2021 Indiana Civic Health Index

This fifth edition of the Indiana Bar Foundation's Indiana Civic Health Index (INCHI) takes stock of Indiana's successes and shortcomings during the past decade and defines action steps to ensure Indiana becomes a national leader in civic health. In this latest INCHI we examine three election cycles – six elections during 10 years – and analyze trends during that time. The insights gained by examining Hoosiers' participation in civic life from 2010 to the present will inform and inspire citizens and leaders alike to build a culture of civic engagement enhancing our economic, social, and political well-being.Building on the recommendations outlined in the 2019 Indiana Civic Health Index, section one of the report details progress in advancing civic education in schools and promoting citizen participation in the election process, two goals that are profoundly intertwined. Studies show a consistent and robust relationship between school experiences with voting education and civic participation later in life. As cornerstones of representative democracy, civic education and participation are crucial to advancing our civic health.The second section of the report continues the review of Indiana's performance on an array of civic health indicators. Drawing on earlier analyses and incorporating the newest data, we examine ten years (2010-2020) of Indiana's civic activity, identifying areas of strength as well as opportunities for improvement. We hope this unique overview will further stimulate discussion and inspire a renewed commitment to advancing our civic health.  Strengthening Hoosiers' civic health will require a concerted effort of all stakeholders interested in supporting citizen participation in its many forms; the result will be a more vibrant, successful, and engaged Indiana and nation

2021 Veterans Civic Health Index Defining Our Future Leaders: The Civic Health of Post- 9/11 Veterans

This report represents the fourth edition of this type of analysis on the veterans community- again showing that veterans outperform non-veterans in multiple forms of civic engagement including voting, donating, and volunteering

A distributed geospatial approach to describe community characteristics for multisite studies

Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research

The State of School Infrastructure in the Assembly Constituencies of Rural India: Analysis of 11 Census Indicators from Pre-Primary to Higher Education

In India, assembly constituencies (ACs), represented by elected officials, are the primary geopolitical units for state-level policy development. However, data on social indicators are traditionally reported and analyzed at the district level, and are rarely available for ACs. Here, we combine village-level data from the 2011 Indian Census and AC shapefiles to systematically derive AC-level estimates for the first time. We apply this methodology to describe the distribution of 11 education infrastructures—ranging from pre-primary school to senior secondary school—across rural villages in 3773 ACs. We found high variability in access to higher education infrastructures and low variability in access to lower education variables. For 40.3% (25th percentile) to 79.7% (75th percentile) of villages in an AC, the nearest government senior secondary school was >5 km away, whereas the nearest government primary school was >5 km away in just 0% (25th percentile) to 1.9% (75th percentile) of villages in an AC. The states of Manipur, Arunachal Pradesh, and Bihar showed the greatest within-state variation in access to education infrastructures. We present a novel analysis of access to education infrastructure to inform AC-level policy, and demonstrate how geospatial and Census data can be leveraged to derive AC-level estimates for any population health and development indicators collected in the Census at the village level

Combining global positioning system and accelerometer data to determine the locations of physical activity in children

Abstract. National trends indicate that children and adolescents are not achieving sufficient levels of physical activity. Combining global positioning system (GPS) technology with accelerometers has the potential to provide an objective determination in locations where youth engage in physical activity. The aim of this study was to identify the optimal methods for collecting combined accelerometer and GPS data in youth, to best locate where children spend time and are physically active. A convenience sample of 24 mid-school children in Massachusetts was included. Accelerometers and GPS units were used to quantify and locate childhood physical activity over 5 weekdays and 2 weekend days. Accelerometer and GPS data were joined by time and mapped with a geographical information system (GIS) using ArcGIS software. Data were collected in winter, spring, summer in 2009-2010, collecting a total of 26,406 matched datapoints overall. Matched data yield was low (19.1 % total), regardless of season (winter, 12.8%; spring, 30.1%; summer, 14.3%). Teacher-provided, pre-charged equipment yielded the most matched (30.1%; range: 10.1-52.3%) and greatest average days (6.1 days) of data. Across all seasons, children spent most of their time at home. Outdoor use patterns appeared to vary by season, with street use increasing in spring, and park and playground use increasing in summer. Children spent equal amounts of physical activity time at home and walking in the streets. Overall, the various methods for combining GPS and accelerometer data provided similarly low amounts of combined data. No combined GPS and accelerometer data collection method proved superior in every data return category, but use of GIS to map joined accelerometer and GPS data can demarcate childhood physical activit

The influence of the built environment on outcomes from a “walking school bus study”: a cross-sectional analysis using geographical information systems

Active commuting to school increases children’s daily physical activity. The built environment is associated with children’s physical activity levels in cross-sectional studies. This study examined the role of the built environment on the out- comes of a “walking school bus” study. Geographical information systems was used to map out and compare the built envi- ronments around schools participating in a pilot walking school bus randomised controlled trial, as well as along school routes. Multi-level modelling was used to determine the built environment attributes associated with the outcomes of active commuting to school and accelerometer-determined moderate-to-vigorous physical activity (MPVA). There were no differ- ences in the surrounding built environments of control (n = 4) and intervention (n = 4) schools participating in the walking school bus study. Among school walking routes, park space was inversely associated with active commuting to school (β = -0.008, SE = 0.004, P = 0.03), while mixed-land use was positively associated with daily MPVA (β = 60.0, SE = 24.3, P = 0.02). There was effect modification such that high traffic volume and high street connectivity were associated with greater moderate-to-vigorous physical activity. The results of this study suggest that the built environment may play a role in active school commuting outcomes and daily physical activity

Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?

