To assess the perceptions, practices, and needs of state and local health officers with respect to professional interactions with the media. A survey of 759 public health officers (56 state and 703 local) on jurisdiction demographics, frequency of media interactions, agency process for media contacts, provision and need for media training, and character of media relations. Fifty-two state health officers and 568 US local health officers responded, for a survey response rate of 82%. Media reporting was perceived as accurate 52% to 73% of the time, although reporters were seen as needing improved technical and scientific knowledge. Media were used frequently as a component of health education. State health jurisdictions were more likely than local jurisdictions to have a media protocol and designated media contact, to internally review media releases, to interact regularly with media, and to provide staff training on media relations. Media interaction time comprised print media (63%), television (19%), and ratio (17%). One third of the health officers found media relations adversarial, but most held a positive overall view of the media. Favorable evaluation of the media was associated with high frequency of media contact, high perceived accuracy of reporting, and presence of an institutional media protocol. While health officers evaluated media favorably, problem areas were identified where mutual education could improve the accuracy and value of media reporting on health issues. Training capacity for both professions should be developed to increase the effectiveness of public health in media relations.