The web-based survey was created based on existing instruments (Environmental Defense Fund 2008) and on a focus group discussion with PHNAs of Ohio local public health departments (n = 6).
Most respondents were PHNAs, female, and white, had worked in public health for [greater than or equal to] 5 years, held a baccalaureate degree or higher, and worked in a county public health department (Table 1).
PHNAs identified fewer (4.8 [+ or -] 3.7) health-related impacts of climate change than did PHNs (6.6 [+ or -] 3-9; F = 4.7, p = 0.03).
Overall, PHNs and PHNAs view the environment as under threat by human activities.
Compared with PHNAs, more PHNs in our study identified flood-related displacement, disruption of health care services during extreme weather events, and cold-related illnesses as health-related impacts of climate change.
Although this response rate is less than other surveys of PHNAs (52-68%) (Cole et al.
Finally, although the survey instrument was developed with input from a focus group with PHNAs, was based on another existing tool, and was reviewed by several public health colleagues, there was no formal pilot testing of the instrument.