We compared our results with the original study results and examined the percentage differences in descriptive statistics and differences in effect size, significance, and precision of inferential statistics. All project work was completed in 2017. RESULTS: We found consistency between original and reproduced results for each paper in at least 1 of the 4 areas examined. However, we also found some inconsistency. We identified incorrect transcription of results and omitting detail about data management and analyses as the primary contributors to the inconsistencies. RECOMMENDATIONS: Increasing reproducibility, or reanalysis of data to verify published results, can improve the quality of science. Researchers, journals, employers, and funders can all play a role in improving the reproducibility of science through several strategies including publishing data and statistical code, using guidelines to write clear and complete methods sections, conducting reproducibility reviews, and incentivizing reproducible science.

Messengers and Messages for Tweets That Used #thinspo and #fitspo Hashtags in 2016.

INTRODUCTION: Twitter is widely used by young adults and is popular for seeking and sharing health information. The hashtags #thinspo and #fitspo provide a way to identify tweets designed to inspire thinness (thinspiration, thinspo) or fitness (fitspiration, fitspo). However, despite having different purposes, both terms may be associated with content that promotes eating disorders. We sought to 1) examine and compare the characteristics of senders and the content of tweets using these hashtags and 2) identify characteristics associated with engagement with a #thinspo or #fitspo tweet. METHODS: In May 2016 we collected 1,035 tweets with #thinspo and #fitspo hashtags by using a constructed week sampling procedure. Using consensus coding, pairs of raters assessed each tweet's topic and associated images and videos. We used descriptive statistics to examine topics and user characteristics and inferential models to determine topics and characteristics associated with retweets, likes, and replies to tweets. RESULTS: Of the 1,035 tweets, 696 (67.2%) were relevant to body image, fitness, food, dieting, or eating disorders. Fitspo tweets came from organizations or businesses, were promotional, and focused on nutrition and exercise, whereas #thinspo tweets came from individuals, focused on thinness and disordered eating behaviors, and contained images of extremely thin women. Rates of retweeting and liking were significantly higher for #thinspo than for #fitspo. CONCLUSION: Characteristics of messages and messengers differed between #thinspo and #fitspo tweets; #thinspo tweets were used for messages about disordered eating. Public health professionals should consider using the #thinspo hashtag to reach the #thinspo group.

Availability of Foodborne Illness Reporting Mechanisms for the Public on Local Health Department Web Sites.

CONTEXT: Foodborne illness is a serious and preventable public health problem, with high health and economic tolls in the United States. Local governments play an important role in food safety, with local health departments (LHDs) responsible for licensing and inspecting restaurants. Foodborne illness complaints from the public result in identification of more serious and critical food safety violations than regularly scheduled inspections; however, few people report foodborne illness. Availability of existing methods for the public to report foodborne illness to LHDs across the United States was examined. OBJECTIVE: In 2016, data were collected and analyzed from a nationally representative stratified sample of 816 LHDs. Each LHD Web site was examined to determine whether the Web site included a way for constituents to report a suspected foodborne illness. RESULTS: Just 27.6% of LHD Web sites included a way for constituents to report a suspected foodborne illness. LHDs with reporting mechanisms were serving significantly larger populations and had significantly more staff members, higher revenues, and higher expenditures. Health departments with reporting mechanisms were also significantly more likely to conduct environmental health surveillance activities, to regulate, inspect, and/or license food service establishments, and to be involved in food safety policy. CONCLUSIONS: Consumer reports of suspected foodborne illness help identify serious and critical food safety violations in food establishments; however, foodborne illness is vastly underreported by the US public. While more evidence is needed on how current systems are working, increasing the visibility and availability of Web-based reporting mechanisms through the following strategies is recommended: (1) test and modify search functions on LHD Web sites to ensure consumers find reporting mechanisms; (2) add a downloadable form as an option for reporting; (3) coordinate with state health departments to ensure clear instructions are available for reporting at both state and local levels; and (4) consider linking directly to state health department reporting mechanisms.

Getting the Word Out: New Approaches for Disseminating Public Health Science.

