There is no consensus about the most important or legitimate measures of PHEP (Nelson et al.
Based on the literature, we expected to find a large population size, BOH presence, and experience in organizing coalitions to be associated with better PHEP outcomes.
Therefore, the association between independent variables and PHEP outcomes was investigated using summary variables in addition to single items.
The relationship between having a BOH and PHEP outcomes was significant for 6 out of 21 EP-Activities, but for 2 of these 6 activities it worked in a direction opposite to what was expected: having a BOH was negatively associated with the LHD's ability to employ a PIS and perform EMS activities.
These relationships suggest an interaction between population size and the presence of a BOH, which led us to explore their joint relationship with PHEP outcomes using a logistic regression model for each of the four summary variables.
Seeing the impact of population size on the effect of having a BOH, we tested whether population size was a confounder of the relationship between having participated in coalitions and PHEP outcomes, but the effect was not substantially changed (Tables 1 and 2).
Because it is a general-purpose survey, we believe the response is less likely to be biased to accentuate a single program such as PHEP.
The most consistent result in this analysis is that LHDs' PHEP activities are strongly and consistendy associated with the jurisdiction's population size.
The NACCHO profile, designed as a general-purpose survey, does not provide the most relevant information about PHEP. Whether EMS services are provided by the health department, for instance, is not the same as the availability, or the quality, of these services in the community.