National Environmental Public Health Tracking Research Articles

Trends in the Heat Waves: Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005–2010

Background: The relationship between extreme heat and increased heat stress illness (HSI) is well established, but there is limited research on HSI variability by urbanicity (i.e. urban-rural class...

Public Perceptions of Environmental Health Risks in the United States

Public Perceptions of Environmental Health Risks in the United StatesAbstract Number:1892 Mikyong Shin*, Lisa B Hines, Heather Strosnider, and Lina Balluz Mikyong Shin* Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] Search for more papers by this author , Lisa B Hines Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] Search for more papers by this author , Heather Strosnider Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] Search for more papers by this author , and Lina Balluz Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, United States, E-mail Address: [email protected] Search for more papers by this author AbstractUnderstanding perceptions about exposure to environmental hazards and the related health conditions can help environmental public health practitioners prioritize and target policy needs, community activities, and communication strategies. The ConsummerStyles© surveys were conducted in 2013 using nationally representative sample and included five questions related to the awareness and perception of environmental health issues as well as government efforts and resources for information. Adjusted odds ratios (aOR) and 95% confidence interval (CI) were estimated by logistic regression to evaluate demographic and regional differences in the level of concern and perceptions about environmental risks. The survey results showed that more than one-third (40.0%) were aware of government efforts to track environmental hazards and related health outcomes. More than half of respondents (57.8%) were concerned about the risks to their health from environmental pollutants. Blacks (aOR1.6, CI: 1.2-2.3), females (aOR: 1.5, CI:1.3-1.8), people with a college or higher education (aOR:1.3, 1.0-1.6), and people living in the Mideast (aOR: 1.29, CI:1.0-1.6) or South regions (aOR:1.5, CI:1.1-1.9) are more likely than their counterparts to be concerned about the environments effect on their health. Respondents were most concerned about chemicals in consumer products (48.7%), outdoor air quality (47.9%), and drinking water quality (40.7%). Respiratory illness (41.7 %%), asthma (36.6 %%) and cancer (31.8%) were selected as top three health concerns that respondents thought might be affected by the environment. These results provide information on the public’s perceptions of environmental health issues and can be used to improve communication messages to the public, prioritize additional contents for CDC’s National Environmental Public Health Tracking Network, and identify gaps in awareness of common health issues associated with environmental exposures.

The effects of air pollution on adverse birth outcomes

BackgroundAir pollution has been shown to have adverse effects on many health outcomes including cardiorespiratory diseases and cancer. However, evidence on the effects of prenatal exposure is still limited. The purpose of this retrospective cohort study is to evaluate the effects of prenatal exposure to air pollutants including particulate matter with aerodynamic diameter less than 2.5μm (PM2.5) and ozone (O3) on the risk of adverse birth outcomes (ABOs) including term low birth weight (LBW), preterm delivery (PTD) and very PTD (VPTD). Methodssingleton births from 2004 to 2005 in Florida were included in the study (N=423,719). Trimester-specific exposures to O3 and PM2.5 at maternal residence at delivery were estimated using the National Environmental Public Health Tracking Network data, which were interpolated using Hierarchical Bayesian models. ResultsAfter adjustment for potential confounders such as demographics, medical and lifestyle factors PM2.5 exposures in all trimesters were found to be significantly and positively associated with the risk of all ABOs. Second-trimester exposure had the strongest effects. For an interquartile range (IQR) increase in PM2.5 during the second trimester, the risk of term LBW, PTD and VPTD increased by 3% [95% confidence interval (CI): 1–6%)], 12% (11–14%) and 22% (18–25%), respectively. O3 was also found to be positively associated with PTD and VPTD with the strongest effects over the whole pregnancy period [3% (1–5%) for PTD and 13% (7–19%) for VPTD for each IQR increase]. However, O3 was observed to have protective effects on term LBW. Results were consistent for multi-pollutant models. ConclusionPM2.5 has consistent adverse effects on ABOs whereas O3 has inconsistent effects. These findings warrant further investigation.

Engaging academia to advance the science and practice of environmental public health tracking

Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention׳s National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking.

