Environmental Public Health Tracking Research Articles

Common and Unique Barriers to the Exchange of Administrative Healthcare Data in Environmental Public Health Tracking Program.

CDC’s National Environmental Public Health Tracking Program (Tracking Program) receives administrative data annually from 25–30 states to track potential environmental exposures and to make data available for public access. In 2019, the CDC Tracking Program conducted a cross-sectional survey among principal investigators or program managers of the 26 funded programs to improve access to timely, accurate, and local data. All 26 funding recipients reported having access to hospital inpatient data, and most states (69.2%) regularly update data user agreements to receive the data. Among the respondents, 15 receive record-level data with protected health information (PHI) and seven receive record-level data without PHI. Regarding geospatial resolution, approximately 50.0% of recipients have access to the street address or census tract information, 34.6% have access to ZIP code, and 11.5% have other sub-county geographies (e.g., town). Only three states receive administrative data for their residents from all border states. The survey results will help the Tracking Program to identify knowledge gaps and perceived barriers to the use and accessibility of administrative data for the CDC Tracking Program. The information collected will inform the development of resources that can provide solutions for more efficient and timely data exchange.

Aggregated cumulative county arsenic in drinking water and associations with bladder, colorectal, and kidney cancers, accounting for population served.

Many studies neglect to account for variation in population served by community water systems (CWSs) when aggregating CWS-level contaminant concentrations to county level. In an ecological epidemiologic analysis, we explored two methods-unweighted and weighted (proportion of CWS population served by county population)-to account for population served by CWS in association between arsenic and three cancers to determine the impact of population served on aggregated measures of exposure. CWS arsenic concentration data for 19 states were obtained from Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Network for 2000-10, aggregated to county level, and linked to county-level cancer data for 2011-5 from National Cancer Institute and CDC State Cancer Profiles. Negative binomial regression models estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI) between county-level bladder, colorectal, and kidney cancers and quartiles of aggregated cumulative county-level arsenic concentration (ppb-years). We observed positive associations between the highest quartileof exposure, compared to the lowest, ofaggregated cumulative county-level arsenic concentration (ppb-year) for bladder [weighted aRR: 1.89(1.53, 2.35)], colorectal [1.64(1.33, 2.01)], and kidney [1.69(1.37, 2.09)] cancers. We observed stronger associations utilizing the weighted exposure assessment method. However, inferences from this study are limited due to the ecologic nature of the analyses and different analytic study designs are needed to assess the utility that the weighted by CWS population served metric has for exposure assessment. Weighting by CWS population served accounts for some potential exposure assignment error in epidemiologic analysis.

Establishing and extending EPHT capacity in England: governance and operational aspects

Within Public Health England (PHE), an Environmental Public Health Tracking (EPHT) programme was established that includes several activities on surveillance of environmental hazards, exposures and health outcomes. We aim to account for key aspects of EPHT governance and operations in England. We describe the process for selecting topics to be included in EPHT and managing its data. This core infrastructure of EPHT within PHE has delivered capacity to support activities on ongoing concerns regarding hazardous pollutants and chemicals in drinking water, land, food and air, as well as linking with novel interpretative frameworks derived from research programmes in collaboration with external research groups. The English EPHT programme has adopted an approach providing common governance for disparate themes, this includes a EPHT board accountable to PHE’s executive via an environmental hazards programme board, a strategic advisory group, stakeholder consultations, and PHE working groups with the remit to establish surveillance structures and functions appropriate to specific information needs. This process has produced activities on population exposure estimation of arsenic in private water supplies, the burden of disease of carbon monoxide poisoning, lead exposure in children, fluoridation monitoring, and guidance for investigating non-infectious disease clusters from potential environmental causes. Recent developments include national systems for enhanced air pollution exposure surveillance and access to weather data for public health use. Studies of distribution of vectors, climate variability and infectious disease, coastal changes and toxin-producing algae, social factors affecting use of green spaces and related health benefits, all illustrate novel interpretative frameworks that were first tested and documented in a research setting, and having been co-designed and co-produced with public health agencies, their relevance for EPHT can more easily be considered. In conclusion, EPHT in England is a programme that enables both activities on well-known environmental factors, and the capacity to integrate emerging concerns.

