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