Year of Publication



Public Health

Date Available


Degree Name

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

Committee Chair

Dr. Julia Costich

Committee Member

Dr. Rachel Hogg-Graham

Committee Member

Dr. Richard Ingram


Background: Deaths due to opioid overdose are a significant public health burden in the United States. Studies suggest that local public health systems that perform a high number of essential activities where local health departments contribute to the delivery of the activities and promote increased partnership may positively influence population health outcomes such as overdose mortality. Studies have shown that comprehensive public health systems are associated with improved health outcomes, but this association has not been addressed in the context of opioid overdose deaths. Study Aim: The purpose of this study is to evaluate the associations between local public health system comprehensiveness and drug overdose mortality among a nationally representative cohort of U.S. communities. Study Design & Data Source: A longitudinal cohort study was performed using data from the National Longitudinal Survey of Public Health Systems (NALSYS) and the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) portal. Methods: We performed a log transformation of the outcome variable death rate per 100,000. Descriptive analyses and multiple linear regression were performed to estimate relationship between public health system comprehensiveness and opioid overdose mortality while controlling for population and community characteristics. Results: Across 3 rounds of the NALSYS survey, we found a significant negative association between opioid drug overdose mortality and public health system comprehensiveness (p=0.02). Compared with comprehensive public health systems, when all other variables were held constant, non-comprehensive public health systems had a 10 percentage points higher rate of death per 100,000. Conclusion: Overall, public health systems defined as comprehensive had significantly fewer deaths due to opioid overdose. Allocation of resources to improve availability of services or community partnerships should take this finding into consideration. Future research is necessary to determine the long-term effects on opioid overdose mortality by changing the level of comprehensiveness within a local public health system.

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