Community-level Indicators Research Articles

Community Characteristics and Implementation Factors Associated with Effective Systems of Care

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

Substance Abuse, Violence, HIV, and Depression

Evidence from the literature suggests that substance abuse, violence, HIV risk, depressive symptoms, and underlying socioeconomic conditions are tied intrinsically to health disparities among Latinas. Although these health and social conditions appear to comprise a syndemic, an underlying phenomenon disproportionately accounting for the burden of disease among marginalized groups, these hypothesized relationships have not been formally tested. The aim of this study was to assess (a) if substance abuse, violence, HIV risk, and depressive symptoms comprised a syndemic and (b) if this syndemic was related to socioeconomic disadvantage among Latinas. Baseline assessment data from a randomized controlled community trial testing the efficacy of an HIV risk reduction program for adult Latinas (n = 548) were used to measure demographic variables, substance abuse, violence, risk for HIV, and depressive symptoms. Structural equation modeling was used to test a single underlying syndemic factor model and any relation to socioeconomic disadvantage. The results of this study support the idea that HIV risk, substance abuse, violence, and depressive symptoms comprise a syndemic, χ(27) = 53.26, p < .01 (relative χ = 1.97, comparative fit index = .91, root mean square error of approximation = .04). In addition, in limited accord with theory, this factor was related to 2 measures of socioeconomic disadvantage, percentage of years in the United States (b = 7.55, SE = 1.53, p < .001) and education (b = -1.98, SE = .87, p < .05). The results of this study could be used to guide public health programs and policies targeting behavioral health disparity conditions among Latinos and other vulnerable populations. Further study of the influence of gender-role expectations and community-level socioeconomic indicators may provide additional insight into this syndemic.

Climate Change or Land Use Dynamics: Do We Know What Climate Change Indicators Indicate?

Different components of global change can have interacting effects on biodiversity and this may influence our ability to detect the specific consequences of climate change through biodiversity indicators. Here, we analyze whether climate change indicators can be affected by land use dynamics that are not directly determined by climate change. To this aim, we analyzed three community-level indicators of climate change impacts that are based on the optimal thermal environment and average latitude of the distribution of bird species present at local communities. We used multiple regression models to relate the variation in climate change indicators to: i) environmental temperature; and ii) three landscape gradients reflecting important current land use change processes (land abandonment, fire impacts and urbanization), all of them having forest areas at their positive extremes. We found that, with few exceptions, landscape gradients determined the figures of climate change indicators as strongly as temperature. Bird communities in forest habitats had colder-dwelling bird species with more northern distributions than farmland, burnt or urban areas. Our results show that land use changes can reverse, hide or exacerbate our perception of climate change impacts when measured through community-level climate change indicators. We stress the need of an explicit incorporation of the interactions between climate change and land use dynamics to understand what are current climate change indicators indicating and be able to isolate real climate change impacts.

Spatio-temporal patterns and nutrient status of macroalgae in a heavily managed region of Biscayne Bay, Florida, USA

The coastal bays of South Florida are located downstream of the Florida Everglades, where a comprehensive restoration plan will strongly impact the hydrology of the region. Submerged aquatic vegetation communities are common components of benthic habitats of Biscayne Bay, and will be directly affected by changes in water quality. This study explores community structure, spatio-temporal dynamics, and tissue nutrient content of macroalgae to detect and describe relationships with water quality. The macroalgal community responded to strong variability in salinity; three distinctive macroalgal assemblages were correlated with salinity as follows: (1) low-salinity, dominated by Chara hornemannii and a mix of filamentous algae; (2) brackish, dominated by Penicillus capitatus, Batophora oerstedii, and Acetabularia schenckii; and (3) marine, dominated by Halimeda incrassata and Anadyomene stellata. Tissue-nutrient content was variable in space and time but tissues at all sites had high nitrogen and N:P values, demonstrating high nitrogen availability and phosphorus limitation in this region. This study clearly shows that distinct macroalgal assemblages are related to specific water quality conditions, and that macroalgal assemblages can be used as community-level indicators within an adaptive management framework to evaluate performance and restoration impacts in Biscayne Bay and other regions where both freshwater and nutrient inputs are modified by water management decisions.

A multi-level analysis of urban/rural and socioeconomic differences in functional health status transition among older Chinese

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers individual responses to be embedded within communities. Data come from the 2004 and 2006 rounds of the Chinese Health and Nutrition Survey. The study considers the functional transitions of 2944 individuals living across 209 communities in nine Chinese provinces. Functioning is measured at baseline as being able or not being able to conduct all of the following: walking, standing, climbing stairs, lifting, kneeling. Outcomes include having or not having a functional limitation, measured the same way, dying, or not responding. Outcomes are modeled adjusted for baseline functional status. Findings indicate urbanites have substantial advantages. They are less likely to have a limitation at follow-up and less likely to die over the study period. Some of this is explained by socioeconomic indicators measured at two levels. Cross-level interactions suggest education and having insurance operate differently in urban and rural areas. Community-level indicators are somewhat less predictive, and much of the urban advantage is unexplained. In conclusion, the study suggests differences in the influences of socioeconomic indicators in China versus what has been found in the past, and that place of residence in China is a particularly robust predictor of functional health transitions.

