Current Epidemiology Projects at the Baltimore City Health Department Elizabeth Toure, MPH Candidate 2016 Preceptor: Dr. Darcy Phelan-Emrick, Chief Epidemiologist

6 month internship at the Baltimore City Health Department (BCHD) Epidemiology Services Epidemiology potpourri 3 major projects Side projects Background

Healthy Baltimore Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

Set targets for10 priority areas Healthy Baltimore

Healthy Baltimore )Promote Access to Quality Health Care for All 2)Be Tobacco Free 3)Redesign Communities to Prevent Obesity 4)Promote Heart Health 5)Stop the Spread of HIV and Other STIs 6)Recognize and Treat Mental Health Needs 7)Reduce Drug Use and Alcohol Abuse 8)Encourage Early Detection of Cancer 9)Promote Healthy Children and Adolescents 10)Create Health Promoting Neighborhoods

Set targets for10 priority areas 35 goals & indicators Decrease percent of adults who are obese by 15% Decrease percent of teens who currently smoke by 20% Healthy Baltimore

Healthy Baltimore

Healthy Baltimore data not yet available Trends from Summary for each indicator Highlighting work underway

Healthy Baltimore 2015

Healthy Baltimore RESULTS 11/35 indicators met or exceeded targets

Healthy Baltimore RESULTS 11/35 indicators met or exceeded targets  Health insurance coverage  New HIV cases  Rates of adolescent gonorrhea and chlamydia  Infant mortality rate among black infants

Healthy Baltimore RESULTS 11/35 indicators met or exceeded targets Some surprising/alarming results

Healthy Baltimore RESULTS 11/35 indicators met or exceeded targets Some surprising/alarming results  Rate of syphilis  Infant morality rate among white infants  Emergency Department visits for chronic conditions

Stay tuned for Healthy Baltimore 2020

Background Healthy Baltimore Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

Neighborhood Health Profiles Collection of 55 reports Neighborhood – level health indicators Demographics Socio/economic factors Built and social environment Health outcomes 2008

Neighborhood Health Profiles

Neighborhood Health Profiles 2016 Neighborhood Health Profiles

Neighborhood Health Profiles Indicator selection Research other cities’ neighborhood indicators Avoid duplication from Baltimore Neighborhood Indicators Alliance Vital Signs Internal and external stakeholder input Data availability

Neighborhood Health Profiles Preliminary indicators (30) Percent of uninsured residents Rate of 311 calls for rodents Percent of neighborhood covered by green space Percent of neighborhood in a food desert Motor vehicle traffic mortality rate

Neighborhood Health Profiles Next steps Finish collecting data Draft reports and report layout Approval within BCHD and Mayor’s Office Community engagement & rollout

Background Healthy Baltimore Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

Synthetic cannabinoids

The current outbreak of illnesses associated with synthetic cannabinoid use in Mississippi is part of a larger multistate outbreak. To date, this is the largest outbreak of synthetic cannabinoid-associated adverse events ever recorded.

Synthetic cannabinoids

Syndromic surveillance dashboard

Synthetic cannabinoids Syndromic surveillance dashboard Maryland Poison Control (MPC) – weekly call data

Synthetic cannabinoids Syndromic surveillance dashboard Maryland Poison Control (MPC) Twitter Tracker using R software

Synthetic cannabinoids Syndromic surveillance dashboard Maryland Poison Control (MPC) Twitter Tracker using R software

Synthetic cannabinoids – MPC results 31 weeks of data 95 cases 48 (50.5%) with moderate or major clinical effects Only 85 cases had treatment data 66 (78%) were treated in ED 11 (13%) were admitted

Weekly Exposure Calls for Synthetic Cannabinoids in Baltimore City (Aug. 30, April 9, 2016)

Synthetic cannabinoids Next steps Continue weekly surveillance – find additional data sources Monitor for changes after new Baltimore law banning sale of synthetic drugs Establish plan for how to respond to outbreaks

Background Healthy Baltimore Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

Fast-paced environment at the city-level: be flexible Carefully record data sources and methods to ensure reproducibility Difficulty sharing data Conclusion – lessons learned

Darcy Phelan-Emrick Chris Fuller Jonathan Gross Paulani Mui Beth Resnick Thank you all very much for your support, mentorship and encouragement throughout out this internship. Acknowledgements

Elizabeth Toure MPH Candidate, 2016 etoure Questions? Thank You!