Community-level Indicators Research Articles

The Individual-Level and Community-Level Social Determinants of Burn Injuries: A Single-Institution Study From the Southwestern United States.

Burn injuries are a significant public health concern, causing life-threatening complications and substantial hospitalization costs for patients. It has been shown that burn injuries may affect individuals differently based on demographic factors and socioeconomic status, among other variables. In the Southwestern United States with high ambient temperatures, specific burn etiologies, such as pavement burns, may pose a disproportionately high risk for disadvantaged communities and homeless individuals. This study uniquely explores burn injuries in relation to patients' socioeconomic status in Las Vegas, Nevada by using the Distressed Community Index to quantify socioeconomic status utilizing individual-level and community-level indicators. This single-institution and retrospective study collected data from all patients admitted to a burn center located in Las Vegas. Data were analyzed through Chi-square, one-way ANOVA, and post-hoc analysis with Tukey's test. Patients residing in distressed communities contributed to the greatest number of burn injuries, however there was a lack of significant association between socioeconomic status and burn injury (p = 202). Additionally, specific burn etiologies and demographic characteristics were associated with variations in burn patient hospital course, complications, resources utilized and outcomes. Distressed patients were significantly associated with public insurance (p < 0.001), and public insurance users were associated with pavement burns-one of the most severe burn injuries (p < 0.001). This study emphasizes the importance of developing comprehensive burn prevention resources tailored to vulnerable populations, especially in regions with increased incidence of severe burn injuries, in order to reduce burn burden and mortality.

Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis.

Introduction: Evidence exists that individual-level sociodemographic factors contribute to vaccine hesitancy, but it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nationwide survey on COVID-19 vaccine hesitancy with a community-level indicator, i.e., the Distressed Communities Index (DCI). Methods: Attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust were measured using a 48-item, psychometrically valid and reliable survey tool. In this study, 2138 survey participants residing in the United States were divided into quintiles of varying community distress levels based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post hoc analysis with Tukey's test. Results: A significantly higher proportion of participants from the distressed communities had lower trust than their prosperous counterparts (26.6% vs. 37.6%, p < 0.001). On the contrary, participants from the prosperous communities had significantly higher vaccine confidence index scores than those in distressed communities (2.22 ± 1.13 vs. 1.70 ± 1.01, p < 0.001). Conclusions: These findings affirm the importance of developing community-level interventions to promote trust in COVID-19 vaccinations and increase booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions.

Characterizing Socioecological Markers of Differentiated HIV Risk Among Men Who Have Sex with Men in Indonesia

HIV prevention programs typically focus on changing individuals’ risk behaviors, often without considering the socioecological factors that can moderate this risk. We characterized HIV risk among men who have sex with men (MSM) in Indonesia (n = 1314) using latent class analysis and used multinomial logistic regression to identify latent class relationships with demographics, social/sexual networks, and community-level socioecological indicators of HIV risk. Three HIV risk latent classes were identified—“Sexually Moderate” (n = 333), “Sexual Explorative” (n = 575), and “Navigating Complexities” (n = 406). Using “Sexually Moderate” (lowest risk) as the reference group, MSM in the “Sexual Explorative” class had additional social/sexual network-level risks (meeting partner(s) using both online and offline methods [RR = 3.8; 95%CI 1.7–8.6] or general social media and gay-specific online platforms [RR = 2.6; 95%CI 1.9–3.6] to meet partners, group sex [RR = 10.9; 95%CI 4.5–25.4], transactional sex [RR = 1.6; 95%CI 1.2–2.2]), and community-level risks (experiencing homosexual-related assaults [RR = 1.4; 95%CI 1.1–1.9]). MSM in the “Navigating Complexities” class had additional social/sexual network-level risks (low social support [RR = 1.6; 95%CI 1.1–2.5], less disclosure of their sexuality [RR = 1.4; 95%CI 1.0–1.9]) and community-level risks (higher internalized homonegativity scores [RR = 1.2; 95%CI 1.1–1.4], ever experiencing homosexual-related assaults [RR = 1.4:95%CI 1.1–1.9], less exposure to HIV/STI health promotion [RR = 0.7; 95%CI 0.5–0.9], attending STI-related services in the past 6 months [RR = 0.6; 95%CI 0.4–0.8]). Co-occurring individual and socioecological risk recommend holistic HIV prevention strategies tailored to consider the social and structural conditions of MSM in Indonesia are needed.

