The structure and systems of state health departments (SHD) may affect reporting of foodborne disease outbreak (FBDO) hospitalizations. Evaluation of SHD by investigating the contributions of structural capacity elements (SCE) will provide an accurate measure of performance and highlight areas for development of effective strategies for improvement. This study investigated the relationship between organizational and structural characteristics of SHD and systems for FBDO reporting, and included three manuscripts designed to address seven hypotheses, as well as a conclusion chapter interpreting the findings as they relate to the overall research question. Study findings identified consistently higher reports of hospitalization due to foodborne illness from third party payers compared to SHDs between 2006 and 2009 in 30 of the 31 states analyzed. Furthermore, significantly different rates of reporting among states with mixed governance classification were seen when compared to those with centralized and decentralized governance; associations between total laboratory expenditures and total food-related hospitalizations reported were also identified when analyzing healthcare claims data. This dissertation contributes to the current knowledge base for public health services and systems research, as well as food safety surveillance and reporting, and provides an innovative approach to using secondary databases to investigate food safety issues. Findings support the conclusion that collaboration between public and private agencies would support improvements in data collection and foodborne illness surveillance. / Public Health