The gap between discovery of public health knowledge and application in practice settings and policy development is due in part to ineffective dissemination. This article describes (1) lessons related to dissemination from related disciplines (eg, communication, agriculture, social marketing, political science), (2) current practices among researchers, (3) key audience characteristics, (4) available tools for dissemination, and (5) measures of impact. Dissemination efforts need to take into account the message, source, audience, and channel. Practitioners and policy makers can be more effectively reached via news media, social media, issue or policy briefs, one-on-one meetings, and workshops and seminars. Numerous "upstream" and "midstream" indicators of impact include changes in public perception or awareness, greater use of evidence-based interventions, and changes in policy. By employing ideas outlined in this article, scientific discoveries are more likely to be applied in public health agencies and policy-making bodies.

Local Health Departments Tweeting About Ebola: Characteristics and Messaging.

CONTEXT: The first imported US Ebola hemorrhagic fever case during the 2014 West Africa Ebola outbreak triggered an increase in online activity through various social media platforms, including Twitter. OBJECTIVES: The purpose of our study was to examine characteristics of local health departments (LHDs) tweeting about Ebola, in addition to how and when LHDs were communicating Ebola-related messages. DESIGN: All tweets sent by 287 LHDs known to be using Twitter were collected from September 3 to November 2, 2014. Twitter data were merged with the 2013 National Association of County & City Health Officials Profile study to assess LHD characteristics associated with sending Ebola-related tweets. To examine the content of Ebola tweets, we reviewed all such tweets and developed a codebook including 4 major message categories: information giving, news update, event promotion, and preparedness. A time line tracking the trends in Ebola tweets was created by aligning daily tweets with major Ebola news events posted on the Centers for Disease Control and Prevention Ebola Web site. RESULTS: Approximately 60% (n = 174) of all LHDs using Twitter sent a total of 1648 Ebola-related tweets during the study period. Sending more tweets in general (odds ratio: 2.42; 95% confidence interval, 1.00-5.84) and employing at least 1 public information specialist (odds ratio: 2.61; 95% confidence interval, 1.14-5.95) significantly increased the odds that an LHD tweeted about Ebola. Of all the Ebola tweets collected, 78.6% were information giving, 22.5% were on preparedness, 20.8% were news updates, and 10.3% were event promotion tweets. A temporal analysis of Ebola tweets indicated 5 distinct waves, each corresponding with major Ebola news events. CONCLUSIONS: Twitter has become a communication tool frequently used by many LHDs to respond to novel outbreaks, but messaging strategies vary widely across LHDs. We recommend that LHDs increase tweet frequency during public health emergencies in order to ensure timely dissemination of critical information.

Using Twitter to Identify and Respond to Food Poisoning: The Food Safety STL Project.

CONTEXT: Foodborne illness affects 1 in 4 US residents each year. Few of those sickened seek medical care or report the illness to public health authorities, complicating prevention efforts. Citizens who report illness identify food establishments with more serious and critical violations than found by regular inspections. New media sources, including online restaurant reviews and social media postings, have the potential to improve reporting. OBJECTIVE: We implemented a Web-based Dashboard (HealthMap Foodborne Dashboard) to identify and respond to tweets about food poisoning from St Louis City residents. DESIGN AND SETTING: This report examines the performance of the Dashboard in its first 7 months after implementation in the City of St Louis Department of Health. MAIN OUTCOME MEASURES: We examined the number of relevant tweets captured and replied to, the number of foodborne illness reports received as a result of the new process, and the results of restaurant inspections following each report. RESULTS: In its first 7 months (October 2015-May 2016), the Dashboard captured 193 relevant tweets. Our replies to relevant tweets resulted in more filed reports than several previously existing foodborne illness reporting mechanisms in St Louis during the same time frame. The proportion of restaurants with food safety violations was not statistically different (P = .60) in restaurants inspected after reports from the Dashboard compared with those inspected following reports through other mechanisms. CONCLUSION: The Dashboard differs from other citizen engagement mechanisms in its use of current data, allowing direct interaction with constituents on issues when relevant to the constituent to provide time-sensitive education and mobilizing information. In doing so, the Dashboard technology has potential for improving foodborne illness reporting and can be implemented in other areas to improve response to public health issues such as suicidality, spread of Zika virus infection, and hospital quality.