Environmental Public Health Tracking: Success Stories from a Collaborative Surveillance System

The National Environmental Public Health Tracking Program facilitates the linkage of environmental information to health outcomes through development of a national standards-based public health surveillance system that provides useful information to improve where we live and work. State tracking programs have successfully used their tracking networks to identify and educate at-risk communities. Other success stories include endeavours to improve surveillance, support epidemiologic studies, target prevention efforts, and inform policymakers. Future directions include identifying knowledge gaps, developing plans for adding new data sources and collaborators to fill those gaps, and improving application and utility of the Tracking Networks.

Biomonitoring and Environmental Public Health Tracking: Making the Link

Background: The National Environmental Public Health Tracking Network (Tracking Network) is a web-based information system of standardized health and environmental data established in 23 states and New York City. State and national partners work together with the US Centers for Disease Control and Prevention to provide data that informs public health action, and furthers our understanding of the impacts of environmental contaminants on public health. The Tracking Program’s Biomonitoring Task Force is assessing state/community-level biomonitoring data for use on the Tracking Network. Methods: In 2012, we evaluated information provided by funded Tracking states to assess available biomonitoring data maintained in state and local agencies from projects or program activities completed over the past 10 years. Data were assessed in 5 categories: mandatory reports (under state law), population-based surveillance, targeted investigations, support of academic research, and rapid response. Results: Results showed that 13 of 21 Tracking states collect mandatory reports of exposure (poisonings) for one or more chemicals (in addition to children’s blood lead), most commonly for metals. Population-based statewide surveillance data are currently available in 5 states, 4 of these with sample sizes exceeding 1,000 participants and 93% funded by federal grants. Most available data are from targeted investigations with sample size less than 500, using non-probability based sampling designs. Seventy percent of these targeted investigations relied on state public health laboratories for analyses. Conclusions: While most Tracking states have limited data available, many have established laboratory and epidemiological capacity for biomonitoring. Biomonitoring in state and local public health agencies has demonstrated utility for tracking vulnerable community exposures and disparities that can supplement data collected in large national surveys for informing local public health action.

Comparison of Individual-level and Ecologic Studies of the Association of Drinking Water Contaminants on Adverse Birth Outcomes

Background Several epidemiological studies of the effects of drinking water contaminants have used ecologic designs, comparing groups defined by the community water system that they use. While ecologic studies are subject to bias, the degree of bias has rarely been assessed. Aims The aim of this analysis was to assess the bias from the use of ecologic study designs by comparing results from an individual-level study and an ecologic study of the association of arsenic in drinking water to adverse birth outcomes. Methods Maternal addresses at time of delivery were geocoded for over 651,000 live births (1989–2006) in the state of Utah, USA. Annual average arsenic levels were estimated for 476 Community Water Systems using water quality monitoring data. Arsenic levels were assigned to each birth by linking geocoded addresses to georeferenced water system service areas. Logistic regression was used to estimate the associations between individual arsenic levels and the occurrence of low birth weight (LBW), small for gestation age (SGA), pre-term and very preterm birth. For the ecologic study negative binomial regression was used to assess the relationship between annual average arsenic levels for each community water system and the proportion of births that were LBW, SGA, pre-term or very pre-term. Results There were significant associations between arsenic levels and the risk of LBW and SGA in both the individual-level and ecologic studies. Drinking water arsenic levels of 5 to <10 µg/L were associated with LBW in the individual-level study (aOR=1.18; 95% CI 1.06, 1.32) and in the ecologic study (IRR=1.09; 95% CI 1.00, 1.19). There were no significant associations with pre-term or very pre-term in either analysis. Conclusions Results from the ecologic study were comparable with results from an individual-level study of the effects of arsenic on LBW and SGA. This work was supported by the Centers for Disease Control and Prevention, National Environmental Public Health Tracking Program (contract number 200-2010-37353).