Bridging the digital health divide-patient experiences with mobile integrated health and facilitated telehealth by community-level indicators of health disparity.

Evaluate the impact of community tele-paramedicine (CTP) on patient experience and satisfaction relative to community-level indicators of health disparity. This mixed-methods study evaluates patient-reported satisfaction and experience with CTP, a facilitated telehealth program combining in-home paramedic visits with video visits by emergency physicians. Anonymous post-CTP visit survey responses and themes derived from directed content analysis of in-depth interviews from participants of a randomized clinical trial of mobile integrated health and telehealth were stratified into high, moderate, and low health disparity Community Health Districts (CHD) according to the 2018 New York City (NYC) Community Health Survey. Among 232 CTP patients, 55% resided in high or moderate disparity CHDs but accounted for 66% of visits between April 2019 and October 2021. CHDs with the highest proportion of CTP visits were more adversely impacted by social determinants of health relative to the NYC average. Satisfaction surveys were completed in 37% of 2078 CTP visits between February 2021 and March 2023 demonstrating high patient satisfaction that did not vary by community-level health disparity. Qualitative interviews conducted with 19 patients identified differing perspectives on the value of CTP: patients in high-disparity CHDs expressed themes aligned with improved health literacy, self-efficacy, and a more engaged health system, whereas those from low-disparity CHDs focused on convenience and uniquely identified redundancies in at-home services. This mixed-methods analysis suggests CTP bridges the digital health divide by facilitating telehealth in communities negatively impacted by health disparities.

Response of Forest Bird Communities to Managed Landscapes in the Acadian Forest

The loss of mature forests is a known stressor of forest management on biodiversity. Mature forests provide unique habitat for forest birds. Here, we examine the capacity of mature forest stands embedded in an intensively managed landscape to provide habitat for landbird species that are associated with mature, unfragmented habitats. We carry this out by comparing bird communities in forest stands in three landscapes with a gradient of management activity. We examined community-level indicators (richness, diversity, abundance and community structure), and trait-level indicators (species groups associated with cavity nesting, mature forests, interior forests and area sensitivity). We found no obvious negative effects on bird communities, species and trait groups in forest stands in the most intensively managed landscape relative to the less intensively managed landscapes. Our ability to draw inferences about the influence of management intensity is limited due to lack of replication; however, these results do provide evidence that mature forest stands within intensively managed landscapes can provide valuable habitat to mature forest associates. There are often trade-offs between generating wood products from the forest and the provision of mature forest habitats. Research on forest birds can provide some of the necessary information for assessing the size and shape of those trade-offs and help to inform the conversation about the desired structure, function and composition of forests.

Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South

IntroductionFederally Qualified Health Centers (FQHCs) may increase access to HIV prevention, care, and treatment for at-risk populations. MethodsA pooled cross-section of Zip Code Tabulation Areas (ZCTAs) from cites in the US South with high HIV diagnoses were used to examine FQHC density and indicators of HIV epidemic control. The explanatory variable was FQHC density – number of FQHCs in a ZCTA's Primary Care Service Area (PCSA) per low-income population – high vs. medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) 1) number of new HIV diagnoses, 2) percent late diagnosis, 3) percent linked to care, and 4) percent virally suppressed, which was assessed over 1-year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZCTA-level sociodemographic and city-level HIV funding variables with state fixed-effects, and data analysis was completed in 2022-2023. Sensitivity analyses included examining, 1) ZCTAs with fewer non-FQHC primary care providers (PCPs), 2) controlling for county-level PCP-density, 3) excluding highest HIV prevalence ZCTAs, and 4) excluding Florida ZCTAs. ResultsHigh density ZCTAs had lower percent late diagnosis and virally suppressed, higher percent linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high, compared to medium/low, density was associated with greater number new diagnoses (number or percent, 5.65; 95% Confidence Interval, 2.81, 8.49), lower percent late diagnosis (-3.71%; -5.99, -1.42), higher percent linked to care (2.13%; 0.20, 4.06), and higher percent virally suppressed (1.87%; 0.53, 2.74). ConclusionsResults suggest access to FQHCs may benefit community-level HIV epidemic indicators.

