Market characteristics associated with community health assessments by local health departments.

OBJECTIVES: Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN: The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS: Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS: Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS: Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.

Wellness among US adolescents ages 12-17 years.

BACKGROUND: Wellness is a multidimensional construct related to an individual's physical, emotional, intellectual and social well-being. We present estimates of wellness among US adolescents aged 12-17 years and explore how demographic characteristics are associated with wellness. METHODS: All respondents aged 12 to 17 years (n = 34,601) from the 2011-2012 National Survey of Children's Health were included in the sample. Survey items were coded to operationalize an overall wellness score, comprised of four subdimensions (physical, intellectual, emotional and social). RESULTS: The mean adjusted overall wellness score was 30.2 (out of 40). Mean raw subdimensions scores were: social = 3.14 (out of 4), emotional = 4.79 (out of 6), intellectual = 4.80 (out of 8) and physical = 6.57 (out of 8). Older adolescents, those with special health needs, those in lower income families and those whose mother or father report fair-poor mental health status had lower wellness scores. CONCLUSIONS: US adolescents have wellness scores towards the upper or higher end of our scale. Several adolescent and family characteristics were associated with either lower overall wellness and/or lower wellness on multiple subdimensions. Assessing wellness during critical developmental periods of adolescence is a first step towards promoting behaviours that support increased wellness into adulthood.

Correlates of wellness among youth with functional disabilities.

BACKGROUND: The literature is more informative on the impediments to wellness among youth with functional limitations and less instructive on the state of wellness for this population. OBJECTIVE: To explore overall wellness, and each sub-dimension of wellness, in a national sample of youth with functional limitations and to determine how demographic characteristics are associated with wellness. METHODS: Using a previously validated screening instrument, we identify youth with functional limitations aged 12 to 17 represented in the 2011/12 National Survey of Children's Health. Survey items were coded to operationalize an overall wellness score comprised of four sub-dimensions of wellness (i.e., physical, intellectual, emotional, and social). RESULTS: The mean overall wellness score was 26.7 (out of 40) and had an approximate normal distribution. Mean raw scores for each sub-dimension were as follows: social = 2.79 (out of 4; 69.7%); emotional = 4.09 (out of 6; 68.2%); intellectual = 3.79 (out of 8; 47.4%); and physical = 6.30 (out of 8; 78.7%). Lower wellness scores were associated with older age among youth, increasing number of chronic health conditions, lower income, single mother homes, and youth whose mother reported fair or poor mental health status (all p < 0.05). Higher wellness scores were positively associated with mother's education (p < 0.001). CONCLUSIONS: Program planners should consider interventions that target youth with functional limitations shown to be at particular risk for lower overall wellness and promote family involvement and comprehensive supports, including maternal educational attainment, mental health screening, and referral.