Small area environmental health data: Challenges and solutions from a surveillance system perspective

Timely, locally-relevant information is important for conducting environmental epidemiology studies; however, public health data are often lagging, spatially unresolved, or unavailable. The Centers for Disease Control and Prevention’s Environmental Public Health Tracking Program (Tracking Program) is building a system of sub-county data to enhance the spatial resolution. This presentation covers the main challenges of increasing spatial resolution. The validity of epidemiologic research depends on positional accuracy of geocodes. Geocoding presents several challenges (e.g., handling special cases like PO Boxes and group quarters, match score thresholds, and how to categorize geocoding quality). The Tracking Program developed geocoding guidelines to transform address-level health data to census tract while addressing these issues. Many health outcomes cannot be displayed at census tract for reasons of confidentiality and stability due to too few cases and/or people in an area. To overcome this, the Tracking Program created standardized sub-county geographies (census tract aggregations) that can be compared over time, space, and dataset to allow data to be displayed at a finer scale while ensuring minimal suppression and instability. Multiple challenges were addressed, including selection of population thresholds and handling group quarters. There are multiple choices of denominator datasets available for public health surveillance (e.g., decennial census). The choice of denominator dataset may or may not have an impact on calculated rates and public health interpretation. To address this and answer the question of which denominator dataset to use, the Tracking Program created a framework to evaluate denominator datasets. The efforts from this project will help meet increasing demand for finer resolution data. These data can inform environmental health studies, where there is often local-level heterogeneity in the environment. Having small area environmental health data can allow for better understanding of local variation within counties, prioritize needs, and advance our understanding of environmental health processes and impacts.

Publicly available UV irradiance data in the contiguous United States and its applications

Background: Skin cancer is the most common type of cancer in the United States. The majority of skin cancer is caused by overexposure to ultraviolet (UV) light. National Environmental Public Health Tracking Program at CDC has collaborated with partners to develop and disseminate county-level daily UV irradiance (2005 to 2015) data for the contiguous United States.Methods: UV dataset was derived based on measurements from the Ozone Monitoring Instrument (OMI) during 2005-2015. UV irradiance data were first calculated at the census tract level; then daily population-weighted UV irradiance were calculated at the county level. We analyzed the spatial distributions and long-term trends of UV irradiance, and ratio of UV irradiance to solar irradiance. We also have used the newly developed dataset in a few applications to improve characterization of UV exposure.Results: The UV dataset is currently the only publicly-available, spatially-resolved, and long-term UV radiation dataset covering the contiguous United States. The national averages across all years available is 2,700 J/m2 for erythemally weighted daily dose of UV irradiance (EDD). UV irradiance increased toward the South and the West. The ratio of UV to solar irradiance mainly increased toward the South and in some areas with high altitude. This spatial variation suggests that using solar irradiance as indicator of UV irradiance in studies covering large geographic regions may bias the true pattern of UV exposure. National annual average daily UV irradiance increased significantly over the years by about 0.5% per year. In addition, we identified hotspots of skin cancer vulnerability, which took into consideration demographic, social risk factors and UV exposure intensity. We also examined state laws allowing sunscreen use in schools in the context of state average UV irradiance. Finally, we are currently studying the association between UV irradiance and cutaneous melanoma incidence rates among white US residents.

