1	The Alameda County Demonstration Project in Environmental Public Health Tracking
2	Alameda County Demonstration Project Philadelphia, 2004 presentations: Eric Roberts (Wed, 1:30 pm): Demonstration project overview Michelle Wong (Wed, 6:00 pm): Stakeholder characteristics, findings, and conclusions from participation in first demonstration project meeting Paul English (Thurs, 11:00 am): Visualization and analytic methods for the tracking of birth outcomes and traffic exposure
3	The (concrete) Process of EPHT
4	Alameda County Demonstration Project Where: Alameda County When: 2001 What to track: Adverse birth outcomes Asthma Traffic pollution exposure
5	Stakeholder Meeting Sequence Jan-04: Introduction; birth outcomes findings May-04: Asthma findings; review birth outcomes materials Sep-04: Traffic findings; review asthma materials Jan-05: Associations between traffic and health; review traffic materials May-05: Review associations materials; wrap-up
6	Data Source for Birth Outcomes Birth certificates (Vital Records) collected by counties and some municipalities File (without names or SSNs) obtained from California Center for Health Statistics All births in 2001 where mother resided in Alameda County were included (n= 22,041) Singletons only (no twins or triplets) 96.1% of maternal addresses were successfully geocoded Final sample size was 19,540
7	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
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9	Problems with zip code maps Prefer higher resolution for Tracking purposes Crossing the street from one zip code to another should not appear to take you from one level of risk to another Interested in multiple ways to visualize data for use in discussions with stakeholders
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11	Smoothed maps Representation of statistical significance: Some “hot spots” may be random variation Spatial autocorrelation and overlapping area buffers violate assumption of independence of rates Monte Carlo simulation used to calculate significance
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13	Different challenges: Representing Asthma Diagnosis based on a constellation of symptoms and findings—need a survey (+/- physical exam) to determine prevalence School nursing infrastructure (e.g. Massachusetts) not available in California For this project we are interested in ongoing surveillance systems
14	Health utilization data sources for Alameda County Private: Kaiser-Permanente of Northern California; 577,687 people or 6,030,910 person-months Broadly representative of Alameda County population Public: Medi-Cal; 227,086 people or 2,203,739 person-months Half of these beneficiaries are enrolled in managed care plans—data for these are very incomplete For this project we will only use fee-for-service beneficiaries Confounding issue: Kaiser-Permanente clinicians have uniform, higher standard of care; different geographic distribution of patients
15	Asthma Indicators (c.f. Massachusetts presentation)
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18	Stakeholder meeting results (birth outcomes) Wide variety of stakeholders came to meeting with ideas about Tracking and its uses Visualization tools (maps, interactive GIS interface) helped to Enable rich discussion about data needs and uses of EPHT Make statistical issues more accessible to stakeholders
19	Example: Stakeholder information needs 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
20	Next steps… Analysis of stakeholder feedback Prepare information materials based on feedback Incorporate recommendations into ongoing analyses
21	Thank you… Principle Investigator Paul English, PhD MPH Research Director Geoff Lomax, DrPH IT/GIS Manager Craig Wolff, MS Eng Administration Maile Newman Community Health Education Michelle Wong, MPH Mimi Johnson, MPH Eddie Oh, MPH University of California Center for Excellence Jonathan Balmes, MD Ira Tager, PhD Amy Kyle, PhD