142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

309168
Influence of Public Health Spending and Staffing on Variation in Process and Outcome of Local Health Department Food Safety Inspections

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 1:30 PM - 1:50 PM

Scott Frank, MD, MS , Master of Public Health Program, Case Western Reserve University School of Medicine, Cleveland, OH
Michelle Menegay, MPH , Ohio Research Association for Public Health Improvement, Case Western Reserve University, Cleveland, OH
Purpose: Describe how Local Health Department (LHD) spending and staffing influence variation in process and outcome of food safety inspections. Background: Public health financing research has typically focused on structure and outcomes with little emphasis on process. Investigation of food safety inspections has identified important variations in outcome based on differences in LHD and Sanitarian characteristics.  This investigation examines the influence of public health spending and staffing on process and outcome. Methods: Original data gathered through direct observation of food service establishment (FSE) inspections in 20 LHDs by 77 Registered Sanitarians (RS) conducting 551 inspections. Ohio Annual Financial Report (AFR) provides public health spending and staffing data. This comparative case study utilizes mixed methods, including direct observation, survey, interview, and AFR. Analysis includes multivariable data integration between original data and AFR. Results: Citations were issued in 67% of inspections (2.19/FSE inspection); and verbal corrections given in 80% of inspections (1.93/inspection). Sanitarians frequently discussed improvement plans (87%) and offered food safety education (69%). Low budget LHDs produced more citations; greater thoroughness; greater job strain; more negative attitudes toward FSE; yet showed higher professionalism and fewer encounters with negative interactions. High budget LHDs offered more verbal corrections; more food safety education; and more effective checkouts. Lower staffing levels were related to more citations; greater thoroughness; less effective checkouts; more job strain; more negative attitudes toward FSEs; yet more positive attitudes about their jobs; and greater expression of gratitude from FSEs. Conclusion: Variations related to public health spending/staffing were common and often paradoxical. Low budget/staff demonstrate better performance on some food safety inspection characteristics; while high budget/staff perform better on others. Food safety inspection process and outcomes demonstrate important variation based on public health spending and staffing. Opportunities for cross jurisdictional communication and training may enhance performance in all LHDs.

Learning Areas:

Administration, management, leadership
Biostatistics, economics
Environmental health sciences
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the impact of public health spending and staffing on food safety inspections by LHDs. Examine the influence of public health spending and staffing on sanitarian job strain; and the subsequent impact on the process and outcomes of food safety inspections. Discuss the value of understanding the relationship of public health spending and staffing to the process and outcomes of food safety inspections.

Keyword(s): Public Health Policy, Food Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a family medicine and public health practitioner, educator, and researcher. I am director of a Local Health Department and the CWRU Master of Public Health Program. I am principal investigator for the Ohio Research Association for Public Health Improvement (RAPHI), an RWJF funded Public Health Practice Based Research Network. I have substantial experience in Public Health Services and Systems research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.