Developing an air pollution exposure surveillance system in England; a new national vulnerability indicator

Background: Air pollution is a serious public health issue. Providing better information on vulnerabilities to poor air quality will help stakeholders (local authorities) focus on protecting those most at risk. Public Health England was tasked to develop enhanced vulnerability surveillance for air pollution, as part of the Environmental Public Health Tracking programme, which includes surveillance of hazards (such as air pollution), exposures (concentrations of PM2.5 and NO2) and susceptibility (pre-existing health conditions). Aims: 1) To scope and develop pilots to demonstrate feasibility of air pollution exposure surveillance for stakeholders in England, 2) To agree potential new indicators to represent human vulnerabilities to air pollution, and 3) to help identify areas with populations who are sensitive, i.e. by age or socio-economic status (SES). Methods: We formed a working group which included several surveillance experts. In developing a new model for England, the vulnerability indicator development was split into two stages: 1) choice of exposure data and susceptibility indicator, and 2) linkage of the exposure and susceptibility indicators to produce population-vulnerability that can be provided in a useful output format, e.g. map, rating index or indicator. Results: Initially, we focused on susceptibility to ambient air pollution: age, SES and location, and related these to air pollution (PM2.5 and NO2) concentrations. We combined the exposure data and susceptibility to derive the vulnerabilities indicator. We scoped out different methodologies, practicalities, constraints and their application to pilot areas. Conclusions: An air pollution exposure surveillance system is being designed for England. The priority was showing where exposure needs to be tackled to reduce health effects including mortality associated with exposure to outdoor air pollution. Next, the indicator needs to reflect the impact of interventions where changes in air pollution occur.

Groundwater Arsenic Distribution in India by Machine Learning Geospatial Modeling.

Groundwater is a critical resource in India for the supply of drinking water and for irrigation. Its usage is limited not only by its quantity but also by its quality. Among the most important contaminants of groundwater in India is arsenic, which naturally accumulates in some aquifers. In this study we create a random forest model with over 145,000 arsenic concentration measurements and over two dozen predictor variables of surface environmental parameters to produce hazard and exposure maps of the areas and populations potentially exposed to high arsenic concentrations (>10 µg/L) in groundwater. Statistical relationships found between the predictor variables and arsenic measurements are broadly consistent with major geochemical processes known to mobilize arsenic in aquifers. In addition to known high arsenic areas, such as along the Ganges and Brahmaputra rivers, we have identified several other areas around the country that have hitherto not been identified as potential arsenic hotspots. Based on recent reported rates of household groundwater use for rural and urban areas, we estimate that between about 18–30 million people in India are currently at risk of high exposure to arsenic through their drinking water supply. The hazard models here can be used to inform prioritization of groundwater quality testing and environmental public health tracking programs.

Addressing lead exposure in children in Georgia: challenges and successes of a multi-agency response

Abstract The national response for reducing lead (Pb) exposure in Georgia is coordinated by the National Centre for Disease Control and Public Health (NCDC&PH) and implemented as a multi-agency (CDC, UNICEF, WHO, University of Emory) response. Given concerns about the extent of Pb exposure, in 2018 Multiple Indicator Cluster Surveys (MICS) of representative samples of children have been conducted to study several demographic and health aspects, including a study of the prevalence of blood Pb levels among 2 to 7 years old children (n = 1578). This survey was conducted in collaboration with the Italian Instituto Superiore di Sanita' (ISS), UNICEF and NCDC. The laboratory analyses were conducted at ISS in Italy. Initial results showed that in 41% of all children, blood Pb concentration was ≥ 5 µg/dl, a challenge which motivated public agencies to establish an initial public health action plan to assess environmental samples (paint, dust, water, soil, selected food items such as spices and imported sweets) in families where Pb concentrations were ≥ 10 µg/dL. A State intervention programme, monitoring Pb blood concentration among MICS children and their family members, provided relevant information on exposed households and led to a reduction of Pb blood concentration across the most exposed households. In collaboration with Public Health England, NCDC has conducted a small Pb isotope ratio study aimed at identifying the most relevant sources of Pb exposure contributing to elevated blood Pb in MICS children. It is expected that these data will support the design of more detailed public health interventions to reduce exposure to key sources of Pb, thus leading to further reduction of Pb-induced health effects in Georgia. In addition, this experience will clarify elements of an ongoing monitoring of environmental factors such as an Environmental Public Health Tracking system, to support national capacity to manage the risks to public health. Key messages Environmental health response requires extensive research and multi-agency approach. If State implements adequate intervention it is possible to reduce blood lead (Pb) level.

