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 epidemiology Overview Session 5, Part 1 • Framework for epidemiology specialties • Disaster epidemiology methods • Environmental epidemiology Framework for Epidemiologic Applications Reminder: 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 injury 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 Methodologies • Rapid assessments using CASPER methods • GIS and GPS Technology • Examples of rapid needs assessment/ CASPER in disaster and non-disaster settings – 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 information 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 area • Do not provide direct services to residents such as cleanup or home repair CASPER 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 Field Team 1 Field Team 2 Field Team 3 Field Team 4 Field Team 5 Field data collection using handheld computers equipped with GPS, GIS software and data collection forms. ARCPad GIS Software on Handheld Computer ArcPad Routing Function Customized Form ArcPad programmed to automatically insert cluster # in database for complex samples analysis ArcPad form programmed to automatically insert census block group population in survey Assigns a unique case ID or incident # Creating Forms in ArcPad Studio Example 1: PHRST Tool for CASPER PHRST Toolbar created for ArcMap 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 evacuated – 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 needs • Collaborate with community leaders, public health, hospitals, private practitioners, academic partners Community Health Assessments • CHA Report – Gives information about the health of the community – Describes community capacity to improve the lives of residents • CASPER – Reduces the number of surveys needed – Allows for efficient and more accurate data collection Example 4: KI Distribution Survey, 2010 • Very low household coverage rates (<5%) • Knowledge of KI positively correlated with: – – – – Age 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 assessments – – – – 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 Epidemiology • 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 Programs 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 communications – Human-environment interaction • State-based hazard and pollution programs Preparedness • 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 • • • • Pesticides Air pollution Hazardous waste Special studies Summary • Epidemiology methods can have many applications • Disaster epidemiology to assess disaster impacts, guide response and prepare for future disasters • Environmental epidemiology monitors populations for health repercussions of environmental contamination References • • • • • • 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.