Health Services Research Commons^™

Beyond Original Intent – The Use Of A Corporation’S Administrative Databases For Academic Research, Martin D. Slade, Linda Cantley, Baylah Tessier-Sherman, Deron Galusha, Michael Mctague

Yale Day of Data

Large corporations maintain a variety of administrative databases as part of their normal operations. These databases, created for distinct functions by separate organizational entities, are generally independent. For instance, a company’s Human Resources organization typically maintains a database containing information such as demographics, job and salary history, and employee status for all employees.. The environmental, health and safety department maintains information regarding work-place exposures and exposure levels for various agents within each job as well as injury and illness surveillance records. The medical department maintains occupational health information including audiometric and pulmonary function test results. As many large corporations are …

The Yoda Project: Developing Methods For Sharing Clinical Trial Data, Jessica Ritchie, Harlan Krumholz, Joseph Ross, Cary Gross, Beth Hodshon

Yale Day of Data

Abstract

Data sharing and data transparency are becoming the new standard in clinical research to ensure that patients and clinicians possess all necessary information about a drug or device when making treatment decisions. The Yale University Open Data Access (YODA) Project developed a model to facilitate access to participant-level clinical research data to promote independent analysis by external investigators. The YODA Project is currently collaborating with Medtronic, Inc. and Janssen, the pharmaceutical companies of Johnson & Johnson, to facilitate access to their clinical trial program data by external investigators in a manner that is aligned with the following principles: advance …

Lack Of Awareness Of Human Immunodeficiency Virus (Hiv) Infection: Problems And Solutions With Self-Reported Hiv Serostatus Of Men Who Have Sex With Men, Travis H. Sanchez, Colleen F. Kelley, Eli Rosenberg, Nicole Luisi, Brandon O'Hara, Rodriques Lambert, Raphael Coleman, Paula M. Frew, Laura F. Salazar, Sijia Tao, William Clarke, Carlos Del Rio, Patrick S. Sullivan

Environmental & Global Health Faculty Research

Background. Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alternatives are needed.Methods. The InvolveMENt study examined HIV disparities between black and white MSM from Atlanta. Among HIV-positive participants who did not report knowing they were positive, we examined other measures of awareness: … See full text for complete abstract.

Doctors’ Perspectives Of Informed Consent For Non‐Emergency Surgical Procedures: A Qualitative Interview Study, Fiona Wood, Sean Michael Martin, Andrew Carson-Stevens, Glyn Elwyn, Elizabeth Precious, Paul Kinnersley

Dartmouth Scholarship

Background: The need to involve patients more in decisions about their care, the ethical imperative and concerns about ligation and complaints has highlighted the issue of informed consent and how it is obtained. In order for a patient to make an informed decision about their treatment, they need appropriate discussion of the risks and benefits of the treatment.

Objectives: To explore doctors' perspectives of gaining informed consent for routine surgical procedures.

Design: Qualitative study using semi-structured interviews selected by purposive sampling. Data were analysed thematically.

Association Analysis Of Reported Attitudes And Culturally Competent Behavior Engagement Among Public Health Department Employees, Marla B. Hall Phd, Jeffrey J. Guidry Phd, E. Lisako Mckyer Phd, Corliss Outley Phd, Danny Ballard Phd

Journal of Health Disparities Research and Practice

Objective: The purpose of this research is to analyze the association of attitudes and beliefs on engaging in culturally competent behavior.

Design: Explorational case study of individuals employed within an urban public health department.

Participants: Employees (n=90) from four metropolitan clinical sites of an urban public health department located in the southwest region of the United States were solicited and recruited during a monthly staff meeting. This sample is representative of 84% of the total employees which is comprised of 107 individuals.

Main Outcome Measures: The Cultural Competence Assessment is designed to explore individual knowledge, feelings …

Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2012 nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA’s large investment in the health center program provides new resources to help meet growing needs.

