Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Glen Mays, PhD, MPH

Committee Member

F. Douglas Scutchfield, MD

Committee Member

Julia F. Costich,JD, PhD

Committee Member

Tyrone Borders, PhD


Clinical preventive services, such as cancer and cardiovascular (CVD) disease screenings are critical components essential for reaching optimal population health outcomes. Although clinical preventive services are recognized to save lives, roughly three-fourths of adults between the ages of 50 and 64 and over 50% of adults aged 65 years and older forego clinical preventive services. Private medical practitioners can provide such services. However, public sector entities, such as local health departments (LHDs), can also deliver them in addition to population based activities. Because of a possible substitution effect among health systems, we hypothesized that a LHD’s choice to be involved with providing cancer or CVD screenings, is contingent on the availability and capacity of other providers in the community. We merged the 2013 NACCHO Profile Survey with the Area Health Resource Files (AHRF) and used maximum likelihood estimation. Results revealed a LHD’s choice to be involved in performing CVD screening directly in a LHD is statistically associated with the availability and supply of private providers in the community, whereas involvement with cancer screening did not reach statistical significance. Other key organizational and sociodemographic variables were strongly associated. The interplay between health systems and its impact on population health outcomes further illustrates the need to support public health practice and policy.

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