Examination of Laws Allowing Sunscreen Use in Schools in the Context of UV Levels by State

PurposeSunscreen use provides ultraviolet radiation (UV) protection but is often limited in school settings because sunscreen is classified as an over-the-counter drug product. Some US states have laws allowing students to carry and self-apply sunscreen. We examined these laws in the context of state UV levels. MethodsWe obtained legislative information through April 2020 from the American Society for Dermatologic Surgery Association website and UV data for years 2005–2015 from Centers for Disease Control and Prevention's National Environmental Public Health Tracking website. ResultsTwenty-three states and District of Columbia have sunscreen laws, including 11 states with UV levels above the median UV level across states. There was no significant association between state UV levels and sunscreen laws. ConclusionsThe presence of state sunscreen legislation has increased but is not associated with UV levels. Future research could examine the implementation and public health effects of these laws.

Software application profile: the Rapid Inquiry Facility 4.0: an open access tool for environmental public health tracking.

The Rapid Inquiry Facility 4.0 (RIF) is a new user-friendly and open-access tool, developed by the UK Small Area Health Statistics Unit (SAHSU), to facilitate environment public health tracking (EPHT) or surveillance (EPHS). The RIF is designed to help public health professionals and academics to rapidly perform exploratory investigations of health and environmental data at the small-area level (e.g. postcode or detailed census areas) in order to identify unusual signals, such as disease clusters and potential environmental hazards, whether localized (e.g. industrial site) or widespread (e.g. air and noise pollution). The RIF allows the use of advanced disease mapping methods, including Bayesian small-area smoothing and complex risk analysis functionalities, while accounting for confounders. The RIF could be particularly useful to monitor spatio-temporal trends in mortality and morbidity associated with cardiovascular diseases, cancers, diabetes and chronic lung diseases, or to conduct local or national studies on air pollution, flooding, low-magnetic fields or nuclear power plants.

Availability, access, analysis and dissemination of small-area data

In this era of ‘big data’, there is growing recognition of the value of environmental, health, social and demographic data for research. Open government data initiatives are growing in number and in terms of content. Remote sensing data are finding widespread use in environmental research, including in low- and middle-income settings. While our ability to study environment and health associations across countries and continents grows, data protection rules and greater patient control over the use of their data present new challenges to using health data in research. Innovative tools that circumvent the need for the physical sharing of data by supporting non-disclosive sharing of information, or that permit spatial analysis without researchers needing access to underlying patient data can be used to support analyses while protecting data confidentiality. User-friendly visualizations, allowing small-area data to be seen and understood by non-expert audiences, are revolutionizing public and researcher interactions with data. The UK Small Area Health Statistics Unit’s Environment and Health Atlas for England and Wales, and the US National Environmental Public Health Tracking Network offer good examples. Open data facilitates user-generated outputs, and ‘mash-ups’, and user-generated inputs from social media, mobile devices and wearable tech are new data streams that will find utility in future studies, and bring novel dimensions with respect to ethical use of small-area data.

Developing a surveillance system of sub-county data: Finding suitable population thresholds for geographic aggregations

The Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program created standardized sub-county geographies that are comparable over time, place, and outcomes. Expected census tract-level counts were calculated for asthma emergency department visits and lung cancer. Census tracts were aggregated for various total population and sub-population thresholds, then suppression and stability were examined. A total of 5,000 persons was recommended for the more common outcome scheme and a total of 20,000 persons was recommended for the rare outcome scheme. Health outcomes with a median case count of 17.0 cases or higher should produce stable estimates at the census tract level. This project generated recommendations for three sub-county geographies that will be useful for surveillance purposes: census tract, a more common outcome aggregation scheme, and a rare outcome aggregation scheme. This methodology can be applied anywhere to aggregate geographic units and produce stable rates at a finer resolution.