지역 사회 세계시민 역량 지표 개발에 관한 델파이 조사 연구: 인천시 Y구 사례를 중심으로

The purpose of this study is to develop local community-level indicators that can monitor the capabilities of global citizens to measure the effectiveness of global citizenship education for adults amid the spread of global citizenship education. It followed the distinction of cognitive, social and emotional, and behavioral areas, which are the core competencies of global citizens presented by UNESCO. The categories were selected after reflecting the main conceptual words derived through prior research analysis and the preliminary survey results for related parties, and considering the major conceptual words necessary for Y-gu, Incheon. After that, an expert Delphi survey was conducted twice to develop indicators. The results of the study are as follows. A total of 46 indicators were developed, including 3 categories, 14 conceptual elements, and 17 questions in the cognitive domain, 3 categories, 13 concept elements, 15 questions in the social and emotional domain, and 3 categories, 10 concept elements, and 14 questions in the behavioral domain. Through this study, it was confirmed that global citizenship and local citizenship should be recognized from an integrated perspective, and that global problems should be viewed in connection with local daily lives. This study is meaningful in that it presented examples that can be appropriately used in other regions where global citizenship education is being conducted.

Lexical analysis improves the identification of contextual drivers and farm typologies in the assessment of transitions to agroecology through TAPE – A case study from rural Nicaragua

CONTEXTThe Tool for Agroecological Performance Evaluation (TAPE) has been developed to assess the degree of transition to agroecology (Step 1) and the agroecological performance (Step 2) of family farms. However, while methods and indicators for Steps 1 and 2 are well established, the phases of system characterization (Step 0) and the delineation of typologies (Step 1-bis) are not prescribed nor standardised. This results in highly heterogeneous, unstructured and narrative information, subject to the background of the field enumerator. Analytical methods are needed to deal with these, in order to arrive at relevant domains of recommendations for policy and development. OBJECTIVEWe assessed whether lexical analysis improves the ability of TAPE to elucidate: i) how household characteristics and contextual factors influence such agroecological transitions, ii) whether a high degree of transition to agroecology (Step 1) translates into better agroecological performances (Step 2), and iii) whether data from Step 0 could improve the delineation of transition typologies. METHODSWe considered 29 rural households located in separate localities across three regions of Nicaragua and analysed the results of applying TAPE to assess their agroecological transition and performance, combining descriptive and lexical analysis. Iramuteq software was used for lexical analysis, including descendent hierarchical classification by Reinert's method and co-occurrence networks. A corpus text based on information provided by desk review and unstructured interviews during Step 0 was used for system description and identification of context variables; while a matrix of categorical variables based on data from Steps 1, 2 and 0 was used to identify agroecological transition typologies. RESULTS AND CONCLUSIONSLexical analysis allowed to summarize data, describe farm systems and identify context drivers (Step 0) and patterns from highly heterogeneous, subjective information. The assessment of agroecological transition (Step 1) and performance (Step 2) indicates that the farms studied were at least in transition to agroecology. Farm-level indicators of agroecological transition were more advanced than community-level indicators. Using Reinert's method we identified two main groups, that cluster seven classes of farms, representing different policy and development intervention targets. The differences detected between farms managed by women or men highlight the relevance of including gender perspective on TAPE analyses. SIGNIFICANCEWe show that lexical analysis was useful to deal with unstructured, narrative data describing systems and contexts, and for identifying agroecology recommendation domains based on local actors's perspectives.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Are ecological niche optimum and width of forest plant species related to their functional traits?

The ecological niche is one of the central concepts in plant ecology. Understanding which biological traits influence plant niches remains limited, preventing large-scale generalizations. Using a representative pool of 94 herb-layer species frequently occurring in the Slovenian forest vegetation types and an extensive suite of 28 plant functional traits, we tested whether traits serve as predictors for the optimum and width of plant species ecological niche. Niche optimum (mean) and niche width (standard deviation) of each species were derived from community-level ecological indicator values for six environmental gradients, i.e., light, temperature, continentality, moisture, soil reaction and nutrients. We investigated relationships between niche parameters and functional traits through a random forest analysis to account for relatively high trait correlations. Our results suggest that niche optimum and width of forest plant species are related to their functional traits. The two niche parameters were best explained by similar set of traits; however, the relative importance of traits differed substantially. Traits associated with disturbances (frequency and severity), plant dispersal (seed mass, dispersal syndrome), leaf economics spectrum (specific leaf area) and life strategy (CSR scores) showed the highest overall significance in predicting niche optimum and width. Functional traits were, on average, better predictors for niche optimum (average variance explained across all six environmental factors: 20.2%) than for niche width (average variance explained: 7.7%). Intraspecific trait variability, not considered in this study, likely plays an important role in case of niche width. The analyses suggest that, while not all traits impact niche parameters to the same degree, it is crucial to consider traits representing different ecological dimensions and revealing leading patterns of trait coordination. We recommend that the relative importance of traits for species niche parameters should be tested on a larger spatial scale using broader pool of forest understory plants across Europe.

