Examples of Community-Level Indicators

The tables below give examples of community-level indicators for tobacco use, diet and nutrition, and physical activity. Also included are measures that apply to all three health targets. The list of indicators was generated at a brainstorming session of evaluators brought together by the Centers for Disease Control and Prevention in 1994.

The indicators in each health target area are grouped further by:

After generating the list, the participants rated each indicator (1-5, 5 is best) according to:

The list is sorted by the overall quality rating, from highest to lowest. Note that the list is only intended as a starting point for future indicator development: to be actually used, many more details about specification, data collection and analysis would have to be added.


Tobacco use

 

Mean rating

Indicator

Overall

Quality

Feasibility

Policy and regulation

     

Clean air laws for public buildings, restaurants, worksites, etc.

4.50

4.55

4.40

Prohibition on use of tobacco products on public property

4.34

4.32

3.85

Fines or loss of license for violations

4.25

4.28

4.50

Excise tax on tobacco products (local option)

4.22

3.80

4.50

Existence of community tobacco control ordinances

4.21

4.05

4.14

Excise/license fee for tobacco sales

4.17

4.14

4.50

Vending machine regulations in communities

4.14

4.14

3.90

Restrictions on advertising for tobacco products

3.98

4.05

4.15

Enforcement of "SYNAR" ordinances (no sales to minors) throughout the community

3.93

4.39

3.20

School policies banning smoking by staff

3.88

3.95

3.55

Evidence of enforcement (fines, litigation)

3.83

4.05

2.85

Youth access to tobacco laws in communities

3.79

3.94

3.70

School policies banning smoking by students

3.79

3.82

3.55

Stringency of local tobacco control ordinances

3.79

3.73

3.18

Presence of worksite no-smoking policies

3.78

3.66

3.41

Proportion of restaurant seats that are non-smoking

3.75

3.77

3.05

Restrictions on tobacco vending machine locations in schools

3.68

3.25

3.90

Prohibitions on free distribution of tobacco products

3.67

3.95

3.71

Differential insurance rates for smokers/non-smokers

3.64

3.73

3.23

Organizational policies directed toward smoking cessation

3.64

3.65

2.55

Differential rate of health care premium capitation for smokers/non-smokers

3.58

3.70

3.20

Number of tobacco-related enforcement actions

3.54

3.77

2.77

Regulation of tobacco promotion materials and sponsorship by tobacco industry of events

3.43

3.68

3.18

Limit on sale of cigarettes within certain boundaries (e.g. near schools)

3.35

3.36

2.95

Percent of agencies/organizations that are "smoke free"

3.29

3.68

2.82

Local funds dedicated to smoking cessation

3.29

3.35

3.90

Percent of organizations granting time off for employees to take smoking cessation classes

2.93

3.60

2.75

Differential hiring of smoking/non-smoking staff

2.86

2.40

2.68

Policy to divest in tobacco company stock

2.36

2.60

2.11

Differential hiring for smoking/non-smoking teachers

2.32

2.39

2.17

       

Information

     

Materials for screening and cessation in use by health professionals

2.85

2.67

2.67

Signs telling of environmental tobacco smoke

2.64

2.50

3.15

       

Environmental change

     

Percent of restaurant seats in no-smoking sections

3.75

3.83

3.08

Price of tobacco products

3.68

3.67

4.21

Existence of smoking control programs in public health agencies

3.67

3.65

3.60

Percent of worksites with no-smoking areas

3.43

3.86

3.00

Existence of smoking cessation campaigns within worksites

3.35

3.45

2.90

Presence of vending machines in restaurants

3.32

3.58

3.17

Number of community coalitions for tobacco control

3.31

3.15

3.85

Level of involvement of community coalitions in tobacco control

3.08

2.67

2.50

Presence of tobacco vending machines in hotels

3.07

3.25

3.13

Training of local leaders on tobacco advocacy

2.78

2.40

2.80

Location of tobacco vending machines in restaurants (e.g. near front door)

2.28

2.58

2.54

Location of tobacco vending machines in hotels (e.g. by front door)

2.25

2.29

2.63

       

Behavioral outcome measures

     

Surveillance data on tobacco sales to minors

4.16

4.10

2.85

Disappearance of tobacco products (store inventory)