Visualizing Carbon Monoxide Poisoning Surveillance Data on the US CDC National Environmental Public Health Tracking Network

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: CDC’s National Environmental Public Health Tracking Program (Tracking Program) aims to provide information from a nationwide network of integrated unintentional carbon monoxide (CO) poisoning data that could inform relevant public health action and prevention. Methods: The Tracking Program has developed dynamic environmental health surveillance system that includes standard visualization tools such as charts, interactive maps, and tables, and displays a variety of measures of morbidity and mortality (e.g., crude, and age-adjusted rates per 100,000) for unintentional CO poisoning. Users also can explore these measures by cause (i.e., fire, non-fire, unknown intent or mechanism). The hospitalization and emergency department (ED) data are obtained by the Tracking Program from funded state recipients (26 states); mortality data are from the National Vital Statistics System. We pooled the CO poisoning data from 2010-2014, and examined the proportion of unintentional non-fire CO poisonings, and compared state-specific age-adjusted rates during the same period. Results: During 2010-2014, there were more than 4,500 unintentional CO poisoning deaths with an average of 916 deaths annually. Deaths and hospitalizations categorized as non-fire comprised of 41.4%, and 55.4% of cases respectively. During the same period, states that had the two highest annual age-adjusted rate of ED visits for unintentional CO poisoning were Connecticut (AR: 21.4 in 2011) and Vermont (AR=15.7 in 2013), and the highest hospitalization rate were observed in New Mexico (AR: 2.1 in 2011) and Maryland (AR=1.8 in 2009). Conclusions: The Tracking Program demonstrates the opportunity to visualize environmental and health data on one data platform. This allows users to examine temporal and spatial trends and to identify communities at greater risk for CO poisoning. The Tracking Program’s CO poisoning data can be used to drive public health policy and actions that ultimately will reduce the burden of mortality and morbidity for CO poisoning.

Ambient air pollution and in vitro fertilization treatment outcomes.

Is air pollution associated with IVF treatment outcomes in the USA? We did not find clear evidence of a meaningful association between reproductive outcomes and average daily concentrations of particulate matter with an aerodynamic diameter ≤2.5μm (PM2.5) and ozone (O3). Maternal exposure to air pollution such as PM2.5, nitrogen oxides, carbon monoxide or O3 may increase risks for adverse perinatal outcomes. Findings from the few studies using data from IVF populations to investigate associations between specific pollutants and treatment outcomes are inconclusive. Retrospective cohort study of 253 528 non-cancelled fresh, autologous IVF cycles including 230 243 fresh, autologous IVF cycles with a transfer of ≥1 embryo was performed between 2010 and 2012. We linked 2010-2012 National ART Surveillance System data for fresh, autologous IVF cycles with the ambient air pollution data generated using a Bayesian fusion model available through the Centers for Disease Control and Prevention's Environmental Public Health Tracking Network. We calculated county-level average daily PM2.5 and O3 concentrations for three time periods: cycle start to oocyte retrieval (T1), oocyte retrieval to embryo transfer (T2) and embryo transfer +14days (T3). Multivariable predicted marginal proportions from logistic and log-linear regression models were used to estimate adjusted risk ratios (aRR) and 95% CI for the association between reproductive outcomes (implantation rate, pregnancy and live birth) and interquartile increases in PM2.5 and O3. The multipollutant models were also adjusted for patients and treatment characteristics and accounted for clustering by clinic and county of residence. For all exposure periods, O3 was weakly positively associated with implantation (aRR 1.01, 95% CI 1.001-1.02 for T1; aRR 1.01, 95% CI 1.001-1.02 for T2 and aRR 1.01, 95% CI 1.001-1.02 for T3) and live birth (aRR 1.01, 95% CI 1.002-1.02 for T1; aRR 1.01, 95% CI 1.004-1.02 for T2 and aRR 1.02, 95% CI 1.004-1.03 for T3). PM2.5 was not associated with any of the reproductive outcomes assessed. The main limitation of this study is the use of aggregated air pollution data as proxies for individual exposure. The weak positive associations found in this study might be related to confounding by factors that we were unable to assess and may not reflect clinically meaningful differences. More research is needed to assess the impact of air pollution on reproductive function. None.