Individual- and Contextual-Level Determinants of Social Inequities in Under-Five Mortality in Nigeria: Differentials by Religious Affiliation of the Mother

In sub-Saharan Africa, social factors such as religion have been linked with significant child morbidity and mortality. In religiously multi-denominational societies, one dominant religious group tends to subject the other groups to some form of economic, social or political discrimination, resulting in inequities in child survival. This study assessed the influence of individual- and community-level indicators underlying the association between religion and under-five mortality using multilevel logistic regression modelling. There is a significant association between religion and under-five mortality, which is considerably attenuated by sequentially adjusting for other risk factors. The effect of religion on under-five mortality is influenced by contextual-level characteristics of the community. Traditional religion is associated with under-five mortality, which is attributed to individual- and community-level indicators. Policy measures aimed at tackling child health inequities due to social factors such as religion need to consider the significance of the context in which mothers in different communities live, when healthcare interventions are being planned.

Rating Health and Social Indicators for Use with Indigenous Communities: A Tool for Balancing Cultural and Scientific Utility

This study reports on the development and evaluation of a rating tool to assess the scientific utility and cultural appropriateness of community-level indicators for application with Indigenous populations. Indicator criteria proposed by the U.S. Institute of Medicine were culturally adapted through reviewing the literature and consultations with academic and Indigenous stakeholders. Pre-testing and collaborator feedback drove the iterative development of the tool with stakeholder groups in Canada, Aotearoa/New Zealand, and Australia. Pilot testing with 17 raters across countries involved rating the same selection of six health and social indicators using a six-point ordinal scale. The final version of the rating tool includes 16 questions within three criterion domains: importance, soundness, and viability. Academic and community stakeholder review established face and content validity. The indicator rating tool demonstrated good internal consistency and excellent inter-rater reliability for two of three pilot testing groups. Use of this instrument can strengthen collaborative research planning and evaluation with Indigenous communities through selection of relevant and culturally appropriate indicators for application to public health research, prevention programmes, and health and social policy.

Measuring the impact of law enforcement on organized crime

This article explores the possibility of measuring the impact of law enforcement on organized crime in a reliable and accountable manner, both in general terms and with a practical focus on the Canadian context. In considering measures to combat organized crime, a focus on process measurement has obscured the more substantial question of progress as regards the dependent variable itself: the bottom line of reducing the impact of organized criminal behaviour. While outcome measures are more challenging to identify than process measures, this fact alone does not minimize the need to demonstrate the connection between organized crime enforcement and its presumed outcomes to a greater degree of certainty. To date, this has not been realized to any significant degree, as revealed by a review of existing international approaches to measuring the impact of enforcement activity. The article argues that a multidisciplinary focus on community level indicators of crime, if initially less accessible than process measures of impact on organized crime groups, offers promise as a measurement of absolute and relative impact of state investment in enforcement.

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California communities, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community characteristics included measures of male unemployment, household income, low education (i.e., no high school diploma) and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e., community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g., lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics.

Promoting mental health and well-being: integrating individual, organisational and community-level indicators

The development of an integrated set of mental health promotion indicators at individual, organisational and community levels. There is increasing recognition that the implementation of effective and sustainable strategies for the promotion of mental health and well-being requires the development of indicators to support priority setting, establishing targets and measuring progress. This article aims to contribute to this task by bringing together recent work on individual, organisational and community indicators that shows progress in the promotion of mental health and well-being. An initial set of indicators is proposed, informed by current knowledge from research and practice settings.

Community- versus individual-level indicators to identify pediatric health care need.

Increasingly, geographic information systems employing spatial data are being used to identify communities with poorer health care status. Since health care indicators are strongly linked to income, could these data, usually based on adult indicators, be used for pediatric health care need? We hypothesized that individual-level indicators such as quality of life scales (QOL) would be better than community-level indicators at identifying families with poorer health care practices. Surveys and medical record reviews were used for a sample of 174 caregivers of young children. Lower level of income was associated with poorer scores on several QOL domains, and on the primary health practices (i.e., non-urgent emergency room use and lack of age-appropriate immunization status). One community-level indicator, the medically underserved area (MUA), was almost as good as the best individual-level indicators at predicting primary health care practices. The community-level indicator of MUA appears to meet its initial intent, providing information on the location of very low-income individuals with high health care need even among a sample of Medicaid-insured children with an identified health care provider.