3.18

3.64

2.33

Observations of behavior in no-smoking areas (especially where children are present)

2.67

2.80

2.65


Physical Activity

 

Mean rating

Indicator

Overall

Quality

Feasibility

Policy and regulation

     

Highway funds for non-vehicle transport (ISTEA)

4.00

3.61

3.63

Presence of local policy to include PE in public K-12 curriculum

3.91

3.73

4.15

Walk/bike paths included in local zoning/rezoning requirements

3.70

3.67

3.50

Amount/percent of local budget per capita devoted to physical activity/recreation

3.63

3.63

3.81

Insurance reimbursement for physical activity services and counseling in health organizations

3.47

4.06

3.00

Presence of policies promoting inclusion of recreation facilities with new construction

3.41

3.50

3.25

Local policy to include PE in private school curriculum

3.36

3.00

3.90

Evidence that local zoning board considers health (CVD) in its decisions

3.34

3.36

2.94

Percent of public schools that include lifetime activity skills

3.30

3.39

3.31

Presence of formal worksite policies that support physical activity (e.g. flextime)

3.20

3.02

3.33

Local policy to include PE in college or technical school curriculum

3.18

3.14

3.95

Insurance policies that include physical activity incentives

3.06

3.75

2.70

Extent of dog leash and other laws that facilitate physical activity

3.03

3.11

2.81

Rewarded level of fitness for schools

2.89

3.07

2.43

Extent of private schools that include lifetime activity skills

2.86

3.06

2.63

Extent of colleges and technical schools that include lifetime activity skills

2.74

2.94

2.69

Use of effective physical activity curriculum in schools

2.74

3.39

2.39

Parks policy in community

2.68

3.00

3.50

Policy that new building plans include a "physical activity friendliness" assessment

2.68

3.00

2.33

Mandated level of fitness for schools

2.65

3.25

2.44

Presence of tax rebates for physical activity equipment in schools

2.63

3.13

3.56

Limit on liability for physical activity equipment use

2.50

2.60

2.55

       

Information

     

% of health care providers that routinely advise patients to exercise more

3.15

3.35

2.80

Availability of materials in worksites linking PA to CVD

1.70

1.95

2.56

       

Environmental change

     

Miles of walking trails per capita

3.48

3.32

3.77

Miles of bike lanes per capita

3.48

3.23

3.77

Number of physical activity facilities per capita in schools

3.48

3.33

3.58

Availability of facilities to community members (number, hours open, etc.)

3.43

3.50

3.36

Number of worksites that sponsor teams, sporting events, etc.

3.11

3.50

2.60

Hours that physical activity facilities are open

3.02

3.13

2.67

Number of worksites that allow staff to do PA during working hours

2.93

3.15

2.55

Capacity of physical activity facilities (fields, gyms, pools)

2.88

2.83

2.79

       

Behavioral outcome measures

     

Observations of usage (in malls, trails)

3.53

3.86

3.05

Membership in physical activity organizations (Y's, health clubs)

3.48

3.58

3.13

% of time in PE classes spent in "lifetime" exercises

3.34

3.35

2.80

Sales of selected physical activity items (e.g. sports equipment, videos)

2.94

2.92

2.42


Diet and Nutrition

 

Mean rating

Indicator

Overall

Quality

Feasibility

Policy and regulation

     

Percent of schools with lunch options congruent with dietary guidelines

3.50

4.17

2.78

Publicly funded food programs follow dietary guidelines

3.45

3.45

3.00

Index of local policies regarding: nutrition at school, day care, after school and weekend events

3.38

3.89

2.94

Commodity food programs--presence of low fat foods

3.35

3.33

3.39

Presence of state guidelines monitoring school nutrition programs

3.33

3.55

4.19

Presence of food policies for special populations (older adults, WIC)

3.32

3.22

3.25

Third party reimbursement for dietary counseling

3.25

3.60

3.00

Policies that limit junk food sales in schools

3.13

3.63

3.00

Policy to monitor nutrition claims made by local food retailers

3.12

3.38

3.14

Formal policy that supports healthy eating at worksites

3.11

3.20

2.95

Public awareness of local policy to monitor nutrition claims

3.03

3.19

2.38

Nutritional labeling requirements at restaurants, stores, snack bars

3.00

3.13

3.36

Are restaurant owners made aware of policies monitoring nutrition claims

2.75

3.14

2.36

Incentives for employees to attend diet/nutrition programs

2.70

3.22

2.61

Presence of local policy requiring nutrition education during primary health care