This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health …

Chhs September 2014 E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

A Qualitative Examination About Providers’ Perceptions And Recommendations Regarding The Role Of Public Librarians In Addressing Communities’ Health Literacy., Van Ta Park, Lili Luo, Denise Rosidi

Faculty Publications

We assessed health care providers’ perspectives on libraries as a source of health information and elicited input on how to adequately prepare public librarians to provide health information services. Sample text-based reference transactions were shown to determine whether they think the health inquiries were adequately answered. Results showed that participants had favorable perspectives about public libraries, and thought that the public librarians’ role includes addressing the health literacy community needs. Participants provided recommendations for public librarians to improve health literacy. To enhance the ability of public librarians to meet the health literacy needs of their communities, diverse perspectives such as …

Persistent Hiv-Related Stigma In Rural Uganda During A Period Of Increasing Hiv Incidence Despite Treatment Expansion, Brian T. Chan, Sheri D. Weiser, Yap Boum Ii, Mark J. Siedner, Rain Mocello, Jessica E. Haberer, Peter Hunt, Jeffrey N. Martin, Kenneth H. Mayer, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion.

Design—Serial cross-sectional surveys.

Methods—We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We …

Tingkat Pengetahuan Dan Persepsi Terhadap Shisha Pada Mahasiswa, Dhimas Nirwana Yudha, Yayi Suryo Prabandari, Purwanta Purwanta

Kesmas

Isu yang berkembang terkait pengetahuan dan persepsi seorang calon tenaga kesehatan memengaruhi keberhasilan pelayanan kesehatan dalam menjawab tantangan di masyarakat nantinya. Shisha (rokok dari Timur Tengah) mulai marak di Yogyakarta. Tujuan penelitian ini untuk memperoleh gambaran tentang tingkat pengetahuan dan persepsi terhadap shisha pada mahasiswa reguler tahap akademik Fakultas Kedokteran Universitas Gadjah Mada. Penelitian ini merupakan penelitian deskriptif menggunakan rancangan potong lintang. Sampel penelitian adalah mahasiswa dari tiga program studi yang dilakukan pada bulan September - Oktober 2013. Jumlah responden sebanyak 72 mahasiswa ilmu keperawatan, 74 mahasiswa gizi dan kesehatan dan 258 mahasiswa pendidikan dokter. Pengumpulan data dilakukan dengan kuesioner. …

Malnutrisi Akut Berat Dan Determinannya Pada Balita Di Wilayah Rural Dan Urban, Titih Huriah, Laksono Trisnantoro, Fitri Haryanti, Madarina Julia

Kesmas

Malnutrisi akut berat merupakan malnutrisi yang paling serius yang memengaruhi balita dan merupakan masalah kesehatan utama di negara-negara berkembang. Malnutrisi telah meluas baik di perkotaan maupun perdesaan. Akar permasalahan malnutrisi di negara berkembang salah satunya adalah faktor sosial demografi. Tujuan penelitian untuk melihat perbedaan kejadian malnutrisi dan determinannya di area perkotaan dan pedesaan di Yogyakarta. Penelitian menggunakan desain potong lintang dengan responden adalah semua balita malnutrisi akut berat di Kabupaten Sleman (23 balita) dan Kota Yogyakarta (33 balita). Analisis data menggunakan statistik deskriptif dan inferensial. Penelitian dilaksanakan pada Bulan Desember 2012 - Februari 2013. Prevalensi balita malnutrisi akut lebih banyak …

Asupan Karbohidrat Sebagai Faktor Dominan Yang Berhubungan Dengan Kadar Gula Darah Puasa, Aprilya Roza Werdani, Triyanti Triyanti

Kesmas

Peningkatan kadar gula darah memicu peningkatan produksi hormon insulin yang erat hubungannya dengan diabetes melitus. Berdasarkan data Riskesdas, prevalensi diabetes melitus di Indonesia meningkat dari 1,1% (2007) menjadi 2,1% (2013). Penelitian ini bertujuan untuk mengetahui faktor dominan yang berhubungan dengan kadar gula darah puasa pegawai pemberdayaan masyarakat & keluarga dan pegawai sekretariat daerah Kota Depok. Desain penelitian yang digunakan adalah potong lintang dan melibatkan 105 sampel. Variabel independen penelitian meliputi karakteristik individu, asupan zat gizi, hipertensi, aktivitas fisik, status gizi dan pengetahuan gizi. Analisis data yang dilakukan adalah analisis univariat, analisis bivariat menggunakan uji korelasi dan uji beda dua mean, …