Trends in Acute Myocardial Infarction Hospitalization Rates for US States in the CDC Tracking Network

ObjectivesWe examined temporal trends, spatial variation, and gender differences in rates of hospitalization due to acute myocardial infarction.MethodsWe used data from the Centers for Disease Control National Environmental Public Health Tracking Network to evaluate temporal trends, geographic variation, and gender differences in 20 Environmental Public Health Tracking Network states from 2000 to 2008. A longitudinal linear mixed effects model was fitted to the acute myocardial infarction hospitalization rates for the states and counties within each state to examine the overall temporal trend.ResultsThere was a significant overall decrease in age-adjusted acute myocardial infarction hospitalization rates between 2000 and 2008, with most states showing over a 20% decline during the period. The ratio of male/female rates for acute myocardial infarction hospitalization rates remained relatively consistent over time, approximately two-fold higher in men compared to women. A large geographic variability was found for age-adjusted acute myocardial infarction hospitalization rates, with the highest rates found in the Northeastern states. Results of two ecological analyses revealed that the NE region remained significantly associated with increased AMI hospitalization rates after adjustment for socio-demographic factors.ConclusionsThis investigation is one of the first to explore geographic differences in AMI age adjusted hospital rates in individuals 35+ years of age for 2000–2008. We showed a decreasing trend in AMI hospitalization rates in men and women. A large geographic variability in rates was found with particularly higher rates in the New England/Mid-Atlantic region of the US and lower rates in the mountain and Pacific states of the tracking network. It appeared that over time this disparity in rates became less notable.

Environmental Public Health Tracking/Surveillance in Canada: A Commentary

Although public debate in Canada about climate change and air pollution is louder than ever, the state of the environment remains a relatively neglected determinant of health, and environmental public health infrastructure and programs are poorly developed. Health Canada has only recently begun to develop a national environmental public health tracking or surveillance system. The authors review progress on environmental public health tracking in other jurisdictions and suggest a strategic approach to the development of a coherent national system of sensitive, targeted surveillance indicators for environmental health by addressing the following questions: Which environmental hazards and exposures, and which health effects along the continuum from "release" to "health effect," should be tracked? Which indicators are scientifically robust and practical for tracking environmental health problems in Canada?

National Environmental Public Health Tracking Program

National Environmental Public Health Tracking Program

From Patchwork to National Network

Partnership and collaboration are hallmarks for the National Environmental Public Health Tracking Network (EPHT) Program. When CDC issued its first request for proposals for EPHT in August 2002, it required formal collaboration between state public health and environmental protection agencies. In addition, each of the grantees assembled a planning consortium or technical advisory committee to aid in the creation of the National EPHT together with local health agencies, community groups, industry, and healthcare professionals and other organizations. Partnerships have resulted in actions that protect and monitor public health; substantial the development and use of state and national tracking networks; and increase collaboration and information sharing.

Connecting Environmental Health Data To People And Policy: Integrating Information And Mobilizing Communities For Environmental Public Health Tracking

Evaluation of available data is a critical preliminary step in the assessment of local environmental health. As part of a multi-organizational initiative to improve environmental health in the Pittsburgh, Pennsylvania region, the University of Pittsburgh Center for Healthy Environments and Communities (CHEC) interviewed 70 experts in the academic, government, non-profit, and private sectors and reviewed print and electronic resources to characterize environmental and public health data available in the region. The objectives of this undertaking were: to provide a conceptual framework for categorizing data locally on environmental hazards, exposures and health endpoints, to describe and evaluate the types of environmental public health data available nationally and locally, to identify existing endeavors to gather and categorize such data, and to present case studies on the real-life relevance of the availability or lack of availability of environmental health data. The purpose and relevance of this project, the evolution of the methodology, successes and challenges met, and anticipated next steps are presented. This process description and resulting comprehensive report is available to communities, at both the state and local health department level as well as lay community members, engaged in similar endeavors, to characterize their local and regional environmental health landscape. The framework outlined serves as background for a related statewide environmental health project sponsored by the Pennsylvania Department of Health through the Pennsylvania Consortium on Interdisciplinary Environmental Policy (PCIEP) and potentially as a foundation for community-based data evaluation for the National Environmental Public Health Tracking Program.

Ecological modeling for applied science

Ecological modeling is becoming an increasingly important tool for uniting biological observations with remote sensing and ground‐based data networks to develop predictive tools for resource management and human health.The availability of over three petabytes of data from the NASA Earth Observing System Data and Information System (EOSDIS) alone provides an unprecedented opportunity to develop Earth science applications for decision support. In combination with data networks such as the U.S. National Oceanic and Atmospheric Administration's National Climate Data Center, the nonprofit NatureServe's network of biological inventories, the National Environmental Public Health Tracking Network of the U.S. Centers for Disease Control and Prevention, and many others, there is a vast wealth of Earth observation data on parameters as diverse as land cover, sea surface temperature, precipitation, species distribution, and disease occurrence.

