NEHA November 2023 Journal of Environmental Health

on the number of standards achieved and number of SA updates submitted. Rates for these comparisons represented the number of Retail Program Standards that a jurisdic- tion achieved conformance with during that cycle, and incidence rate ratios (IRRs) were used to represent the eect of grant programs and population size. Multiple logistic regres- sion was used to estimate the odds ratios of achieving conformance with the Retail Pro- gram Standards and submitting SA updates related to participation in these grant pro- grams. When developing multiple regression models, we tested the eect of the interaction between participation in the Mentorship Pro- gram and RPS CAP on the goodness-of-fit of the models. All statistical analyses were per- formed using Stata 17 BE.

TABLE 4

Average Time for a Third-Party Verification Audit (VA) Following a Successful Self-Assessment (SA)

Time Between SA and VA (Mean # of Months) Cycle 1 Cycle 2 Cycle 3 Cycle 4 Total *

Grant participation

Mentorship Program

2.6

4.6 0.8 4.1 6.3

–

3.0

3.1 0.6 5.1

RPS CAP

–

0.4 1.3 4.8 1.0 4.6 1.9 3.6

– –

Mentorship Program and RPS CAP

14.0 16.5

Neither

0.7

11.9

Jurisdiction population size ** Small (<50,000)

12.89

6.23

–

10.6 10.0 12.0 10.4

Mid-sized (50,000–500,000)

13.0 20.8 14.8

6.5 6.4 5.8

0.7 6.0 1.6

Large (>500,000)

Results

Overall

* Data in the comparison by cycle are skewed due to an administrative change to the Voluntary National Retail Food Regulatory Program Standards in 2008, which is explained further in the Discussion section. ** Population size was determined using NACCHO member profiles. Missing jurisdictions did not have a current NACCHO profile. Note. RPS CAP = Retail Program Standards Cooperative Agreement Program; NACCHO = National Association of County and City Health Officials.

Objective 1

Average Time to Submission of Self-Assessment Table 3 displays a comparison of the average time to submission of SAs across two group- ings: grant participation and jurisdiction size. When comparing time to submission of SAs in jurisdictions that participated in grant programs with jurisdictions that did not, no meaningful dierence was observed (Supple- mental Table A1, www.neha.org/jeh-supple mentals). In examining dierences between individual cycles, we observed a large eect (Cohen’s d = 0.73) when comparing small and large jurisdictions during their second SA cycles. Larger jurisdictions submitted SAs later than smaller jurisdictions. Average Time to Verification Audit Following First Successful Self-Assessment Table 4 shows the comparison of the average time to VA after an LHD submits a successful SA. We see a clear dierence in the data in the amount of time it takes to verify conformance as LHDs continue to work on the Retail Pro- gram Standards. On average, it takes LHDs much longer to verify successful SAs via VAs (14.8 months) during their first cycle com- pared with subsequent cycles. Average time to VA following a successful SA did not dier meaningfully by jurisdiction size. As noted in Table 4, the data by cycles are skewed due to an administrative change in 2008 that altered the required time for verification from 36

FIGURE 1

Trends of Enrollment in the Voluntary National Retail Food Regulatory Program Standards for State, Local, Tribal, and Territorial Food Regulatory Programs

9 0

3 7

3 4

3 1

2 9

2 8

3 0

2 4

2 1

1 9

2 0

1 6

1 4

1 1

1 0

2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 9 2 0 2 0 Y ear

November 2023 • Journal of Environmental Health