Variation in drivers’ seat belt use by indicators of community-level vulnerability

Introduction: Examining crash reports with linked community-level indicators may optimize efforts aimed at improving traffic safety behaviors, like seat belt use. To examine this, quasi-induced exposure (QIE) methods and linked data were used to (a) estimate trip-level seat belt non-use of New Jersey (NJ) drivers and (b) determine the degree to which seat belt non-use is associated with community-level indicators of vulnerability. Method: Driver-specific characteristics were identified from crash reports (age, sex, number of passengers, vehicle type) and licensing data (license status at the time of the crash). Geocoded residential addresses were leveraged within the NJ Safety and Health Outcomes warehouse to create quintiles of community-level vulnerability. QIE methods were applied to estimate trip-level prevalence of seat belt non-use in non-responsible, crash-involved drivers between 2010–2017 (n = 986,837). Generalized linear mixed models were then conducted to calculate adjusted prevalence ratios and 95 % confidence intervals for being unbelted for driver-specific variables and community-level indicators of vulnerability. Results: Drivers were unbelted during 1.2 % of trips. Males, those with suspended licenses, and those without passengers had higher rates of being unbelted than their counterparts. An increase was observed in traveling unbelted with increasing quintiles of vulnerability, such that drivers in the most vulnerable communities were 121 % more likely to be unbelted than those in the least vulnerable communities. Conclusions: Prevalence of driver seat belt non-use may be lower than previously estimated. Additionally, communities with the highest amount of the population living with three or more indicators of vulnerability have higher rates of seat belt non-use; this may be a particularly useful metric to inform future translational efforts improving seat belt use. Practical Applications: As evidenced by the findings that risk of being unbelted increased as drivers’ community vulnerability increased, novel communication efforts tailored to drivers from vulnerable neighborhoods may optimize efforts.

Geospatial clustering and correlates of deaths during the Ebola outbreak in Liberia: a Bayesian geoadditive semiparametric analysis of nationally representative cross-sectional survey data

ObjectiveTo investigate the extent of geospatial clustering of reported deaths during the Ebola outbreak in Liberia and the covariates associated with the observed clustering.DesignCross-sectional study.ParticipantsMale and female respondents from the...

Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV.

Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes-viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = - 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = - 0.40, BSTP [- 0.87, - 0.09]). This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.

Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis

IntroductionArthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and...

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

A role for community-level socioeconomic indicators in targeting tuberculosis screening interventions

Tuberculosis screening programs commonly target areas with high case notification rates. However, this may exacerbate disparities by excluding areas that already face barriers to accessing diagnostic services. We compared historic case notification rates, demographic, and socioeconomic indicators as predictors of neighborhood-level tuberculosis screening yield during a mobile screening program in 74 neighborhoods in Lima, Peru. We used logistic regression and Classification and Regression Tree (CART) analysis to identify predictors of screening yield. During February 7, 2019–February 6, 2020, the program screened 29,619 people and diagnosed 147 tuberculosis cases. Historic case notification rate was not associated with screening yield in any analysis. In regression analysis, screening yield decreased as the percent of vehicle ownership increased (odds ratio [OR]: 0.76 per 10% increase in vehicle ownership; 95% confidence interval [CI]: 0.58–0.99). CART analysis identified the percent of blender ownership (≤ 83.1% vs > 83.1%; OR: 1.7; 95% CI: 1.2–2.6) and the percent of TB patients with a prior tuberculosis episode (> 10.6% vs ≤ 10.6%; OR: 3.6; 95% CI: 1.0–12.7) as optimal predictors of screening yield. Overall, socioeconomic indicators were better predictors of tuberculosis screening yield than historic case notification rates. Considering community-level socioeconomic characteristics could help identify high-yield locations for screening interventions.

Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas.