Can lessons from public health disease surveillance be applied to environmental public health tracking?

Disease surveillance has a century-long tradition in public health, and environmental data have been collected at a national level by the U.S. Environmental Protection Agency for several decades. Recently, the Centers for Disease Control and Prevention announced an initiative to develop a national environmental public health tracking (EPHT) network with “linkage” of existing environmental and chronic disease data as a central goal. On the basis of experience with long-established disease surveillance systems, in this article we suggest how a system capable of linking routinely collected disease and exposure data should be developed, but caution that formal linkage of data is not the only approach required for an effective EPHT program. The primary operational goal of EPHT has to be the “treatment” of the environment to prevent and/or reduce exposures and minimize population risk for developing chronic diseases. Chronic, multifactorial diseases do not lend themselves to data-driven evaluations of intervention strategies, time trends, exposure patterns, or identification of at-risk populations based only on routinely collected surveillance data. Thus, EPHT should be synonymous with a dynamic process requiring regular system updates to a) incorporate new technologies to improve population-level exposure and disease assessment, b) allow public dissemination of new data that become available, c) allow the policy community to address new and emerging exposures and disease “threads,” and d) evaluate the effectiveness of EPHT over some appropriate time interval. It will be necessary to weigh the benefits of surveillance against its costs, but the major challenge will be to maintain support for this important new system.

Identifying priority health conditions, environmental data, and infrastructure needs: a synopsis of the Pew Environmental Health tracking project.

In this article we describe the methodologic approaches of the Pew Environmental Health Commission at the Johns Hopkins Bloomberg School of Public Health used to identify priority environmental health conditions and develop recommendations to establish a national environmental public health tracking network. We present the results of a survey of public health and environmental practitioners to uncover state and local health tracking needs and priorities. We describe the steps that combined the findings from the state and local health tracking survey and a review of the state of the science on environmental impacts on health to identify priority health end points. Through an examination of national health and health care databases, we then describe trends and public health effects of those diseases that may be linked to the environment. Based on this analysis, respiratory diseases and neurologic diseases are recommended as priorities for tracking. Specific end points recommended for tracking include asthma and chronic respiratory diseases, and chronic neurodegenerative diseases such as multiple sclerosis. Based on trends in reported prevalence, consideration should also be given to developmental disabilities, reproductive disorders, and endocrine/metabolic disorders. Strengthening of current efforts to track cancer and birth defects should also be included as components of a nationwide health tracking network. Finally, we present the recommendations for environmental public health tracking. These recommendations provided the groundwork for the development of the Centers for Disease Control and Prevention’s National Environmental Public Health Tracking Progam that now includes 21 states, three cities, and three academic centers throughout the nation.

Using the Behavioral Risk Factor Surveillance System (BRFSS) for exposure tracking: experiences from Washington State.

One of the goals of the National Environmental Public Health Tracking Network is to link environmental data with chronic disease data as a means of improving our understanding of the environmental determinants of disease. Such efforts will rely on the ongoing collection of population exposure information, and there are few systems in place to track population exposures. In many cases, exposures can be estimated by combining environmental contaminant data with data about human behaviors. The Behavioral Risk Factor Surveillance System (BRFSS) provides a good opportunity to implement tracking of exposure-related behaviors. Washington State has used the BRFSS to collection information on environmentally related knowledge, attitudes, and behaviors. In this article we present case studies of modules covering drinking water, perceptions of environmental risk, and radon awareness and testing. Data on exposure-related behaviors have been useful for population exposure assessments and program evaluation. Questions about knowledge and attitudes and perceptions of environmental issues were not as useful because they lacked sufficient detail from which to modify existing education efforts. In some cases these data had not been used at all, indicating that the need for the data had not been well established. National development efforts should focus on compiling existing questions and developing questions on topics that are a priority at the state and national levels to be included as core questions and optional modules in future BRFSS surveys.

National environmental public health tracking program: bridging the information gap.

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program’s academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.