Optimalisasi Sistem Pelayanan Kesehatan Berjenjang Pada Program Kartu Jakarta Sehat, Fachmi Idris

Kesmas

Peningkatan jumlah kunjungan pasien ke rumah sakit pada awal masa pemberlakuan program Kartu Jakarta Sehat (KJS) disebabkan belum optimalnya sistem pelayanan kesehatan berjenjang. PT Asuransi Kesehatan (PT Askes) bersama Dinas Kesehatan DKI Jakarta melakukan berbagai upaya dalam bentuk paket intervensi untuk mengoptimalkan sistem tersebut. Penelitian ini bertujuan untuk mengevaluasi efektivitas paket intervensi PT Askes dan Dinas Kesehatan DKI Jakarta dalam meningkatkan optimilisasi sistem rujukan pelayanan kesehatan. Penelitian ini menggunakan survei potong lintang dengan metode pengambilan sampel acak pada puskesmas di DKI Jakarta terhadap hasil intervensi PT Askes. Hasil intervensi diukur melalui wawancara pada kepala puskesmas atau petugas yang mewakili. Data …

Pengaruh Pendekatan Child Healthcare Modeldan Transtheoretical Model Terhadap Asupan Makan Anak Overweight Dan Obesitas, Kadek Ayu Erika, Elly Nurachmah

Kesmas

Overweight dan obesitas pada anak merupakan suatu masalah yang kompleks disebabkan multifaktor, yaitu interaksi genetik dan lingkungan. Gaya hidup perkotaan dipicu oleh asupan makanan yang berlebih pada anak overweight dan obesitas. Strategi untuk menurunkan asupan makan berlebih pada anak adalah dengan pendekatan child healthcare model dan transtheoretical model sehingga dapat mengendalikan gaya hidup anak. Penelitian ini bertujuan membuktikan pengaruh pendekatan child healthcare dan transtheoretical model terhadap asupan karbohidrat anak overweight dan obesitas. Penelitian ini dilaksanakan di wilayah kecamatan Biringkanaya dan Tamalanrea, Makassar, pada bulan Agustus 2013 sampai Maret 2014. Desain yang digunakan adalah quasy experiment yaitu pretest and posttest with …

Penelitian Genom Dan Implikasinya Dalam Kesehatan Masyarakat Di Indonesia, Doni Hikmat Ramdhan

Kesmas

Penelitian genom yang mengkaji kaitan antara setiap gen dengan suatu penyakit sekaligus mekanismenya untuk mendapatkan pengetahuan yang menyeluruh dalam pengobatan, telah membawa perubahan besar dunia kedokteran dalam mengobati berbagai penyakit. Namun demikian, penelitian genom seharusnya tidak hanya dimanfaatkan untuk pengobatan tetapi juga untuk pencegahan penyakit. Artikel ini membahas masalah kesehatan masyarakat dan peluang pemanfaatan penelitian genom dalam pencegahan penyakit. Penelitian genom yang dapat dimanfaatkan pada bidang kesehatan masyarakat adalah toksikogenomik dan nutrigenomik. Penelitian toksikogenomik mengkaji respons gen akibat pajanan toksikan yang berdampak pada kesehatan manusia. Penelitian nutrigenomik mengkaji respons gen terhadap makanan yang berdampak pada kesehatan manusia. Penelitian toksikogenomik dan …