Community Participation in Rapidly Growing Communities in Southern Utah

Amenity-rich locations attract individuals searching for places to recreate, live, or retire. As a result, such areas, many of which are in the Western United States, experience changes related to population in-migration. Past research shows how the extensive in-migration of people with different values and perspectives can contribute to social conflict in affected communities. This study focuses on the relationship of community level indicators with community participation in a five-county rapidly growing amenity-rich area in southern Utah. The research team studied two main types of community members—seasonal and permanent residents. Differences among such residents can contribute to shifts in community social interaction and affect overall participation in community affairs. Because participation in community is a central aspect of fostering local community development, it is important to understand how these processes occur. This study found structural and interactional differences between permanent and seasonal residents. Both factors were stronger predictors of community participation for permanent compared to seasonal residents. This study adds to the literature on newcomers and long-term residents and their structural and interactional differences.

Community-level Impacts of AIDS-Related Mortality: Panel Survey Evidence from Zambia*

n communities hit hard by HIV and AIDS, households not directly incurring a death may nevertheless be affected by taking in orphans, losing access to resources owned by kin-related afflicted households, or transferring resources to afflicted households. In addition, broader effects of high mortality rates on communities’ economic and social structures are likely. To date, relatively little quantitative research has been devoted to examining community “resilience,” that is, the factors explaining why some communities appear better able than others to withstand the impacts of AIDSrelated mortality despite suffering similar adult mortality rates (AMRs). This study measures the effects of prime age (PA) AMRs on community resilience using a set of community level indicators—changes in area of land under cultivation, crop output, and per capita income.

CONSTRUCTING A HEALTH AND SOCIAL INDICATOR FRAMEWORK FOR INDIGENOUS COMMUNITY HEALTH RESEARCH

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators.

A length-based multispecies model for evaluating community responses to fishing

Quantitative ecosystem indicators are needed to fulfill the mandate for ecosystem-based fisheries management. A variety of community metrics could potentially be used, but before reference levels for such indices can be established the sensitivity of candidate indices to fishing and other disturbances must be determined. One approach for obtaining such information is to test candidate indicators with models that mimic real ecosystems and can be manipulated experimentally. Here we construct a size-based multispecies model of a community of fish species that interact by predation. The model was parameterized for 21 fish species to obtain a predation-regulated community. Following an analysis of the sensitivity of the model to parameter uncertainty, we tested the sensitivity of community-level indicators to increasing levels of fishing mortality (F). Abundance and biomass spectra were sensitive to fishing mortality, with the slope decreasing with increasing F. Species diversity size spectra were also very sensitive to F, with diversity in the largest size classes declining rapidly. In contrast, k-dominance curves were less sensitive to fishing pressure. Importantly, however, although most community-level metrics showed clear trends in response to fishing, single-species declines in spawning stock biomass were the most sensitive indicators of fishing effects.

Engaging Numbers: Developing Health Indicators that Matter for First Nations and Inuit People

This paper addresses citizen participation in the development of community-level health and capacity indicators with a specific focus on processes that can be used to engage community members in indicator development. It is based on work that the authors completed with the Inuit Tapiriit Kanatami (ITK) in 2002 and work they have been conducting in partnership with the Prince Albert Grand Council (PAGC) and Athabasca Health Authority (AHA) in northern Saskatchewan.The latter project developed tools for First Nations health organizations to assess the impacts of their health and social service programs on community wellness and capacity.The project included a critical review of existing community-level population health indicators and indicator frameworks, the identification of gaps in the literature related to culturally appropriate community health indicators, and the utilization of a process by which these indicators might be implemented and tracked by First Nations health organizations at the community level. In addition to the results of our work to date,we highlight some of the literature that specifically addresses Aboriginal conceptions of community health and community capacity along with an assessment of gaps in the literature in the context of culturally appropriate indicators.We conclude by discussing the processes that we have used with Inuit health groups and community-based First Nations health organizations in identifying culturally appropriate and relevant community health and capacity indicators.

RACE, ETHNICITY, THREAT AND THE LABELING OF CONVICTED FELONS*

Florida law allows judges to withhold adjudication of guilt for persons who have either pled guilty or been found guilty of a felony. This provision may apply only to persons who will be sentenced to probation, and it allows such individuals to retain all civil rights and to truthfully assert they had not been convicted of a felony. This paper examines the effects of race and Hispanic ethnicity on the withholding of adjudication for 91,477 males sentenced to probation in Florida between 1999 and 2002. Hierarchical Generalized Linear Modeling is used to assess the direct effects of defendant attributes as well as the cross-level interactions between race, ethnicity and community level indicators of threat, such as percentage black and Hispanic and concentrated disadvantage. Our results show that Hispanics and blacks are significantly less likely to have adjudication withheld when other individual and community level factors are controlled. This effect is especially pronounced for blacks and for drug offenders. Cross-level interactions show that concentrated disadvantage has a substantial effect on the adjudication withheld outcome for both black and Hispanic defendants. The implications of these results for the conceptualization of racial/ethnic threat at the individual, situational and social levels are discussed.

