April 6 -8, 2004 Environmental Health Monitoring for Community Action in Alameda County, California...
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Transcript of April 6 -8, 2004 Environmental Health Monitoring for Community Action in Alameda County, California...
April 6 -8, 2004
Environmental Health Monitoring for Community Action in Alameda County,
California ( 在 Alameda县环境卫生的监测 )
• Eric M. Roberts, MD PhD (爱瑞克•罗佰兹 )
• Paul English, PhD MPH, Principal Investigator
• Geoff Lomax, DrPH, Research Director• Michelle Wong, MPH, Health Educator• Craig Wolff, MS Eng, IT/GIS Manager
April 6 -8, 2004
Functions of an EPHT System
• Track environmental hazards, exposures, and diseases to help monitor ‘hotspots’ where exposure to environmental hazards is excessive and requires reduction;
• Track trends over time to help evaluate the success of environmental protection and public health measures;
• Link environmental hazard information and disease information to help generate hypotheses about possible connections; and
• Provide the foundation researchers need in order to do scientific studies designed to identify the causes of disease.
April 6 -8, 2004
• stakeholder input
• develop and field test materials
• create mechanisms for access and dissemination
The Process of EPHT
Disparate sources of data
Useable datasets
Results
• coordinate between agencies
• develop IT infrastructure
• format and process data
• tabulation
• statistical analysis
• map making
Information for action
Poverty rate in mother’s census tract
Preterm birth rate 95%-CI
Low (< 20%) 8.0 7.5 – 8.4
High (≥ 20%) 10.79.8 – 11.7
April 6 -8, 2004
Outline
1. Alameda County Demonstration Project
2. Birth outcomes findings
3. Stakeholder participation
4. Next steps• Asthma monitoring• Exposure to traffic pollution
April 6 -8, 2004
Alameda County Demonstration Project
• Where: Alameda County– Population 1.4 million– Ethnically and socioeconomically diverse– 27.1% foreign born
• When: 2001• What to track:
– Adverse birth outcomes– Asthma– Traffic pollution exposure
April 6 -8, 2004
Alameda 县
加州省
大海太平洋
April 6 -8, 2004
Indicators (in order of complexity)
• Birth outcome– Term low birthweight (IUGR) – Preterm birth
• Asthma– Hospitalizations– ER visits– Outpatient visits– Prescription purchasing
• Traffic pollution– Distance-weighted traffic volume – Modeled criteria pollutants
April 6 -8, 2004
Outline
1. Alameda County Demonstration Project
2. Birth outcomes findings
3. Stakeholder participation
4. Next steps• Asthma monitoring• Exposure to traffic pollution
April 6 -8, 2004
Data Source
• Birth certificates (Vital Records) collected by counties and some municipalities, centrally maintained by the California Center for Health Statistics
• All births in 2001 where mother resided in Alameda County were included (n= 22,041)
• Singletons with validly recorded weight and gestational ages only
• 96.1% of maternal addresses were successfully geocoded
• Final sample size was 19,540
April 6 -8, 2004
Results
• Overall, the preterm birth rate was 8.5% (Confidence interval 8.2-8.9)
• Overall, the term-low birthweight rate was 2.5% (Confidence interval 2.2-2.7)
• Previously documented racial and SES disparities were clearly evident in this sample
April 6 -8, 2004
Racial and Ethnic Disparities
Mother’s race/ethnicity
Preterm birth rate 95%-CI
African-American 13.3 12.1 – 14.6
Asian-American 7.1 6.2 – 8.1
European-American
7.3 6.6 – 8.0
Latina 8.0 7.7 – 9.1
Native American --- ---
Pacific Islander 8.2 7.2 – 9.3
April 6 -8, 2004
Income Disparities
Poverty rate in mother’s census
tractPreterm birth
rate 95%-CI
Low (< 20%) 8.0 7.5 – 8.4
High (≥ 20%) 10.7 9.8 – 11.7
April 6 -8, 2004
Preterm singleton births:Alameda County, 2001
April 6 -8, 2004
Elevated preterm singleton birth rates:
Alameda County, 2001
April 6 -8, 2004
Outline
1. Alameda County Demonstration Project
2. Birth outcomes findings
3. Stakeholder participation
4. Next steps• Asthma monitoring• Exposure to traffic pollution
April 6 -8, 2004
Community stakeholder input for planning an EPHT system
• What are the information needs of– Community-based organizations?– Non-governmental organizations?– Local health and environmental agencies?
