I always look forward to reading your journal because it is typically relevant and cutting edge. That said, I am writing you today because of my disappointment in your March-April issue of the Journal. As a local Health director for over 10 years and a current PhD student in health services research, I am very aware of the disconnect among research results, dissemination, and best practice implementation at the local level. Your journal elucidated yet again the extent to which this is a problem. My concern is the following: how many times do we locals need to hear from the folks in the academic ivory towers how we are not doing it right, before those folks actually spend some time in our shoes trying to figure out why? I do not believe it is because local health officials are stubbornly clinging to our tried and true methods, nor do I believe it is because we do not know how to understand or interpret research results. I believe that just like in clinical medicine where there is a vast difference between a drug's efficacy in clinical trials and its actual effectiveness in real-world applications, a parallel exits in real-world public health. Have any academicians tried to implement a best practice obesity prevention intervention in a local community outside the scope of a research project? We cannot exclude participants because they do not meet our selection criteria and we cannot pay them to participate, only cajole. Yes, I understand the need to develop gold standard research studies to identify what works, but we are missing the implementation component. You may tell me paragraph such and so says exactly the same thing, but here is really my point: not one of the lead authors of any of the articles in this issue is currently working in local public health. You may be saying the right thing, but you have the wrong people saying it. Including even one article from the local perspective would have gone a long way to differentiate this journal issue from all the others we have seen about how locals just need more training and then we will get it right.

Colleen Bridger, MPH

Gaston County Health Director