1. Update on CDC’s National Environmental Public Health Tracking Program Judith R. Qualters, PhD Chief, Environmental Health Tracking Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention June 4, 2008

2. Environmental Public Health Tracking  Pew Commission Study  America’s Environmental Health Gap  Congressional funding  Program initiated, 2002  Mission: To provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities

3. Tracking = Surveillance

4. 2002 to 2006: Building Capacity and Demonstrating Utility

5. CDC’s Tracking Program, 2008

6. Tracking Network: At-A-Glance Functions:  Provide Nationally Consistent Data and Measures  Describe and Discover Data  Exchange Data  Provide Data Management and Analysis Tools  Inform and Interact with the Public A web-based information system that exists at the local, state, and national level that serves the public, environmental public health agencies, health care providers and researchers

7. Network Goes Live in 2008! Building the National Network:  Design principles Re-use existing software and infrastructure Metadata for everything Adopt standards that exist Provide a flexible framework for Network  Iterative Process  Involves partners  Continues beyond 2008

9. National Public Portal  Place to disseminate information  Provides the public and policy makers with integrated one- stop access to health and environment information  Allows for feedback and input from information users Under Development!

11. National Secure Portal  Supports secure communication and collaboration among multiple partners  Integrates health, exposure, hazard, and other data  Allows for sharing of methods, tools, and ideas  Serves as drawing board for turning data into information

13. Examples of State Network Requirements and Recommendations  Grantee Portal  Comply with Section 508 standards  Analysis Visualization & Reporting  Support the means to generate visual displays of data, including maps, charts, tables, & graphs  Data Content & Discovery  Provide the capability to execute queries to obtain data  Documentation  Provide on-line documentation  Metadata  Allow for the search & discovery of metadata  Secure Access  Provide a secure login where users will be authenticated & authorized to use data & services

14. Collaborative Development Process CDC Program Marketing & Outreach Workgroup Content Workgroup Network Architecture Security Geography & Locational Referencing Metadata Health Disparities Data Stewards Outreach Content Messaging Air Water Cancer Lead Birth Defects CO Poisoning Vital Statistics – Births Hospitalizations – Asthma/CVD Standards & Network Development Workgroup Portal Analysis and Visualization Team

15. Content Workgroup  NCDM recommendations to CDC  Identify, adopt/adapt/develop, pilot indicators/measures Rationale Data sources Limitations Future directions How-to-guides  Data to support measures  Presentation  Public health messages

16. Vital Statistics - Birth Outcome Team Members  Co-chaired by CA Tracking Program and NAPHSIS  State and academic tracking grantees  ASTHO, other state health depts.  CDC Tracking Program Consult or review: CDC DRH; NCHS Surveillance goals  Identify populations at risk for adverse reproductive outcomes and infertility  Assist health providers in targeting medical care resources (e.g. prenatal care)  Examine changes in temporal and spatial patterns of reproductive outcomes which may provide clues on contributing factors and etiology

17. Team Recommendations  Indicator of Prematurity a. Incidence (Percent) of preterm births among singleton live born infants b. Incidence (Percent) of very preterm births among singleton live born infants c. Incidence (Percent) very low birth weight births (<1500 g) among singleton live born births  Indicator of Growth Retardation a. Incidence (Percent) low birth weight births (<2500 g) among term singleton live born births  Indicator of Mortality a. Infant Mortality Rate b. Neonatal Mortality Rate c. Perinatal Mortality Rate d. Post-Neonatal Mortality Rate

18. Team Recommendations  Geographic scale for national portal: county, state  CDC Tracking Program obtain through NCHS  Indicator of Fertility a. Total Fertility Rate b. Infertility Rate (developmental) – not adopted  Indicator of Sex ratio at birth a. Sex Ratio at Birth  Indicator of Early Puberty  Age at menarche (developmental) – not adopted

19. Issues Being Addressed  Communicating any difference between Tracking and standard VS measures  E.g. singleton vs. all births  Data used by State Tracking Programs  Options for generating measures for use on state portals  Multi-state analysis

