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Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA
  1. Rachel G Tabak1,
  2. Renee G Parks1,
  3. Peg Allen1,
  4. Rebekah R Jacob1,
  5. Stephanie Mazzucca1,
  6. Katherine A Stamatakis2,
  7. Allison R Poehler1,
  8. Marshall H Chin3,
  9. Maureen Dobbins4,
  10. Debra Dekker5,
  11. Ross C Brownson1,6
  1. 1 Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
  2. 2 Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
  3. 3 Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
  4. 4 National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Hamilton, Ontario, Canada
  5. 5 National Association of County and City Health Officials (NACCHO), District of Columbia, Washington, USA
  6. 6 Department of Surgery (Division of Public Health Sciences) and Alvin J Siteman Cancer Center, Washington University School of Medicine, Washington University, St Louis, Missouri, USA
  1. Correspondence to Dr Rachel G Tabak; rtabak{at}


Objective The nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently known about use of diabetes-related EBIs among LHDs. This study used a national online survey to determine the patterns and correlates of the Centers for Disease Control and Prevention Community Guide-recommended EBIs for diabetes control in LHDs.

Research design and methods A cross-sectional study was conducted to survey a stratified random sample of LHDs regarding department characteristics, respondent characteristics, evidence-based decision making within the LHD, and delivery of EBIs (directly or in collaboration) within five categories (diabetes-related, nutrition, physical activity, obesity, and tobacco). Associations between delivering EBIs and respondent and LHD characteristics and evidence-based decision making were explored using logistic regression models.

Results Among 240 LHDs there was considerable variation among the EBIs delivered. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI 1.02 to 1.62)), diabetes self-management education (OR=1.32 (95% CI 1.04 to 1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI 1.05 to 1.54)). Although all organizational supports for evidence-based decision making factors were related in a positive direction, the only significant association was between evaluation capacity and identifying patients with diabetes and determining effective treatment (OR=1.54 (95% CI 1.08 to 2.19)).

Conclusion Supporting evidence-based decision making and increasing the implementation of these EBIs by more LHDs can help control diabetes nationwide.

  • public health
  • prevention
  • chronic disease prevention and treatment

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Presented at An abstract describing similar results has been accepted to the American Diabetes Association 78th Scientific Sessions (June 2018).

  • Contributors Conceptualization and design: RGT, RCB, RGP, PA, MHC. Survey instrument development and testing: RCB, RGT, PA, KAS, RGP, MHC. Statistical support: RGT, RGP, RRJ, RCB. Writing: RGT, RGP, RCB. Manuscript content revisions: RCB, PA, SM, RGP, MHC, RGT, KAS, MD, DD.

  • Funding This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers 5R01DK109913, 2P30DK092949, and P30DK092950. The findings and conclusions in this article are those of the authors and do not necessarily represent the official positions of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Institutional Review Board at Washington University in St Louis Human Research Protection Office reviewed and approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement A limited data set without identifiable participant data is available on request in coordination with the Human Research Protection Office.

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