Fertilitas Remaja Di Indonesia, Mugia Bayu Raharja

Kesmas

Fertilitas remaja merupakan isu penting dari segi kesehatan dan sosial karena berhubungan dengan tingkat morbiditas serta mortalitas ibu dan anak. Tujuan penelitian adalah mempelajari faktor-faktor yang memengaruhi fertilitas remaja di Indonesia. Data yang digunakan adalah hasil Survei Demografi dan Kesehatan Indonesia tahun 2012 dengan unit analisis wanita usia subur yang termasuk dalam kategori usia remaja (15 - 19 tahun). Jumlah sampel sebanyak 6.927 responden. Analisis dilakukan dengan metode deskriptif dan inferensial menggunakan model regresi logistik biner. Hasil analisis menunjukkan bahwa satu dari sepuluh remaja wanita tersebut pernah melahirkan dan atau sedang hamil saat survei dilakukan; sebesar 95,2% dari remaja yang …

Pattern Of Household Drug Storage, Retno Gitawati

Kesmas

Household storage of pharmaceutical is world-widely practice, including in Indonesia. The purpose of this study was to obtain the pattern of medicine storage, the sources and reasons of medicine kept in households. Acrosssectional survey was conducted on October 2011, involving 250 adult household respondents, randomly selected from three subdistricts in North Jakarta, and have approved the written consents, and interviewed with structured questionnaire. Data were performed in univariate and bivariate analysis with chi square test. The majority of household (82%) stored drugs at home; analgesic-antipyretic nonsteroidal anti-inflammatory was the type of drugs kept by mostly (76.1%) of household. Out of …

Peningkatan Determinan Sosial Dalam Menurunkan Kejadian Tuberkulosis Paru, Dyah Wulan Sumekar Rengganis Wardani

Kesmas

Upaya pengendalian tuberkulosis paru oleh World Health Organization telah meningkatkan angka kesembuhan dan menyelamatkan banyak jiwa, tetapi kurang berhasil dalam menurunkan insiden tuberkulosis. Oleh karena itu, pengendalian tuberkulosis akan lebih menekankan pada kebijakan determinan sosial karena determinan sosial secara langsung maupun melalui faktor risiko tuberkulosis berpengaruh terhadap tuberkulosis. Di Bandar Lampung, angka notifikasi tuberkulosis dari tahun 2009 – 2010 mengalami peningkatan walaupun angka kesembuhan sudah lebih dari 85%. Bandar Lampung juga merupakan bagian dari salah satu provinsi termiskin di Indonesia. Penelitian ini bertujuan untuk mempelajari pengaruh determinan sosial (yang diukur melalui indikator pendidikan, pendapatan dan kelas sosial) terhadap kejadian tuberkulosis. …

Pertumbuhan Dan Perkembangan Anak Usia 3-24 Bulan Di Daerah Konflik, Hastuti Usman, Hadyana Sukandar, Ma’Mun Sutisna

Kesmas

Lima tahun pertama adalah masa penting dalam proses tumbuh kembang anak. Anak lahir dan tinggal di daerah rawan bencana (bencana alam, perang, atau konflik bersenjata) berisiko mengalami kegagalan pertumbuhan dan keterlambatan perkembangan. Penelitian ini bertujuan mengukur perbedaan pertumbuhan dan perkembangan anak usia 3 - 24 bulan antara yang tinggal di daerah konflik dan bukan konflik dan menganalisis korelasi tempat tinggal daerah konflik dengan pertumbuhan serta perkembangan anak usia 3 - 24 bulan. Metode penelitian secara potong lintang dilakukan di Kabupaten Poso periode Februari - Maret 2014 terhadap 40 anak usia 3 - 24 bulan di daerah konflik dan bukan konflik. …

Family Role Towards Smoking Behaviour Among Children In Jakarta, Wahyu Septiono, Dan Wolf Meyrowitsch

Kesmas

In Indonesia, the prevalence of smoking among 5 – 9 years old children has increased from 0.4% in 2001 to 2% in 2007. Among present adults smokers (>20 years), 17% started to smoke before the age of 13 years. This study identified factors related to smoking behaviour among 8 – 12 years old children in Jakarta, Indonesia using a questionnaire based cross sectional survey to obtain smoking status and possible predictors towards smoking habit. The total sample size was 1,097 students among 3rd - 7th grade students from schools in Jakarta. Self-reported smoking status was defined as whether the …