Research examining homelessness in rural areas has been sparse. The current study aims to expand conceptions of rural homelessness by mapping community-level risk factors related to housing insecurity. Geographic information systems (GIS) techniques were used to map the distribution of select community-level risk indicators in the State of Maine. Three methodological choices related to this process are demonstrated: (1) selection and distribution of housing insecurity risk indicators; (2) use of location quotients; and (3) use of spatial lags. After examining and mapping selected risk factors against the location of homeless service supports, four areas in Maine were identified as communities of concern for housing insecurity. Better understanding the extent and location of areas of high need that are resource poor can help service and funding agencies to plan for the more efficient and effective distribution of homeless prevention and mitigation services. Implications for research in rural areas are discussed.

Pre-arrest diversion to addiction treatment by law enforcement: protocol for the community-level policing initiative to reduce addiction-related harm, including crime

BackgroundDespite evidence that treatment reduces addiction-related harms, including crime and overdose, only a minority of addiction-affected individuals receive it. Linking individuals who committed an addiction-related crime to addiction treatment could improve outcomes.MethodsThe aim of this city-wide, pre-arrest diversion program, Madison Addiction Recovery Initiative (MARI) is to reduce crime and improve health (i.e., reduce the overdose deaths) among adults who committed a minor, non-violent, drug use-related offense by offering them a referral to treatment in lieu of arrest and prosecution of criminal charges. This manuscript outlines the protocol and methods for the MARI program development and implementation. MARI requires its participants to engage in the recommended treatment, without reoffending, during the six-month program, after which the initial criminal charges are “voided” by the law enforcement agency. The project, implemented in a mid-size U.S. city, has involved numerous partners, including law enforcement, criminal justice, public health, and academia. It includes training of the police officer workforce and collaboration with clinical partners for treatment need assessment, treatment placement, and peer support. Program evaluation includes formative, process, outcome (participant-level) and exploratory impact (community-level) assessments. For outcome evaluation, we will compare crime (primary outcome), overdose-related offenses, and incarceration-related data 12 months before and 12 months after the index crime between participants who completed (Group 1), started but not completed (Group 2), and were offered but did not start (Group 3) the program, and adults who would have been eligible should MARI existed (Historical Comparison, Group 4). Clinical characteristics will be compared at baseline between Groups 1–2, and pre-post the program within Group 1. Participant baseline data will be assessed as potential covariates. Surveys of police officers and program completers, and community-level indicators of crime and overdose pre- versus post-program will provide additional data on the program impact.DiscussionBy offering addiction treatment in lieu of arrest and prosecution of criminal charges, this pre-arrest diversion program has the potential to disrupt the cycle of crime, reduce the likelihood of future offenses, and promote public health and safety.

Survey of rapid development of environmental surveillance methods for SARS-CoV-2 detection in wastewater

Environmental surveillance as a part of wastewater-based epidemiology (WBE) of SARS-CoV-2 can provide an early, cost-effective, unbiased community-level indicator of circulating COVID-19 in a population. The objective of this study was to determine how widely SARS-CoV-2 detection in wastewater is being investigated and what methods are used. A survey was developed and distributed, with results showing that methods were rapidly applied to conduct SARS-CoV-2 WBE, primarily to test wastewater influent from large urban wastewater treatment plants. Additionally, most methods utilized small wastewater volumes and the primary concentration methods used were polyethylene glycol precipitation, membrane filtration and centrifugal ultrafiltration followed by nucleic acid extraction and assay for primarily nucleocapsid gene targets (N1, N2, and/or N3). Since this survey was performed, many laboratories have continued to optimize and implement a variety of methods for SARS-CoV-2 WBE. Method comparison studies completed since this survey was conducted will assist in developing WBE as a supplemental tool to support public health and policy decision making responses.

Mobile physical activity planning and tracking: a brief overview of current options and desiderata for future solutions.

Consistent and enjoyable physical activity (PA) can be a crucial component to improving or maintaining one's overall health status. Using advanced features on smartphones (GPS, Bluetooth, motion sensing, etc.) coupled with an app or game that is able to assist mobile users to not only track location, but also to interact socially with others based in real-life (IRL), virtual reality (VR), or alternate-reality (ARG), has the potential to give health experts better tools to encourage higher compliance to protocols, rehabilitation, behaviour change and health outcomes. This paper outlines the available mHealth apps that capitalize on pervasive smartphone features coupled with sensors, and suggests which features might impact future PA patterns. The authors argue that the ultimate mobile PA planning and tracking app/platform will be the one capable of supporting both precision and accuracy health (offering truly individualized PA advice and coaching while preserving user privacy) and precision and accuracy public health (providing public health decision makers with community-level PA indicators obtained from app data aggregates of user populations).