Estimating health-related costs of ten US climate-sensitive events in 2012: a retrospective study

BackgroundClimate change threatens human health, but there is a lack of evidence on the economic toll of these risks. Health-related cost estimates for climate-sensitive impacts illuminate an understudied impact of climate change and highlight how this threat is affecting sectors beyond property and infrastructure. Furthermore, cost estimates can guide health interventions and help public health professionals assess whether climate change adaptation measures are achieving their intended benefits. MethodsWe estimate mortality and morbidity costs associated with ten climate-sensitive case studies spanning eleven US states in 2012 (when the country experienced some of its warmest weather to date); the case studies include wildfires, extreme heat, West Nile Virus and Lyme disease, extreme precipitation and flooding, harmful algal blooms, allergenic pollen, ozone air pollution, and a major hurricane. We estimate the mortality and morbidity associated with each event using data reported in peer-reviewed epidemiology studies, state and federal data, and environmental public health tracking network data collected by state public health agencies. We augment this information with imputed incidence data from national healthcare utilisation statistics. FindingsApplying value of a statistical life and cost-of-illness approaches to publicly-available data from the Agency for Healthcare Research and Quality, we estimate total health-related costs associated with these case studies (from 917 deaths, 20 568 hospitalisations and 17 857 emergency department visits) of about $10·0 billion in 2018 dollars, with a sensitivity range of $2·7 billion to $24·6 billion. InterpretationBy better characterising these health damages in economic terms, this work helps characterise the burden that climate change already places on human health. In doing so, we provide a quantitative framework for broader estimation of climate-sensitive health-related costs. Expanded quantification of the budgetary pressures posed by climate change can help decision makers engage with the scale of the challenge and prioritise efficient adaptation strategies to protect public health. FundingNone.

Community drinking water data on the National Environmental Public Health Tracking Network: a surveillance summary of data from 2000 to 2010

This report describes the available drinking water quality monitoring data on the Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Network (Tracking Network). This surveillance summary serves to identify the degree to which ten drinking water contaminants are present in finished water delivered to populations served by community water systems (CWS) in 24 states from 2000 to 2010. For each state, data were collected from every CWS. CWS are sampled on a monitoring schedule established by the Environmental Protection Agency (EPA) for each contaminant monitored. Annual mean and maximum concentrations by CWS for ten water contaminants were summarized from 2000 to 2010 for 24 states. For each contaminant, we calculated the number and percent of CWS with mean and maximum concentrations above the maximum contaminant level (MCL) and the number and percent of population served by CWS with mean and maximum concentrations above the MCL by year and then calculated the median number of those exceedances for the 11-year period. We also summarized these measures by CWS size and by state and identified the source water used by those CWS with exceedances of the MCL. The contaminants that occur more frequently in CWS with annual mean and annual maximum concentrations greater than the MCL include the disinfection byproducts, total trihalomethanes (TTHM), and haloacetic acids (HAA5); arsenic; nitrate; radium and uranium. A very high proportion of exceedances based on MCLs occurred mostly in very small and small CWS, which serve a year-round population of 3,300 or less. Arsenic in New Mexico and disinfection byproducts HAA5 and TTHM, represent the greatest health risk in terms of exposure to regulated drinking water contaminants. Very small and small CWS are the systems’ greatest difficulty in achieving compliance.

