Bexar County Community Health Assessment
The 2006 Bexar County Community Health Assessment (BCCHA) is being conducted in three phases. This report combines the results of the first two phases of the assessment. Phase 1 of the assessment relies on traditional public health sources such as vital records of births and deaths to construct outcome indicators of community health, such as low birth weight and causes of death. Information about community health that can be derived from hospital discharges and health care providers is also included in the initial phase. These are labeled in the footer as health outcomes. Phase 2 relies on the Bexar County component of the Behavior Risk Factor Surveillance System (BRFSS) administered by the Centers for Disease Control (CDC) and other sources of information that pertain to the county. Indicators of behaviors that promote good health outcomes and that elevate the risk of poor health outcomes are included in phase 2; these are labeled in the footer as health behaviors.
The emphasis of the third phase is providing the community the opportunity to have a direct voice in the health assessment process. A Community forum was held in June to help understand community health concerns from the resident perspective and to recommend a list of health issues by priority for further elaboration or for programmatic response. Community-based collaborations were invited to address priority community health concerns by proposing an achievable solution to address the concern in their neighborhoods. These collaboratives were asked to do primary data collection in their neighborhoods to demonstrate the need for their solutions. Mini-grants were awarded to three community-based groups; Edgewood Family Network to address obesity and nutrition education; Mision Luterana to “Revitalize the Mision Luterana Neighborhood …one family at a time!”; and the San Antonio Health Literacy Initiative to conduct a survey to determine the level of health literacy in Bexar County. The phase 3 report will report on these activities.
Community Health Behaviors Assessment
On an annual basis, the Texas Department of State Health Services (DSHS) under a contract with CDC collects Behavioral Risk Factor Surveillance System (BRFSS) data. The health indicator information is survey data collected on individuals. Typically the size of the sample collected in Bexar County is sufficient to make estimates for the county but not for smaller areas within the county.
Sample size considerations
The 2002 Bexar County Community Assessment collected primary data to ensure a sample size large enough to make estimates of health behaviors for geographic areas within the county. Rather than incurring the cost of collecting primary data, the research team for the current assessment focused on using statistical methods that would allow using data collected by DSHS. This method permits the combining of data from two years of data collection to provide community-level estimate for areas within the County. For purposes of reporting health behaviors, the individual level data are aggregated to six sectors that are representative of community on a large scale.
Using these methods, BRFSS data collected by DSHS in 2004 and 2005 were combined to produce estimates of health behaviors in the Bexar sectors. Statistical experience determined that cell sizes smaller than 40 produced unreliable estimates. For questions asked in 2004 or in 2005 but not in both years, the sample size in some instances was still large enough to produce sector estimates. Estimates of behaviors are provided for all sectors with cell sizes of 40 or larger. When the sample was insufficient to produce estimates for all sectors, data were aggregated to produce estimates for north Bexar County (Northwest, North Central, and Northeast sectors) and south Bexar County (West, South, and East sectors).
To provide the maximum utility, data are provided for all sectors for which reliable estimates of behavior can be provided. Estimates for north and south Bexar County are also provided any time that the sample size was not sufficient to estimate one or more sectors. This strategy was used to demonstrate that creative uses of existing data may increase the kind of information available to groups interested in describing populations and circumvent the need to collect primary data. It is important that appropriate statistical methods be used when using these techniques.
Information on health behaviors covers the period 2002 to 2004–2005 to provide a reporting period for comparability with the final report for the 2002 Assessment. Rates for health behaviors generally change slowly; the 2004-2005 data should be consistent for 2004. In some cases, data for important indicators, such as many of these related to child health, were not collected in 2004 or 2005; in those cases, data for 2002 are presented to maintain the emphasis on these measures.
The findings for Bexar County are compared with Texas and another large urban area, Harris County, to provide a larger context for the analysis. The final report will contain a report card format in which each level of geography will be ranked on a dimension of health relative to the other levels of the geography.