A Dictionary of Epidemiology - UNC Center for Public Health

Session 5, Part 1
Epidemiology Applications:
Disaster and Environmental Epidemiology
Learning Objectives
Session 5, Part 1
• Identify epidemiology methods that can be
used regardless of epidemiologic specialty
• Describe the Community Assessment for
Public Health Emergency Response
(CASPER) process
• List 4 functions of environmental
Session 5, Part 1
• Framework for epidemiology
• Disaster epidemiology methods
• Environmental epidemiology
Framework for Epidemiologic
What is Epidemiology?
“Study of the distribution and determinants of
health-related states or events in specified
populations, and the application of this study to
the control of health problems.”
--From A Dictionary of Epidemiology, 3rd ed.
• Study risk associated with exposures
• Identify and control epidemics
• Monitor population rates of disease and exposure
*Last JM, ed
Goals of Epidemiology in a
Health Department
• Collect and use high quality data
• Understand limitations of data
• Work to improve data collection and quality
• Use analytic results for planning and evaluation
of disease and injury prevention programs
• Contribute new information for the
understanding and prevention of disease and
Methods for Accomplishing
Epidemiologic Goals
• Acute response
• Ongoing surveillance
• Epidemiologic analysis
• Dissemination of results
• Advocacy and enforcement
Disaster Epidemiology
Disaster Epidemiology-Defined
• CDC defines as: The use of epidemiology
to assess the short- and long-term
adverse health effects of disasters and to
predict consequences of future disasters
• Unites various topic areas of
epidemiology, e.g. communicable disease,
chronic disease, injury, mental health, etc.
Disaster Epidemiology
• Rapid assessments using CASPER methods
• GIS and GPS Technology
• Examples of rapid needs assessment/
CASPER in disaster and non-disaster
– Example 1: PHRST 5 Tool
– Example 2: Hurricane Irene in NC, 2011
– Example 3: Community Health Assessments
– Example 4: KI distribution survey in NC, 2010
Definition of CASPER
• Format:
– Face-to-face survey with
people living in affected area
• Target audience:
– Decision-makers
• Benefits
– Quick and low-cost
– Accurate and useful
Hurricane Hugo, near Charleston, SC, September, 1989.
Source: CDC Public Health Image Library
Purpose of a CASPER
Determine type and
magnitude of needs to plan
and implement relief efforts
What CASPERs are NOT
• Do not deliver food, medicine, medical
services or other resources to the affected
• Do not provide direct services to residents
such as cleanup or home repair
Sample Selection
• Select a sample area
– Storm path, damage reports, service areas
• Randomly select 30 population weighted
geographic clusters in sample area
• Randomly select 7 households within each
geographic cluster
• 210 total surveys, 10 survey teams
GIS as a CASPER Tool
• Tools for storing, manipulating, analyzing and
displaying spatial data
• Used to construct maps that communicate
spatial data
– Raster-based: Data and image stored in a
regularized grid made of pixels [Satellite]
– Vector-based: Data and image stored separately in
map layers (points, lines, polygons) – [EpiInfo’s Epi
Map, ArcMap]
• Map layers use x-y coordinate system based on
latitude and longitude
GPS (Global
Positioning System)
Field Data Collection
GIS Software
Team 1
Team 2
Team 3
Team 4
Team 5
Field data collection using handheld computers equipped with GPS, GIS
software and data collection forms.
ARCPad GIS Software on
Handheld Computer
Customized Form
programmed to
automatically insert
cluster # in
database for
complex samples
ArcPad form
programmed to
insert census
block group
population in
Assigns a
unique case ID
or incident #
Creating Forms in ArcPad Studio
Example 1:
created for
Stage 1
Stage 2
Site selection toolkit freely available from UNC (cphp.sph.unc.edu/sharpgis/)
Example 2:
Hurricane Irene, 2011
Hurricane Irene
CASPER Results
• 205 interviews
– 27.8% of respondents
– Only 35% of county
residents knew an
evacuation order had
been issued
– Evacuation rates highest
among those living in 100
year flood plain
Example 3:
Community Health Assessments
• Identify factors that affect the
health of the population
• Determine the availability of
resources to meet identified
• Collaborate with community
leaders, public health,
hospitals, private practitioners,
academic partners
Community Health Assessments
• CHA Report
– Gives information about
the health of the
– Describes community
capacity to improve the
lives of residents
– Reduces the number of
surveys needed
– Allows for efficient and
more accurate data
Example 4:
KI Distribution Survey, 2010
• Very low household coverage
rates (<5%)
• Knowledge of KI positively
correlated with:
Length of residence,
EPZ awareness and
White race
• Low levels of concern about
nuclear accident
Disaster Epidemiology Recap…
• CASPERs fulfill vital public health function
• Use of incident command system (ICS) is vital to
rapid deployment of resources
• Handheld computers, GIS and GPS adds value
to field data collection in rapid needs
Eliminates double data entry
Provides routing and direction-finding for field teams
Improved randomization through GIS
Ability to quickly analyze and map data
Environmental Epidemiology
Mission of Environmental
• Reduce incidence and severity of disease
and adverse health conditions due to
environmental exposures
• Identify populations at risk of
environmental exposures
• Understand and prevent disease and
adverse health conditions
Environmental Epidemiology
May exist alone or in combination with other
epidemiologic disciplines:
• Injury
• Chronic
• Occupational
• Zoonotic
• Toxicology
Core Functions of
Environmental Epidemiology
• Conduct site-specific assessments
• Conduct health, environmental, and
biological surveillance
• Respond to community concerns
• Conduct health professional and
community education
Technical Assistance and
Partner Relationships
• Cooperation and coordination with
EPA and local health departments
• State departments of Environment
/ Environmental Management /
Natural Resources
– Chemical release
– Planning and public
– Human-environment interaction
• State-based hazard and
pollution programs
• Technical support for response planning
and implementation
• Education and outreach
– High-risk populations
– First responders
• Identify vulnerable populations
• Chemical terrorism fact sheets
Other Programs in
Environmental Epidemiology
• Toxins, occupational exposures
– Blood lead
– Asbestosis
– Silicosis
Air pollution
Hazardous waste
Special studies
• Epidemiology methods can have many
• Disaster epidemiology to assess disaster
impacts, guide response and prepare for
future disasters
• Environmental epidemiology monitors
populations for health repercussions of
environmental contamination
Last JM. A Dictionary of Epidemiology. 3rd ed. New York, NY: Oxford
University Press; 1995.
Law D. Introduction to Geographic Information Systems. Methods in Field
Epidemiology Lecture Series. Department of Epidemiology, University of
North Carolina at Chapel Hill School of Public Health; 2005.
Malilay J, Flanders WD, Brogan D. A modified cluster-sampling method for
post-disaster rapid assessment of needs. Bull World Health
Organ. 1996;74(4):399-405.
MacDonald PDM. Methods in Field Epidemiology. Burlington, Mass: Jones
& Bartlett Learning; 2012.
Beitsch LM, Brooks RG, Grigg M, Menachemi N. Structure and Functions of
State Public Health Agencies. Am J Public Health. 2006;96(1):167-172.
Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470433/.
Accessed December 29, 2011.
Health Studies Branch - Preparedness and Response for Public Health
Disasters. [Web page.] National Center for Environmental Health, Centers
for Disease Control and Prevention. Available at:
http://www.cdc.gov/nceh/hsb/disaster/. Accessed March 1, 2012.

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