Compilation and spatio-temporal analysis of publicly available total solar and UV irradiance data in the contiguous United States

Skin cancer is the most common type of cancer in the United States, the majority of which is caused by overexposure to ultraviolet (UV) irradiance, which is one component of sunlight. National Environmental Public Health Tracking Program at CDC has collaborated with partners to develop and disseminate county-level daily UV irradiance (2005–2015) and total solar irradiance (1991–2012) data for the contiguous United States. UV irradiance dataset was derived from the Ozone Monitoring Instrument (OMI), and solar irradiance was extracted from National Solar Radiation Data Base (NSRDB) and SolarAnywhere data. Firstly, we produced daily population-weighted UV and solar irradiance datasets at the county level. Then the spatial distributions and long-term trends of UV irradiance, solar irradiance and the ratio of UV irradiance to solar irradiance were analyzed. The national average values across all years are 4300 Wh/m2, 2700 J/m2 and 130 mW/m2 for global horizontal irradiance (GHI), erythemally weighted daily dose of UV irradiance (EDD) and erythemally weighted UV irradiance at local solar noon time (EDR), respectively. Solar, UV irradiances and the ratio of UV to solar irradiance all increased toward the South and in some areas with high altitude, suggesting that using solar irradiance as indicator of UV irradiance in studies covering large geographic regions may bias the true pattern of UV exposure. National annual average daily solar and UV irradiances increased significantly over the years by about 0.3% and 0.5% per year, respectively. Both datasets are available to the public through CDC's Tracking network. The UV irradiance dataset is currently the only publicly-available, spatially-resolved, and long-term UV irradiance dataset covering the contiguous United States. These datasets help us understand the spatial distributions and temporal trends of solar and UV irradiances, and allow for improved characterization of UV and sunlight exposure in future studies.

Understanding Emerging Environmental Health Concerns and Environmental Public Health-Tracking Priorities Among State and Local Professionals in Colorado.

Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources. To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health-tracking priorities. During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation. This work took place in Colorado. Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey. Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities. Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health-tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets. This project illuminates opportunities to strengthen connections between the state's environmental public health-tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities.

Seeing Data in a New Light: Data Visualization Techniques to Improve Understanding

ObjectiveThe presenter will demonstrate complex health and environment surveillance data visualization techniques within the CDC’s Environmental Public Health Tracking Network.IntroductionIn 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges and gaps in the nation’s environmental health surveillance infrastructure. The Tracking Program’s mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. As a primary objective of the Tracking Program, the Environmental Public Health Tracking Network (Tracking Network) was developed as an online surveillance system with data available for 23 topics and over 450 different health, environmental, and population measures. The integration and display of such disparate data can be challenging. For data consumers without scientific training, or even scientists and public health professionals with limited time, it can be difficult to examine and explore the data in an online surveillance system. Additionally, casual data consumers may not require complex data details; a big picture perspective may be appropriate to their needs. The Tracking Network – which applies standardized data, a modern user interface, techniques catering to a variety of data consumers, and best practices in data visualization – provides a dynamic data query system that allows users to visualize different types of environmental health data in numerous ways including a variety of charting, mapping, and graphing options.MethodsAfter the Tracking Program identifies important environmental health topics, data standards are developed to aid in data validation and to ensure consistency and comparability of the data. The data are aggregated into standardized stratifications, summarized, and used to calculate environmental health measures. Visualization requirements for each measure are determined and developed on the Tracking Network. In addition, public health content are developed to provide important context for the user. The final step is the release of the environmental health measures onto the National Tracking Network, where they can be queried, visualized, compared, and analyzed with all of the other environmental health measures on the Tracking Network.ResultsLaunched in 2009, the Tracking Network developed at CDC is home to over 450 standardized environmental health measures spanning 23 topics and multiple years, and can be displayed at a geographic level of state, county, and census tract. The Tracking Network allows data consumers to interpret this data visually using tools including dynamic timeline maps, infographics, advanced charting and a streamlined user interface designed to be simple to use. With varying user levels in mind, this collection of tools provides a variety of avenues for the users to explore the data. Visualization results can be exported and embedded into other websites with data interpretation statements, benchmarks, and other visual cues that allow a broad audience to be able to access to environmental public health surveillance data.ConclusionsWhile the internet contains a wealth of health and environmental datasets, the Tracking Network provides a centralized location to access over 450 environmental health measures and provides a variety of visualization tools to translate the data into useful information. The speaker will present a range of display options available on the Tracking Network, highlight ways to present data for easy understanding and consumption, and provide a brief look into the future of data visualization.