Evaluasi Pelaksanaan Konseling Menyusui, Ika Murtiyarini, Dewi Marhaeni Diah Herawati, Irvan Afriandi

Kesmas

Salah satu upaya pemerintah dalam meningkatkan pemberian ASI di Indonesia adalah dengan memberikan konseling menyusui di pelayanan kesehatan. Penelitian perlu dilakukan untuk mengevaluasi pelaksanaan konseling menyusui di Kota Jambi dengan mengeksplorasi komponen input, activity, output, dan outcome. Penelitian ini merupakan penelitian kualitatif menggunakan strategi studi kasus. Penelitian dilakukan di empat puskesmas Kota Jambi pada bulan Desember 2013 sampai dengan Februari 2014. Pengumpulan data dilakukan dengan studi dokumen, observasi pelaksanaan konseling menyusui dan sarana prasarana, wawancara mendalam, serta focus group discussion. Analisis data yang digunakan adalah analisis tematik. Hasil penelitian menunjukkan bahwa komponen input dan activity kurang optimal seperti kurangnya sumber …

Diagnosis Dini Tuberkulosis Pada Kontak Serumah Dengan Penderita Tuberkulosis Paru Melalui Deteksi Kadar Ifn-Γ, Sri Andarini Indreswari, Suharyo Suharyo

Kesmas

Tuberkulosis paru masih merupakan masalah dunia. Indonesia menempati peringkat ke tiga di dunia pada tahun 2012. Target nasional Case Detection Rate tahun 2012 adalah 70%, sedangkan pencapaian Jawa Tengah sebesar 58,48%. Penelitian ini bertujuan untuk memperoleh batas kadar interferon (IFN) γ pada orang kontak serumah dengan penderita tuberkulosis paru sebagai dasar diagnosis dini penyakit tuberkulosis. Penelitian dilakukan secara kohort selama dua tahun (2011 - 2013) di Balai Kesehatan Masyarakat Paru Semarang. Pada akhir penelitian, terdapat 12 responden kontak dan 13 tidak kontak serumah. Uji Wilcoxon menunjukkan perbedaan bermakna rerata kadar IFN-γ antara kelompok kontak dengan kelompok tidak kontak serumah (nilai …

Pendapatan Daerah, Pembiayaan Kesehatan, Dan Gizi Buruk Pada Balita: Studi Korelasi Tingkat Kabupaten/Kota, Septyana Choirunisa, Asri C. Adisasmita

Kesmas

Pendanaan kesehatan merupakan salah satu faktor penting dalam memengaruhi derajat kesehatan, termasuk salah satu masalah gizi pada balita yang disebut gizi buruk. Oleh karena itu, penelitian ini bertujuan mendeskripsikan pendapatan daerah dan pembiayaan kesehatan serta korelasinya dengan gizi buruk pada balita di tingkat kabupaten/kota di Indonesia tahun 2007. Penelitian ini merupakan studi ekologi/korelasi. Data pendapatan daerah dan pembiayaan kesehatan didapat dari Kementerian Keuangan, sedangkan data gizi buruk menggunakan data Riset Kesehatan Nasional tahun 2007. Sebanyak 250 kabupaten/kota yang diteliti dengan tidak mengikutsertakan kabupaten/kota yang datanya tidak lengkap atau tidak valid. Secara nasional, hanya persentase pendapatan asli daerah (PAD) per total …

Asupan Vitamin D Rendah Dan Keparahan Demam Berdarah Dengue Pada Anak Usia 1-14 Tahun, Nur Siyam, Siswanto Agus Wilopo, Mohammad Hakimi