In Bangladesh, Women's Risk of Domestic Violence Is Linked to Their Status

In rural Bangladesh, a married woman's risk of experiencing domestic violence is associated with her individual autonomy, as well as the autonomy of women within her community.1 In the more culturally conservative of two study areas, women who had been a member of a credit group for less than two years were more likely than nonmembers to report current physical abuse (odds ratio, 1.3), and the greater a woman's autonomy, the higher her odds of being abused (1.6). However, in the less culturally conservative area, the proportion of women in a community participating in a credit group and female autonomy at the community level were linked to a reduced risk of domestic violence. Using data from a 1993 family planning survey of 10,368 currently married women aged 15-49 living in Sirajgonj and Jessore, researchers examined the relationship between women's status and current domestic violence-defined as beating by their husband or his family. Indicators of women's status at the individual level were membership in a savings and credit group and an autonomy score based on women's responses to five questions about their mobility, familial decision-making power and control of resources. Community-level indicators included the proportion of women in the community who belonged to a credit group and the mean female autonomy score. Multivariate logistic regression analyses controlled for the study area; number of living sons; woman's age, religion and education; husband's education; land ownership; family structure; and community level of female education. Of the women surveyed, 42% reported current physical abuse-47% in Sirajgonj and 39% injessore. The proportion of women who had been abused exceeded 50% in about one-half of the communities in Sirajgonj, compared with only one-fifth of communities injessore. Nine in 10 women who had experienced physical violence said that attacks were occasional, whereas one in 10 said they were frequent.

Community and population-level responses to disturbance in a sandflat community

The responses of soft sediment infauna were investigated in an intertidal sandflat to determine patterns of recolonization and succession at the community and population level. Experimental disturbance plots, 1 m 2, were initiated in August and sampled for 4.5 months along with ambient sediments. Sediment grain-size was used as a general indicator of the physical state of the disturbance patches, and grain-size distributions among disturbance and ambient patches became similar after ∼2.5 months. Recolonization varied among the dominant infaunal taxa. Densities of infauna that were most abundant in the habitat, primarily syllid polychaetes, did not recover to ambient levels until 3–4 months after disturbance, when ambient densities were falling to winter lows. Multivariate analysis indicated that community recovery occurred by the end of the study period after 4.5 months. Although community structure recovered by the end of the study, the population structure of the dominant species Parapionosyllis longicirrata remained significantly different among ambient and disturbed patches. On all sampling dates except one, disturbance patches had a higher number of larger individuals than ambient sediments. Previous studies have shown that bedload transport of juveniles and adults, and other processes, can cause recolonization to be relatively rapid on intertidal sandflats. However, our results indicate that recovery times may be on the order of months at large disturbance sizes. Therefore, rapid responses may occur primarily in the case of small-scale (<1 m 2) disturbance patches. Secondly, recovery at the community level does not necessarily mean that population-level characteristics of species comprising the community have recovered. Population-level differences may be longer lasting than indicated by community level indicators of recovery.

Is the prevalence of youth smoking affected by efforts to increase retailer compliance with a minors' access law?

This study correlated measures of youth smoking behavior with community-level indicators of retailer compliance with a minors' tobacco access law. The study was carried out between 1992 and 1996 in 12 communities in Erie County, New York. Retailer compliance was assessed by having adolescents attempt to purchase tobacco products in licensed tobacco-selling outlets in fall 1994 and fall 1995 after implementation of an aggressive enforcement program. Communities were grouped in two ways: (a) those that did or did not increase retailer compliance rates by 200% or more between 1994 and 1995 and (b) those that did or did not achieve an 80% retailer compliance rate in 1995. School-based surveys conducted in 1992 and 1996 assessed the tobacco use behaviors of ninth-grade public school students. Between 1994 and 1995, retailer compliance increased in all 12 communities by an average of 155%. In 1995, six of the 12 communities achieved retailer compliance rates in excess of 80%. Indicators of youth smoking behavior did not vary significantly between communities that increased their retailer compliance rates by more or less than 200%. The prevalence of past 30-day smoking remained stable between 1992 and 1996 in the six communities that achieved a retailer compliance rate of at least 80% and increased slightly in the remaining communities. The prevalence of frequent smoking decreased between 1992 and 1996 in the communities that achieved a retailer compliance rate of at least 80% and increased slightly in the six communities that failed to achieve this rate. Achieving a high rate of retailer compliance with a minors' access law appears to have caused youths to rely more on noncommercial sources of cigarettes and may have had a small effect on adolescent smoking prevalence, especially frequent smoking.