Tracking environmental hazards and health outcomes to inform decision-making in the United States

ObjectiveTo increase the availability and accessibility of standardized environmental health data for public health surveillance and decision-making.IntroductionIn 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges in environmental health surveillance described by the Pew Environmental Commission (1). The report cited gaps in our understanding of how the environment affects our health and attributed these gaps to a dearth of surveillance data for environmental hazards, human exposures, and health effects. The Tracking Program’s mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. Accomplishing this mission requires a range of expertise from environmental health scientists to programmers to communicators employing the best practices and latest technical advances of their disciplines. Critical to this mission, the Tracking Program must identify and prioritize what data are needed, address any gaps found, and integrate the data into the network for ongoing surveillance.MethodsThe Tracking Program identifies important environmental health topics with data challenges based on the recommendations in the Pew Commission report as well as input from federal, state, territorial, tribal, and local partners. For each topic, the first step is to formulate the key surveillance question, which includes identifying the decision-maker or end user. Next, available data are evaluated to determine if the data can answer the question and, if not, what enhancements or new data are needed. Standards are developed to establish data requirements and to ensure consistency and comparability. Standardized data are then integrated into the network at national, state, and local levels. Standardized measures are calculated to translate the data into the information needed. These measures are then publically disseminated via national, state, and local web-based portals. Data are updated annually or as they are available and new data are added regularly. All data undergo a multi-step validation process that is semi-automated, routinized, and reproducible.ResultsThe first set of nationally consistent data and measures (NCDM) was released in 2008 and covered 8 environmental health topics. Since then the NCDM have grown to cover 14 topics. Additional standardized data and measures are integrated into the national network resulting in 23 topics with standardized 450 measures (Figure). On the national network, measures can be queried via the Data Explorer, viewed in the info-by-location application, or connected to via the network’s Application Program Interface (API). On average, 15,000 and 3300 queries are run every month on the Data Explorer and the API respectfully. Additional locally relevant data are available on state and local tracking networks.Gaps in data have been addressed through standards for new data collections, models to extend available data, new methodologies for using existing data, and expansion of the utility of non-traditional public health data. For example, the program has collaborated with the Environmental Protection Agency to develop daily estimates of fine particulate matter and ozone for every county in the conterminous US and to develop the first national database of standardized radon testing data. The program also collaborated with the National Aeronautics and Space Administration and its academic partners to transform satellite data into data products for public health.The Tracking Program has analyzed the data to address important gaps in our understanding of the relationship between negative health outcomes and environmental hazards. Data have been used in epidemiologic studies to better quantify the association between fine particulate matter, ozone, wildfire smoke, and extreme heat on emergency department visits and hospitalizations. Results are translated into measures of health burden for public dissemination and can be used to inform regulatory standards and public health interventions.ConclusionsThe scope of the Tracking Program’s mission and the volume of data within the network requires the program to merge traditional public health expertise and practices with current technical and scientific advances. Data integrated into the network can be used to (1) describe temporal and spatial trends in health outcomes and potential environmental exposures, (2) identify populations most affected, (3) generate hypotheses about associations between health and environmental exposures, and (4) develop, guide, and assess the environmental public health policies and interventions aimed at reducing or eliminating health outcomes associated with environmental factors. The program continues to expand the data within the network and the applications deployed for others to access the data. Current data challenges include the need for more temporally and spatially resolved data to better understand the complex relationships between environmental hazards, health outcomes, and risk factors at a local level. National standards are in development for systematically generating, analyzing, and disseminating small area data and real-time data that will allow for comparisons between different datasets over geography and time.