Projects using community-level indicators

Below is a list of projects that have used or are using community-level indicators, either as part of the evaluation of a specific program or as part of ongoing community monitoring

Organization: Texas Department of Health, Bureau of Chronic Disease Prevention and Control, Adult Health Program
Contact: Phil Huang (, Jennifer Smith (
CLI-related activities: The Texas Department of Health is emphasizing environmental change as a way of achieving chronic disease prevention. Since September, 1995, the Adult Health Program has been shifting the focus of it's activities out of providing clinical services and into partnering with worksites, schools, restaurants, communities and clinic sites using population based approaches.

The following are three examples of specific targets for environmental change:

1. During FY 98, ______ # of restaurants will have initiated nutritional policies that support customers' CVD prevention.
Possible indicators of restaurant changes:

2. During FY 98, ______ # of worksite will have initiated worksite wellness policies thatsupport customers' CVD prevention.
Possible indicators of workplace changes:

3. During FY 96, ______ # communities that have initiated awareness, lifestyle change or policies that support consumers' CVD prevention.
Possible indicators of community changes:

Organization: Ozark Heart Health Project, School of Public Health, St. Louis University
Contact: Jeffrey Mayer, Ph.D. (
CLI-related activities: The Ozark Heart Health Project (OHHP) is a partnership between the Prevention Research Center at St. Louis University and the Missouri Department of Health. OHHP is using community coalitions to design and implement strategies to improve diet, increase physical activity and reduce tobacco use. Six intervention communities have been matched with 6 control communities as part of a quasi-experimental study design. The evaluation of the program includes a variety of indicators, including measures of restaurants, grocery stores and convenience stores.

Grocery store diet measures:

Tobacco display measures (grocery and convenience stores):

Restaurant diet and tobacco measures:

The OHHP evaluators have conducted reliability checks of the measures and found a high degree of reliability in the grocery and convenience store measures (derived from site visits), but less reliability for the restaurant measures (collected over the phone). Restaurant managers tended to overstate the healthfulness of their environment compared with what was observed in site visits.

Future work:
The OHHP evaluation will collect survey data from individuals related to diet, smoking and exercise, in addition to the community-level indicators noted above. This will allow them to compare the individual-level results (e.g. percent of respondents eating low-fat products) to those from the community-level indicators (e.g. percent of shelf-space occupied by low-fat products).

Organization: Oregon Health Division, Tobacco-Free Coalition of Oregon
Contact: Jane Moore, Craig Mosbaek (
CLI-related activities: The Tobacco-Free Coalition is using a variety of individual and environmental strategies to overcome the influence of the tobacco industry and reduce the use of tobacco products in Oregon. These strategies include reducing the use of tobacco by youth, treating tobacco dependence, protecting children from exposure to tobacco and protecting workers and the public from secondhand smoke. To assess the effectiveness of their environmental strategies, the Coalition has come up with a number of specific outcome measures, many of which can be classified as community-level indicators.

Sample indicators:

Organization: Washington State Office of Emergency Medical and Trauma Prevention, Children's Hospital & Medical Center
Contact: Linda Quan, MD, Principal Investigator (; Kathy Williams, MS, Injury Prevention Specialist (; Elizabeth Bennett, MPH, CHES, Lead Health Educator(
CLI-related activities: In October 1994, Washington State Department of Health, Office of Emergency Medical and Trauma Prevention (EM/TP), and Children's Hospital & Medical Center (Children's) were awarded a grant from Emergency Medical Services for Children and the National Highway Traffic Safety Administration. The purpose of the funds has been to support the development of drowning prevention programs in the eight EM/TP regions in Washington State. The overall goal is to decrease the mortality and morbidity of children birth to 21 years of age due to drowning and near drowning. Specific objectives are to establish community-based drowning prevention programs, disseminate water safety education, increase use of life vests by children and integrate drowning prevention into the state EM/TP system. A new grant from Emergency Medical Services for Children to start in October, 1997 will focus on developing a systematic approach to the prevention of adolescent drownings in Washington State.

The following are a preliminary list of community indicators developed by the project. Efforts are currently underway to track these indicators in Washington State.

Community organization indicators:

Data indicators:

Community education:


Access to life vests:



Medical community:

Organization:Fred Hutchinson Cancer Research Center, Cancer Prevention Research Program, Seattle, WA
Contact: Shirley Beresford (, Donald Patrick (
CLI-related activities: The Seattle 5-A-Day project is one of nine projects funded by the National Cancer Instititute to increase fruit and vegetable consumption using the concise and positive message and slogan, "Fruits and Vegetables 5 a Day for Better Health". The Seattle 5-A-Day project is taking place in 28 worksites, using a rigorous randomized controlled trial. The project is designed to integrate a comprehensive multi-component and sustained intervention in the intervention worksites, combining individual-level and community-level interventions around the stages-of-change behavior change model, and to evaluate the intervention using both individual and community-level indicators. All worksites had cafeterias serving employees.

Five indicators were investigated for possible use as community-level indicators: cafeteria space devoted to fruits and vegetables, plate observation of fruit and vegetable selections at the cash register in the worksite, menus posted in the cafeteria, vending machines that contain fruits and vegetables, and produce orders. All indicators were pretested for completeness of data collection at all sites and for distribution of data.

Two indicators were chosen in which data could be obtained from all sites and these indicators have been applied for comparison with individual-level change:

These two indicators could be applied across cafeterias and provided data of sufficient completeness and metric properties to include in analyses. Analyses of longitudinal data are on-going and results will be posted at this website once available.

Organization: Community Health Promotion Grants Program in the West, Kaiser Family Foundation, Menlo Park, CA
Contact: Allen Cheadle (
CLI-related activities: The Community Health Promotion Grants Program in the West (CHPGP) was a randomized trial of community-based health promotion interventions that took place between 1988 and 1992. Health targets included teen pregnancy, substance use, cancer, cardiovascular disease and injuries. Eleven intervention and 11 control communities, mostly counties in California, were involved in the project. In evaluating the CHPGP, researchers at the University of Washington in Seattle and Group Health Cooperative of Puget Sound developed a variety of community-level indicators to help verify the results of individual level surveys. (More details can be found in the articles by Cheadle et al under grocery store and restaurant measures in the academic literature section

Sample indicators:
Grocery store diet measures:

Click on Grocery Store Survey to download a Word for Windows 2.0 version of the grocery store survey used in the CHPGP evaluation (based on in-store observations). The document (gssurv.doc) includes both (1) the instrument for recording measurements and (2) question-by-question notes that explain how to do it.

Restaurant tobacco use measures:

Click on Restaurant Survey to download a Word for Windows 2.0 version of the restaurant survey used in the CHPGP evaluation (telephone survey). The document (restsurv.doc) includes both (1) the instrument for recording measurements and (2) question-by-question notes that explain how to do it.