Abstract
Objective: To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response.
Design: State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing.
Setting: State health departments in the United States.
Results: States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86).
Conclusion: State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.