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

2. 6 month internship at the Baltimore City Health Department (BCHD) Epidemiology Services Epidemiology potpourri 3 major projects Side projects Background

3. Healthy Baltimore 2015 2016 Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

4. Set targets for10 priority areas Healthy Baltimore 2015 2011

5. Healthy Baltimore 2015 2011 1)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

6. 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 2015 2011

7. Healthy Baltimore 2015 20132011

8. Healthy Baltimore 2015 201320162011 2015 data not yet available Trends from 2010-2014 Summary for each indicator Highlighting work underway

9. Healthy Baltimore 2015

11. Healthy Baltimore 2015 - RESULTS 11/35 indicators met or exceeded targets

12. Healthy Baltimore 2015 - 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

13. Healthy Baltimore 2015 - RESULTS 11/35 indicators met or exceeded targets Some surprising/alarming results

14. Healthy Baltimore 2015 - 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

15. Stay tuned for Healthy Baltimore 2020

16. Background Healthy Baltimore 2015 2016 Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

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

18. Neighborhood Health Profiles 2008 2011

19. Neighborhood Health Profiles 2016 Neighborhood Health Profiles 2008 2011 2016

20. 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

21. 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

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

23. Background Healthy Baltimore 2015 2016 Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

24. Synthetic cannabinoids

25. 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.

26. Synthetic cannabinoids

32. Syndromic surveillance dashboard

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

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

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

36. 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

37. Weekly Exposure Calls for Synthetic Cannabinoids in Baltimore City (Aug. 30, 2015 - April 9, 2016)

38. 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

39. Background Healthy Baltimore 2015 2016 Neighborhood Health Profiles Syndromic surveillance of synthetic cannabinoids Conclusion Outline

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

41. 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

42. Elizabeth Toure MPH Candidate, 2016 etoure 1 @jhmi.edu Questions? Thank You!