Term of Award

Summer 2016

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

James Stephens

Committee Member 2

Haresh Rochani


Background: Over 29.1 million people suffer from diabetes in the United States. Diabetes is a chronic debilitating disease that can raise one's risk of stroke, hypertension, neuropathy, skin complications, etc. Local health departments (LHDs) are mandated to provide essential public health services, including screening and preventative care for diabetes. Services offered by local health departments are factors that can be used to determine the impact these health departments have in decreasing the prevalence of diabetes in their jurisdictions. Methods: This study utilizes a cross-sectional research design, and assesses the prevalence of diabetes. The study also examined whether high prevalence of diabetes rates in LHD jurisdiction and other organizational characteristics lead to higher likelihood of LHDs to offer diabetes-related services in those jurisdictions. The study was performed using data acquired for the 2013 National Association of County and City Health Officials (NACCHO), data acquired from the Behavioral Risk Factor Surveillance system (BRFSS), and the Centers for Disease Control and Prevention(CDC). The 2013 NACCHO profile study included survey data that measures the presence and types of diabetes screening and outreach programs that local health departments offer. Additionally, the BRFSS and CDC provide geographic and demographic information in regards to prevalence rates of diabetes in local health departments jurisdictions. Results: The majority of LHDs do not provide diabetes screening services directly. There was an association between the proportion of diabetes in the community and the LHD providing diabetes screening; however no association was found between proportion of diabetes in the community and the LHD providing epidemiological surveillance activities or population based primary prevention activities for chronic disease. Approximately only 32% of local health departments provided diabetes screening services directly. It was found that a local health department that shared authority with state and local officials was more likely to provide diabetes preventative services than any other type of local health department governance. LHD characteristics individually, associated with implementation of diabetes preventative services at least at the 0.05 significance level are: completion of a community health assessment with 3 years, performing epidemiological activities, a local health department serving more than 50,000 people, the proportion of diabetes in the local health department jurisdiction, and local health department being involved in policy for chronic disease. Conclusion: Local health departments with shared governance between the state and local public health officials seemed to be the best at providing diabetes preventative services. Those local health department engaged in policy activities for chronic disease seemed to be more likely and able to provide some diabetes preventatives services than those who did not. Smaller LHDs are more likely to provide direct diabetes screening procedures in their jurisdictions. The completion of a community health assessment was relevant to the likelihood of some local health departments providing diabetes preventative services.

Research Data and Supplementary Material