20. Carbon Monoxide Team Members  Co-chaired by NYC [ME] Tracking Program and CDC/APRHB  State Tracking grantees  RMPDC, Hartford Hospitals, other state health depts., NAHDO, VMMC  CDC Tracking Program Surveillance goals  Develop and implement a sustainable approach for national CO surveillance  Standardize methodology for routine and disaster-related CO surveillance including the development of a standardized case definition and measures for surveillance

21. CO Team Recommendations – Vital Statistics Data Carbon Monoxide Poisoning Mortality a.Annual number of deaths from CO poisoning by State, County and Cause/Intent (Fire-related, non-fire related, unknown) b.Annual crude rate of death from CO poisoning per 100,000 population by State, County and Cause/Intent (Fire-related, non-fire related, unknown) c.Annual age-adjusted rate of death from CO poisoning per 100,000 population by State, County and Cause/Intent (Fire-related, non-fire related, unknown)  CDC Tracking Program obtain through NCHS

22. Childhood Lead Poisoning Team Members  Co-chaired by CDC Tracking Program and CDC/LPPB  State/local/academic Tracking grantees  State CLPPP  CDC Tracking Program Surveillance goals  Identify communities where children are at high risk for lead poisoning for the purposes of guiding & evaluating testing within those communities  Understand spatial and temporal patterns of risk for lead poisoning at national, state, and local levels  Evaluate testing of high risk children Recommendation:  Number & % of children tested for lead poisoning prior to 36 mos of age (by birth year cohort)

23. Example of Type of Data Needed for National Tracking Network suppression aggregate partially De-identified fully de- identified Secure Portal: Public Portal:

24. Public Portal: Providing Information, Protecting Privacy Users want to perform:  Rate readout tasks  Pattern recognition tasks  Pattern comparison tasks  Time series tasks We want to:  Enable and inform the user  Convey uncertainty & comparability issues  Minimize disclosure risk

25. Data Re-release Plan  Guidance: CDC re-release policy; CDC-CSTE workgroup recommendations  Key principles in development:  Utility  Privacy match or exceed current protection standards meet data stewards requirements  Science  EPHT plan:  Prevent display of non-zero counts < 6 for geographic units with population < 100,000 and associated crude rates or percentages  Flag as unstable any rates with a RSE >30%  Or, as determined by DSA with national partner

26. National Public Portal: Products and Procedures to Protect Privacy Product Procedure Prepared reports 1. aggregation & variable restriction 2. primary and complementary suppression 3. warning of statistical instability Pre-configured tables, charts, & maps 1. aggregation & variable restriction 2. primary and complementary suppression 3. warning of statistical instability User-defined queries 1. aggregation & variable restriction 2. presentation of health and biomonitoring data as smoothed or age-adjusted measures 3. warning of statistical instability

27. National Secure Portal  Federal IT Security Stds.  Registered users  Authentication – CDC Secure Data Network  Authorization – Application Level – role based Data access – role and use based  State provided data – approval by state  Federal/federally held data – as determined by DSA

28. Tracking and Vital Statistics Partnership  Improved data  Better tools and methods  Available technical expertise/resources  Increased workforce capacity  Communications & outreach DATA INFORMATION KNOWLEDGE ACTION

29. Example: Methods and Tools Rapid Inquiry Facility (RIF)  Developed by Small Area Health Statistics Unit (SAHSU), Imperial College  Performs risk analysis around hazardous sources and disease mapping  No in-depth knowledge of GIS required  Empirical Bayes smoothing  Additional adjustment Race/Ethnicity Socio-Economic Indicators Others  Can export data for use in WinBUGS and StaTScan Weber County The Great Salt Lake Hill AFB Utah Weber & Davis County contaminated groundwater plumes

30.  Tracking data are essential to successful public health  Provides for better determination of the need for environmental health studies and public health interventions  Important to link people, programs, resources  Significant “up front” work  Requires a multi-tiered approach  Staged implementation Summary

31. Questions? For more information: www.cdc.gov/nceh/tracking