Kesmas

Demam berdarah dengue (DBD) menimbulkan syok dan kematian. Penderita DBD di Yogyakarta sebagian besar usia 1 - 12 tahun dengan DBD parah. Asupan vitamin D rendah diasumsikan penyebab DBD parah. Asumsi ini perlu dibuktikan dengan menganalisis pengaruh asupan Vitamin D dan keparahan DBD. Rancangan penelitian adalah studi kasus kontrol. Penelitian di bangsal rawat inap anak dan instalasi catatan medik RS Jogja dan RSUP Dr. Sardjito. Kasus adalah anak usia 1 - 14 tahun dengan DBD grade III & IV, kontrolnya DBD grade I & II. Data asupan vitamin D diambil dengan food frequency questionnaire (FFQ). Variabel luar adalah indeks massa …

Discovering Community Assets: Master Of Public Health Culminating Experience, Megan E. Sirna

Master's Projects and Capstones

The Sonoma County Department of Health Services, through Cradle to Career, promotes collective impact around educational attainment and workforce development, and has become a leader in developing a framework for community schools. The first step in developing a community schools model is to understand and inventory what is already going on in the community. This process, known more formally as asset mapping, is a participatory process focused on documenting the strengths and resources of a community. The collaborative nature of the process helps to promote community involvement and build community cohesion. In order to assist schools wanting to begin an …

Nutrition Education And Community Advocacy At Marin Health And Human Services, Anna C. Allison

Master's Projects and Capstones

It would be a mistake to assume that all Marin neighborhoods look the same. The life expectancy in Ross is over 88 years. Less than 10 miles away in Hamilton Novato, the life expectancy is 75 years. That is a 13 year difference in life expectancy, roughly equivalent to the difference between living in the United States and Guyana. Marin is a small county, but it holds a great deal of variation. An effective health intervention in one neighborhood will not work in another, more importantly, there may not be the same health issue from one neighborhood to the next. …

Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker

Frontiers in Public Health Services and Systems Research

Anecdotal evidence suggests that historically African American communities on the fringes of cities and towns in North Carolina have been systematically denied access to municipal drinking water service. This paper presents the first statistical analysis of the role of race in determining water access in these fringe areas, known as extraterritorial jurisdictions. Using publicly available property tax data, we quantified the percentage of residences with municipal water service in each census block in Wake County (the second-largest by population in North Carolina). Using the resulting water service maps plus 2010 U.S. Census data, we employed a logistic regression to assess …

Economies Of Scale And Scope In Public Health: An Analysis Of Food Hygiene Services Provided By Local Health Departments In Florida, Simone Singh, Patrick M. Bernet

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) across the United States deliver a range of essential public health services, yet little is known about the costs that LHDs incur in providing these services and the factors that may cause costs to vary both within and across health departments. This report first describes the variations in the costs of one core public health activity commonly provided by LHDs: food hygiene services. It then analyzes the factors that drive LHDs' cost of service provision focusing on the role of economies of scale and economies of scope. Using data for all LHDs in Florida for 2008 …

Editorial Comment: Temporal Trends In Preparedness Capacity, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In view of the critical role local health departments (LHDs) play among agencies responsible for responding to natural and man-made emergencies, Bevc et al. examined the LHDs’ emergency preparedness and capacity. They compared LHDs in North Carolina with those across the country for preparedness along eight domains. Significant declines in emergency preparedness were noted from 2010 to 2012 for five out of eight domains, raising questions about our national priority concerning this important function of public health agencies. These findings have numerous implications, some of which are covered in this commentary.

Temporal Trends In Local Public Health Preparedness Capacity, Christine A. Bevc, Mary V. Davis, Anna P. Schenck

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) are essential to emergency preparedness and response activities. Since 2005, LHD resources for preparedness, including personnel, are declining in the face of continuing gaps and variation in the performance of preparedness activities. The effect of these funding decreases on LHD preparedness performance is not well understood. This study examines the performance of preparedness capacities among NC LHDs and a matched national comparison group of LHDs over three years. We observe significant decreases in five of eight preparedness domains from three years of survey data collected from 2010 through 2012. Most notably, we observe significant decreases in …