Background An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. Methods We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. Results The highest annual surgical utilization rate was 184 operations/100 000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (r(s) = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p<0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p<0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p<0.01). Copyright (C) 2012 John Wiley & Sons, Ltd. Conclusions Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright (C) 2012 John Wiley & Sons, Ltd

Adolescents’ use of the built environment for physical activity

Background: Physical activity is a health-enhancing behavior, but few adolescents achieve the recommended levels of moderate-to-vigorous physical activity. Understanding how adolescents use different built environment spaces for physical activity and activity varies by location could help in designing effective interventions to promote moderate-to-vigorous physical activity. The objective of this study was to describe the locations where adolescents engage in physical activity and compare traditional intensity-based measures with continuous activity when describing built environment use patterns among adolescents. Methods: Eighty adolescents aged 11–14 years recruited from community health and recreation centers. Adolescents wore accelerometers (Actigraph GT3X) and global positioning system receivers (QStarz BT-Q1000XT) for two separate weeks to record their physical activity levels and locations. Accelerometer data provided a continuous measure of physical activity and intensity-based measures (sedentary time, moderate-to-vigorous physical activity). Physical activity was mapped by land-use classification (home, school, park, playground, streets & sidewalks, other) using geographic information systems and this location-based activity was assessed for both continuous and intensity-based physical activity derived from mixed-effects models which accounted for repeated measures and clustering effects within person, date, school, and town. Results: Mean daily moderate-to-vigorous physical activity was 22 minutes, mean sedentary time was 134 minutes. Moderate-to-vigorous physical activity occurred in bouts lasting up to 15 minutes. Compared to being at home, being at school, on the streets and sidewalks, in parks, and playgrounds were all associated with greater odds of being in moderate-to-vigorous physical activity and achieving higher overall activity levels. Playground use was associated with the highest physical activity level (β = 172 activity counts per minute, SE = 4, p < 0.0001) and greatest odds of being in moderate-to-vigorous physical activity (odds ratio 8.3, 95% confidence interval 4.8-14.2). Conclusion: Adolescents were more likely to engage in physical activity, and achieved their highest physical activity levels, when using built environments located outdoors. Novel objective methods for determining physical activity can provide insight into adolescents’ spatial physical activity patterns, which could help guide physical activity interventions. Promoting zoning and health policies that encourage the design and regular use of outdoor spaces may offer another promising opportunity for increasing adolescent physical activity

Measuring adequacy of the midwifery workforce using standards of competency and scope of work: Exploring the density and distribution of midwives in three low- and middle-income countries using cross-sectional and geospatial data.

BackgroundA global midwifery shortage hampers the goal of ending preventable maternal/newborn mortality and stillbirths. Whether current measures of midwifery workforce adequacy are valid is unknown. We compare two measures of density and distribution of midwifery professionals to assess their consistency, and explore how incorporating midwifery scope, competency, and the adjusting reference population impacts this critical metric.Methods and findingsWe collected a census of midwives employed in eligible facilities in our study settings, (422 in Ghana; 909 in India), assessed the number practicing within the scope of work for midwifery professionals defined in the International Labor Organization International Standard Classification of Occupations, and whether they reported possessing the ICM essential competencies for basic midwifery practice. We altered the numerator, iteratively narrowing it from a simple count to include data on scope of practice and competency and reported changes in value. We altered the denominator by calculating the number of midwives per 10,000 total population, women of reproductive age, pregnancies, and births and explored variation in the indicator. Across four districts in Ghana, density of midwives decreased from 8.59/10,000 total population when counting midwives from facility staffing rosters to 1.30/10,000 total population when including only fully competent midwives by the ICM standard. In India, no midwives met the standard, thus the midwifery density of 1.37/10,000 total population from staffing rosters reduced to 0.00 considering competency. Changing the denominator to births vastly altered subnational measures, ranging from ~1700% change in Tolon to ~8700% in Thiruvallur.ConclusionOur study shows that varying underlying parameters significantly affects the value of the estimate. Factoring in competency greatly impacts the effective coverage of midwifery professionals. Disproportionate differences were noted when need was estimated based on total population versus births. Future research should compare various estimates of midwifery density to health system process and outcome measures