The Double Disparity Facing Rural Local Health Departments.

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

Challenges and Innovations in Surveying the Governmental Public Health Workforce.

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest.

Multisector Health Policy Networks in 15 Large US Cities.

CONTEXT: Local health departments (LHDs) have historically not prioritized policy development, although it is one of the 3 core areas they address. One strategy that may influence policy in LHD jurisdictions is the formation of partnerships across sectors to work together on local public health policy. DESIGN: We used a network approach to examine LHD local health policy partnerships across 15 large cities from the Big Cities Health Coalition. SETTING/PARTICIPANTS: We surveyed the health departments and their partners about their working relationships in 5 policy areas: core local funding, tobacco control, obesity and chronic disease, violence and injury prevention, and infant mortality. OUTCOME MEASURES: Drawing on prior literature linking network structures with performance, we examined network density, transitivity, centralization and centrality, member diversity, and assortativity of ties. RESULTS: Networks included an average of 21.8 organizations. Nonprofits and government agencies made up the largest proportions of the networks, with 28.8% and 21.7% of network members, whereas for-profits and foundations made up the smallest proportions in all of the networks, with just 1.2% and 2.4% on average. Mean values of density, transitivity, diversity, assortativity, centralization, and centrality showed similarity across policy areas and most LHDs. The tobacco control and obesity/chronic disease networks were densest and most diverse, whereas the infant mortality policy networks were the most centralized and had the highest assortativity. Core local funding policy networks had lower scores than other policy area networks by most network measures. CONCLUSION: Urban LHDs partner with organizations from diverse sectors to conduct local public health policy work. Network structures are similar across policy areas jurisdictions. Obesity and chronic disease, tobacco control, and infant mortality networks had structures consistent with higher performing networks, whereas core local funding networks had structures consistent with lower performing networks.

A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit.

Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01-2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.

Diabetes topics associated with engagement on Twitter.

INTRODUCTION: Social media are widely used by the general public and by public health and health care professionals. Emerging evidence suggests engagement with public health information on social media may influence health behavior. However, the volume of data accumulating daily on Twitter and other social media is a challenge for researchers with limited resources to further examine how social media influence health. To address this challenge, we used crowdsourcing to facilitate the examination of topics associated with engagement with diabetes information on Twitter. METHODS: We took a random sample of 100 tweets that included the hashtag "#diabetes" from each day during a constructed week in May and June 2014. Crowdsourcing through Amazon's Mechanical Turk platform was used to classify tweets into 9 topic categories and their senders into 3 Twitter user categories. Descriptive statistics and Tweedie regression were used to identify tweet and Twitter user characteristics associated with 2 measures of engagement, "favoriting" and "retweeting." RESULTS: Classification was reliable for tweet topics and Twitter user type. The most common tweet topics were medical and nonmedical resources for diabetes. Tweets that included information about diabetes-related health problems were positively and significantly associated with engagement. Tweets about diabetes prevalence, nonmedical resources for diabetes, and jokes or sarcasm about diabetes were significantly negatively associated with engagement. CONCLUSION: Crowdsourcing is a reliable, quick, and economical option for classifying tweets. Public health practitioners aiming to engage constituents around diabetes may want to focus on topics positively associated with engagement.

Evaluating diabetes mobile applications for health literate designs and functionality, 2014.

INTRODUCTION: The expansion of mobile health technologies, particularly for diabetes-related applications (apps), grew exponentially in the past decade. This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost (free or not). METHODS: We used diabetes-related keywords to identify diabetes-related apps for iOS devices. A random sample of 110 apps (24% of total number of apps identified) was selected for coding. The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable. RESULTS: Most diabetes apps in this sample addressed diabetes management and therapeutics, and paid apps were more likely than free apps to use plain language strategies, to label links clearly, and to have at least 1 feature (a "back" button) that helps with the organization. CONCLUSION: Paid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy. Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible.

The diffusion of evidence-based decision making among local health department practitioners in the United States.

OBJECTIVES: Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM. DESIGN, SETTING, AND PARTICIPANTS: Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes. RESULTS: Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers. CONCLUSIONS: Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.