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Section 9. Gathering and Using Community-Level Indicators

All examples are from Fawcett, S.B., Paine-Andrews, A., Francisco, V.T., Schultz, J.A., Richter, K.P., Lewis, R.K., Williams, E.L., Harris, K.J., Berkley, J.Y., Fisher, J.L., & Lopez, C.M. (1994). Work Group Evaluation Handbook: Evaluating and Supporting Community Initiatives for Health and Development. Lawrence, KS: Work Group on Health Promotion and Community Development, University of Kansas.

Example 1: Recommended Community-Level Indicators for Substance Use Coalitions

  • Number of single-car nighttime vehicle accidents
  • Number of drug positives from urine samples of arrested people
  • Number of arrests for drug possession
  • Cost and purity of street drugs
  • Number of drug positives from urine samples of pregnant women at the time of delivery
  • Number of alcohol or drug (AOD)-related emergency room episodes
  • Number of AOD-related deaths
  • Number of individuals on waiting lists for and admissions to in-patient and out-patient AOD program service
  • Number of referrals and admissions to mental health centers for AOD problems
  • Incidence of AOD-related birth outcomes (e.g., fetal alcohol syndrome, positive drug toxicology)
  • Incidence of drug-related sexually transmitted diseases (STDs), including HIV transmission in AIDS cases
  • Incidence of AOD-related medical conditions (e.g., cirrhosis of the liver, hepatitis)
  • Number of drug positives from urine samples of job applicants and employees
  • Aggregate per capita consumption of alcohol, based on alcohol tax revenue data
  • Student alcohol and drug abuse
  • Juvenile arrests for drug offenses
  • Adult arrests for drug offenses
  • Marijuana plants seized
  • Positives in pre-employment drug testing
  • Employees with employee assistance programs
  • People treated for substance use problems
  • Teen alcohol-involved traffic deaths
  • Adult alcohol-involved traffic deaths
  • Drug overdose deaths

Example 2: Recommended community-level indicators for adolescent pregnancy prevention initiatives

The estimated pregnancy rate for females aged 15-19 is the most commonly used indicator for adolescent pregnancy. Data may also be available for females ages 10-19 and 10-14. Currently, the majority of the pregnancies occur within the 15 to 19 year old age group.

The formula for calculating the estimated pregnancy rate is as follows: (live births + fetal deaths + reported abortion) / population of females age 15-19 x 1000.) This formula can also be used to calculate the estimated pregnancy rate for females of different ages. Epidemiological data such as these rely on the accuracy of both the numerator and denominator. Limitations of each are described below.

Abortion data include only those reported by hospitals and clinics participating in state health department report systems. Because of their sensitivity, abortion data tend to be underreported. For example, in a typical county in 1993, 6.6% of adolescent pregnancies reportedly resulted in an abortion. Yet, nationally, it is estimated that 36% of adolescent pregnancies result in abortions.

Population estimates for the age group may come from different sources. Estimates are available from the Census Bureau and as well as from state offices such as health departments and university research institutes. Population estimates may come from different sources over a given time period. For example, population estimates for years 1 through 5 may have been provide by the state Census Bureau and for years 6 through 10 by a local research institute.

It is important to know the data that are needed to compute the estimated pregnancy rate for a given age group and their limitations. Because of the difficulty in securing data on abortions and population size with absolute certainty, the estimated pregnancy rate for adolescents age 15 through 19 remains an "estimate." Issues around reporting by hospitals in a given area and the accuracy of recording place of residence of the mother may also come into play when exploring the accuracy of estimated pregnancy rate as an indicator. Changes in data collection that may have occurred over the period of the prevention initiative, and a few years prior, should also be explored with the state health department's statistician. This way, you can give the initiative a sense of whether changes in the estimated pregnancy rate could be due to a change in reporting rather than as a result of the initiative.

Example 3: Recommended Community-Level Indicators for Tobacco Control Initiatives

Per capita consumption of tobacco products represents the most objective data available on population levels of tobacco consumption. Data are available from the state health department (or department of revenue) based on the excise taxes that are imposed on tobacco products. Excise taxes are collected at the level of tobacco distributors. This information is available on a monthly basis.

Variability from month to month may be an artifact of this measure. It may reflect patterns of stocking at the retail level. When systematic seasonal variations are adjusted for, however, collective sales data provide the best available estimate of total tobacco use.

The main limitation of these data is that they do not provide information on the behavior of consumers. A change in consumption rate is a composite of many individuals ? uptake and quitting behavior. For example, a drop in cigarette sales may be the result of the same people smoking fewer cigarettes or fewer people smoking. Nor do consumption data indicate what changes in special populations, such as young women or ethnic minorities, might be reflected in the data. Despite these limitations, tobacco consumption remains the best community-level indicator.

Example 4: Recommended Community-Level Indicators for Injury Prevention and Control Initiatives

  • Deaths due to unintentional injuries
  • Hospitalizations due to unintentional injury
  • Deaths caused by motor vehicle crashes
  • Deaths from falls and fall-related injuries
  • Drowning deaths
  • Hip fractures among older adults
  • Emergency room admission for non-fatal poisonings
  • Hospitalizations due to non-fatal head injuries
  • Hospitalizations due to non-fatal spinal injuries
  • Secondary injuries associated with injuries to the head and spinal cord
  • Deaths due to farm-related injuries
  • Hospitalizations due to farm-related injuries
  • Local sources of other measures may include coroner and police reports, data from walk-in clinics and emergency rooms, child care centers, schools, nursing homes, social service agencies, senior services, large businesses, and insurance companies

Example 5: Recommended Community-Level Indicators for Violence Prevention Initiatives

  • Uniform Crime Reports, Federal Bureau of Investigation / Department of Justice : Published annually; includes crimes such as rape, assault, homicide, and robbery
  • National Crime Survey and National Victimization Survey: Administered annually ; includes questions about spouse, child and elder abuse
  • National Center for Health Statistics Mortality Data and Centers for Disease Control Mortality Data (Center for Disease Control and Prevention, Atlanta, GA), which includes data collected based on the ninth edition of the international Classification of Diseases; summarizes the deaths in the United States by cause and demographics
  • State Crime Data (for example, from the Kansas Bureau of Investigation): Published annually; includes the same information given to the FBI for their Uniform Crime Reports, but is broken down by county and metropolitan areas
  • State Incident Based Reporting System (for example, from the Kansas Bureau of Investigation): Unpublished data; includes information provided by police agencies through "Standard Offense Reports" and "Standard Arrest Reports"
  • State Juvenile Justice Information System (for example, from the Kansas Bureau of Investigation): Unpublished data; includes the same information provided by the Incident Based Reporting System as well as information from Child in Need of Care or Child in Need of Services reporting
  • Local sources of data may include coroner reports and local police reports, information collected by the school district on the incidence and prevalence of assaults, and information collected by local women's shelters and social service agencies about spouse abuse

Example 6: Sustainable Seattle's Fourth Set of Regional Sustainability Indicators

After the release of its 1998 Indicators, Sustainable Seattle decided to reassess its indicator program.  The board was concerned that merely publishing the indicators, as Sustainable Seattle did in 1993, 1995, and 1998, was not sufficient and that a successful program should include programs which support actions by citizens, businesses and policy makers to affect the trends documented by the indicators. It has taken several years for the organization to build the professional staff capacity to support an expanded indicator program.