Objective: To quantify variation in public health system engagement with tribal organizations across a national sample of communities, and to identify predictors of engagement. Data Sources: We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally-representative cohort of U.S. public health systems. Study Design: Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two-part regression models estimated predictors of tribal engagement. Data Collection: A stratified random sample of local public health agencies were surveyed yielding 574 respondents. An additional cohort of oversampled respondents were also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n=154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.
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