2.50

3.00

2.33

Accessibility of diet programs to all employees

2.44

2.50

2.38

Incentives that promote presentation of healthy food choices

2.43

2.50

2.29

"Point of Purchase" information provided (e.g. cafeterias)

3.34

3.50

3.09

Presence of shopping tours, demonstrations in supermarkets

2.79

2.78

2.78

Presence of low-fat cooking via the media (cooking shows)

2.39

2.17

3.40

Presence of food pyramid charts in learning environments

2.32

2.17

2.72

       

Environmental change

     

Presence of healthy foods in vending machines in schools

3.57

3.86

2.95

Presence of healthy foods in vending machines in worksites

3.52

3.86

2.80

Healthy menus in schools, worksites, other places

3.27

3.39

2.39

Training for cooks in cafeterias

3.07

3.22

2.78

Number of fast food restaurants per capita

2.77

3.64

3.32

Number of low-fat items in restaurants (menu analysis)

2.75

3.41

1.90

Presence of farmer's markets

2.63

2.95

3.70

Location of farmer's markets

2.50

2.41

2.95

Number of contests for diet change within the community

2.34

2.22

2.96

Number of convenience stores per capita

2.17

2.41

3.14

       

Behavioral outcome measures

     

Bar code sales data

3.47

4.44

2.67

Proportion of low-fat items in schools

3.39

3.85

2.11

Inventory control data (e.g. school and worksite cafeterias) for food usage

3.35

4.05

2.40

Proportion of low-fat items in stores (via use of marker items such as low-fat milk)

3.20

3.32

2.15

Proportion of low-fat items in worksites (via use of marker items such as low-fat milk)

3.17

3.75

1.89

Proportion of shelf-space in grocery stores devoted to low-fat foods

3.15

3.64

2.14

Observations of patrons at grocery stores (e.g. percent choosing low-fat foods)

2.82

3.41

2.09

Exit interviews of patrons from grocery stores

2.45

2.86

2.41


All Three Health Target Areas

 

Mean rating

Indicator

Overall

Quality

Feasibility

Policy and regulation

     

(None identified that crossed all 3 behaviors)

     
       

Information

     

Percent of schools offering curricula in grades K-12

3.39

3.38

3.44

Number of media reports dealing with tobacco, nutrition and physical activity

3.17

3.39

2.78

Presence of media reports in high-risk/low SES communities

3.09

3.06

2.81

Percent of health care providers that routinely counsel about tobacco, PA and nutrition -- monitored in charts

3.08

4.00

1.88

"Point of purchase" education materials

3.03

3.17

3.00

Percent of schools with health promotion programs for staff

2.97

3.19

3.19

Media coverage linking behaviors to health problems

2.97

3.19

2.18

Percent of health care training programs that teach how to counsel about tobacco, PA and nutrition

2.85

3.17

2.72

Presence of community directory listing health promotion classes

2.52

2.33

3.17

Availability of courses for staff, employees that deal with tobacco, PA and nutrition

2.50

2.80

2.44

Percent of health care facilities that have materials in the waiting room about tobacco, PA, nutrition

2.47

2.22

2.67

       

Environmental change

     

Medical charts that monitor feedback about preventive behaviors

3.15

4.00

1.86

Number of programs for nutrition/weight control, tobacco cessation and PA offered in community

2.91

3.00

2.63

Assessments/screenings within the community for CVD risk-factors

2.87

2.56

2.50

Agency collaborations for nutrition, tobacco, and PA

2.57

2.50

2.33

Number of agencies in community that sponsor CVD health events

2.47

2.67

3.17

Percent of families involved with school nutrition, tobacco control, physical activity

2.46

2.64

1.93

       

Behavioral outcome measures

     

Prevalences of overweight, tobacco use, physical activity among student populations

3.75

4.64

2.29

Surveillance data on tobacco use, nutrition and PA for community

3.34

3.93

2.43