1. Unemployment rate.

    For individuals, unemployment reduces household income, can limit access to health insurance, and can contribute to psychological stress. For a community, an increase in the unemployment rate can increase demands on social services and might signal broader economic problems. The unemployment rate can fluctuate considerably from month to month; therefore rates should be obtained by month or quarter for one to two years to determine the underlying trend. Field model domains: individual behavior, social environment, physical environment, prosperity, health care, and health and function. Data sources: state employment security office.

  2. Number and proportion of single-parent families.

    Single-parent families may experience many economic and social stresses that affect the health status of adults and children. Field model domains: individual behavior, social environment, physical environment, prosperity, health care, and well-being. Data sources: decennial census; data on divorce and births to unmarried mothers can be obtained from the state vital records office to monitor changes in family structure.

  3. Number and proportion of persons without health insurance.

    Having health insurance can be key for access to health care services. Without insurance, individuals often do not receive timely treatment or preventive care, which can compound adverse health conditions. Field model domains: disease, social environment, health care, health and function, and well-being. Data sources: no uniform community-level data collection tool is available; state assistance may be necessary to obtain data through community surveys. Oversampling in a state-level survey for the Behavioral Risk Factor Surveillance System (BRFSS) might be a source of information on adults; modifications would be required to obtain information on children.

  4. Infant mortality rate by race or ethnicity.

    This indicator is included in the consensus set recommended by the CDC (1991) for use by all states and communities. It is widely used as an indicator of child health. Because there are many reasons why infants die, infant mortality reflects the effectiveness of health departments, personal health care providers,



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