Abstract
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.
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Acknowledgements
This work was supported by the US Maternal and Child Health Block Grant to New York State. The authors sincerely appreciate the efforts of New York State Department of Health staff who provided the critical outcome data for this project; namely Allison Muse, Director of the Bureau of STD Prevention and Epidemiology, and Lawrence Schoen of the Bureau of Biometrics and Health Statistics.
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Johnson, G.D., Mesler, K. & Kacica, M.A. A Community Needs Index for Adolescent Pregnancy Prevention Program Planning: Application of Spatial Generalized Linear Mixed Models. Matern Child Health J 21, 1227–1233 (2017). https://doi.org/10.1007/s10995-017-2280-5
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DOI: https://doi.org/10.1007/s10995-017-2280-5