Background Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. Objectives (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs’ decision to implement QI initiatives. Methods In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs’ QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration’s Area Resource Files and the Association of State and Territorial Health Officials’ 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. Results The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. Conclusion According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed.

Toxic environmental emissions have the potential to harm already susceptible populations living in close proximity to industries with pollutant emissions such as coal-fired electrical power plants. The organized dissemination of information in communities that find themselves susceptible to occupation by industries with pollutant emissions is a crucial step in the long and arduous process of preventing such harm. Here, we present a blueprint that can be used by community organizations to prevent industries that pollute the environment from locating in communities that are already disproportionately exposed to pollution (referred to here as environmental justice communities). We base this blueprint on a specific case in Taylor County, Florida, where the steps outlined successfully prevented the Taylor Energy Center (TEC) consortium from obtaining the necessary permits for the operation of a proposed coal-fired electrical power plant, thereby minimizing the risks of additional toxicant exposure to the affected community.

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