A Community Needs Index for Adolescent Pregnancy Prevention Program Planning: Application of Spatial Generalized Linear Mixed Models.
Objective The objective is to estimate community needs with respect to risky adolescent sexual behavior in a way that is risk-adjusted for multiple community factors. Methods Generalized linear mixed modeling was applied for estimating teen pregnancy and sexually transmitted disease (STD) incidence by postal ZIP code in New York State, in a way that adjusts for other community covariables and residual spatial autocorrelation. A community needs index was then obtained by summing the risk-adjusted estimates of pregnancy and STD cases. Results Poisson regression with a spatial random effect was chosen among competing modeling approaches. Both the risk-adjusted caseloads and rates were computed for ZIP codes, which allowed risk-based prioritization to help guide funding decisions for a comprehensive adolescent pregnancy prevention program. Conclusions This approach provides quantitative evidence of community needs with respect to risky adolescent sexual behavior, while adjusting for other community-level variables and stabilizing estimates in areas with small populations. Therefore, it was well accepted by the affected groups and proved valuable for program planning. This methodology may also prove valuable for follow up program evaluation. Current research is directed towards further improving the statistical modeling approach and applying to different health and behavioral outcomes, along with different predictor variables.
City University of New York School of Public Health, 55 West 125th Street, New York, NY, 10027, USA. Glen.Johnson@sph.cuny.edu.
Glen D
GD
Johnson
Bureau of Women, Infant and Adolescent Health, New York State Department of Health, Corning Tower Room 859, Albany, NY, 12237, USA.
Kristine
K
Mesler
Division of Family Health, New York State Department of Health, Corning Tower, Room 984, Albany, NY, USA.|Department of Epidemiology and Biostatistics, School of Public Health, State University of New York, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.
Marilyn A
MA
Kacica
D000293:Adolescent; D018672:Community Health Planning / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000073276:Models, Spatial Interaction; D020380:Needs Assessment / Q000706:statistics & numerical data*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control* / Q000706:statistics & numerical data; D012111:Residence Characteristics; D020379:Risk Adjustment / Q000379:methods*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D017062:Small-Area Analysis; D013029:Space-Time Clustering
Adolescent sexual health; Community health needs assessment; Generalized linear mixed models; Pregnancy prevention program; Spatial regression