• How should we best present and distribute information?
• What training and technical assistance are needed?
• What are the potential uses for community goals, promotion of environmental justice, and improving health?
April 6 -8, 2004
Meeting Participants
• 18 people
• 16 organizations– Community-based organizations (3)– Non-governmental organizations (6)– Local government (3)– Health care/social service providers (3)– Federal EPA (1)
April 6 -8, 2004
Stakeholder results
• Visualization tools (maps, interactive computer mapping interface) helped to – Enable rich discussion about data needs and
uses of EPHT– Make statistical issues more accessible to
stakeholders
April 6 -8, 2004
Stakeholder feedback examples
• Stakeholders expressed interest in comparison of health outcomes with – School data– Air quality data– Locations of health care facilities– Economic and social characteristics of
neighborhoods
• Working concept of environment inclusive of both physical and social surroundings
April 6 -8, 2004
Stakeholder feedback examples
• Participants also expressed concerns about potential misuse of tracking information to discriminate against affected communities and individuals
April 6 -8, 2004
Outline
1. Alameda County Demonstration Project
2. Birth outcomes findings
3. Stakeholder participation
4. Next steps• Asthma monitoring• Exposure to traffic pollution
April 6 -8, 2004
Health utilization data sources for Alameda County
• Kaiser-Permanente of Northern California– Private sector health care provider– 577,687 people or 6,030,910 person-months– Broadly representative of Alameda County population
• Medi-Cal– State-funded health care– 227,086 people or 2,203,739 person-months– Only about half of these have complete records,
however– Very low income population
April 6 -8, 2004
How to measure asthma in populations
IndicatorExpected frequency per
1,000 (pediatric)
Hospitalization ~ 1 – 3
ER visits ~ 4 – 10
Outpatient visits ~ 100
Medication purchases ~ 100 – 600
Comparison: Frequency of preterm birth ~85 per 1,000
April 6 -8, 2004
Prescription fills per 1,000 per year
Rates of asthma symptom medication purchasingChildren 0-17 years of age, Kaiser Permanente
Alameda County, 2001
DRAFT COPY-3/17/04
Visualizing Asthma
April 6 -8, 2004
Traffic-related pollution data sources
1. California Department of Transportation (Caltrans)
2. Municipal traffic counts3. Community initiatives for counting legal
and illegal truck traffic in neighborhoods
• Due to project resource constraints, modeling will only use Caltrans data
• Major data gaps (eg, I-880 segment upwind of West Oakland) must be inferred
April 6 -8, 2004
Caltrans Traffic data
Average Daily Traffic, 2001Alameda County
April 6 -8, 2004
Visualizing traffic pollution
• Generation of “surfaces” for criteria pollutants with specialized software (ADMS-Urban) to incorporate– mobile sources– idling trucks– stationary sources– wind patterns and topography
April 6 -8, 2004
Visualizing traffic pollution
Modeled total NOx for 2000, San Diego County
April 6 -8, 2004
Visualizing traffic pollution
• Distance-weighted traffic volume– Another way to gauge exposure to traffic related
pollutants– Each case or control is assigned an exposure
metric based on nearby traffic volume, weighted by the distance of the road from that location
– Compatible with geographically-linked databases such as we are using
April 6 -8, 2004
Visualizing traffic pollution
• Distance-weighted traffic volume
April 6 -8, 2004
谢谢 !
Principle InvestigatorPaul English, PhD MPH
Research DirectorGeoff Lomax, DrPH
IT/GIS ManagerCraig Wolff, MS Eng
AdministrationMailie Newman
Community Health EducationMichelle Wong, MPHMimi Johnson, MPH
Eddie Oh, MPHUniversity of California Center
for ExcellenceJonathan Balmes, MD
Ira Tager, PhDAmy Kyle, PhD
FundingCenters for Disease Control and Prevention,
Environmental Public Health Tracking Program