NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Copyright 2006 – User Insight, Inc. Jerald Fagliano, MPH, PhD Richard E. Opiekun, MA, MS, PhD Lead and Beyond: Progress in Eliminating Lead Poisoning and New Opportunities for Collaboration in New Jersey April 16, 2010 New Jersey’s Environmental Public Health Tracking Network

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Disclaimer Neither Dr. Fagliano nor Dr. Opiekun have any financial interests with any product, software, website or organization mentioned in this presentation. This presentation does not discuss or endorse any non-FDA approved product or device.

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking In 2000, the Pew Environmental Health Commission detailed an "environmental health gap," a lack of basic information needed to document links between environmental hazards and chronic disease.

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Pew Report “…create a federally supported Nationwide Health Tracking Network with the appropriate privacy protection, that informs consumers, communities, public health practitioners, researchers, and policymakers on chronic diseases and related environmental hazards and population exposures. This will provide the capacity to understand, respond and prevent chronic disease in the country.”

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking "A successful tracking system will provide our citizens with critical information on the threats to their health posed by the environment and how well we, as a nation, a state, or a community, are dealing with those threats." Michael McGeehin, PhD Director, Division of Environmental Hazards and Health Effects National Center for Environmental Health, CDC

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking

 Integrated data  Compatible data (exchange- able)  Ability to expand  Linkable data that can be associated epidemiologically  Ability to assess quality of the data  Secure (to protect confidentiality)  Reliable Vision - Vision - Key Needs of Stakeholders / Users  User friendly  Useful for environmental public health actions and etiologic studies  Provides access to and reporting of data at multiple time scales  Tools to support various types of analyses and communicate the results of those analyses  Tools to search for and find data

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking What is Environmental Public Health Tracking? …the ongoing collection, integration, analysis, interpretation, and dissemination of data on human exposure to environmental hazards and health effects that may be related to those exposures.

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking National Tracking Program State Grantees* and Academic Centers of Excellence *current as of FY 2010

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking NJEPHT Demonstration and Linkage Projects A Look into the Past …

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking EPHT Can Be Used to Explore  Time trends and geographical patterns in:  Environmental hazards  Human exposure  Disease occurrence  Surveillance of health outcomes by environmental gradient  Organizing and linking health and environmental information  Comparison of disease or exposure rates among areas aggregated according to levels of an environmental hazard

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Time Trends in Selected Cancers Age-adjusted rates per 100,000 Smoking-related cancers Lung cancer incidence epidemic related to time trends in smoking prevalence by sex Though bladder cancer is smoking-related, no apparent time trend

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Time Trends in Selected Birth Defects Gastroschisis Omphalocele Related birth defects Inverse pattern in prevalence at birth related to diagnostic reviews for special study

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Time Trend in Population Exposed to Trichloroethylene in Drinking Water New Jersey Public Water Supplies,

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Proportion of Tested Children with Elevated Blood Lead ≥ 10µg/dl≥ 20µg/dl

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Cluster Analysis for High Proportion of Tested Children with Elevated Blood Lead ≥ 10µg/dl ≥ 20µg/dl

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Cluster Analysis of Mesothelioma Incidence, Associated with historic occupational exposures to asbestos

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Difficulties in Interpreting Cluster Analyses Maximum Cluster up to 50% of State Population Maximum Cluster up to 1% of State Population

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Linking Data: Surveillance of Health Outcomes by Environmental Gradient To understand relationships among: environmental hazards exposures human health outcomes To provide scientific basis for public health interventions and evaluation of their effectiveness

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Concerns with Data Linkage Information technology issues Database compatibility Common geographic and time scales Data quality Epidemiological issues Plausible hypotheses Exposure misclassification Confounding factors Random statistical associations

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Importance of Exposure Assessment Cumulative individual exposures over points and times a function of: Concentrations in air (ambient, indoor) Individual behavior Inhalation rate, time/activity patterns Exposure assessment in linkage studies: Estimated average concentration in ambient air for an area in a time period Misclassification of individual exposure is inevitable

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Benzene in Ambient Air and Leukemia Incidence Females Males

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Trihalomethanes in Drinking Water and Bladder Cancer Females Males

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Lead in Drinking Water and Elevated Blood Lead in Children (>10 µg/dL) Drinking water lead measurements: 90th percentile of monitoring results by public water system and by year

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Distribution of Blood Lead Levels by Drinking Water Lead Category

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Relationship between Blood Lead and Drinking Water Lead, by Housing Age Group

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking … 2008, 2009, and beyond

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Uses for the EPHT Portal  Time trends and geographical patterns in:  Environmental hazards  Human exposure  Disease occurrence  Surveillance of health outcomes by environmental gradient  Organizing environmental information  Comparison of disease or exposure rates among areas aggregated according to levels of an environmental hazard

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Partnerships are the Key Center for Health Statistics State Health Assessment Data System (NJSHAD) Office of Information Technology Services EPHT Project Staff Data Stewards and Programs in DHSS and DEP

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Features of NJSHAD Link to departmental publications Display of public health indicators Query data sets Provide contact information The NJSHAD system is based on Utah’s open-source Indicator Based Information System (IBIS) for Public Health.

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking EPHT Welcome Page EPHT Content Pages SHAD Welcome Page SHAD Indicator Pages SHAD Custom Query Pages Other Department Welcome Pages From the Web:

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking EPHT/SHAD Implementation at Present  Public Health Indicators  128 total public health indicators  Over 450 views and growing  44 Current EPHT indicators  Air quality, drinking water quality, lead exposure, birth and infant outcomes, asthma hospitalization, heart attack hospitalization, carbon monoxide poisoning  171 views (including charts, graphs and maps)  9 Cancer indicators recently added in March include  Incidence of bladder cancer, adult brain and ONS cancer, child brain and ONS cancer, female breast cancer, adult leukemia, childhood leukemia, lung and bronchus, non-Hodgkin lymphoma, thyroid  Data Queries  Births,  Deaths,  Infant ( ) and fetal deaths ( )

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking And Now for a Live Demonstration of the NJ EPHT Portal and NJ SHAD The N.J. shad The N.J. ibis The N.J. tracking network

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Planned Enhancements in Next Year  Mapping  Indicator displays (static)  Data query output (dynamic)  Additional EPHT indicator categories:  Birth defects, cancers  Emergency department, mortality and survey data  Climate and weather  Cumulative impact  Additional data sets for query system:  Hospitalization and emergency department  Childhood lead exposure  Cancer  Secure portal

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking How Far Have We Come? Strengthened infrastructure and capacity with EPHT funding New & enhanced: Partnerships Surveillance Communications

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Achieving the Full Vision of Tracking Still Requires Work

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Big Picture Where do YOU fit in? Visit to learn more.

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking Support Acknowledgement The New Jersey Environmental Public Health Tracking Program and development of the state’s Environmental Public Health Tracking web portal was supported by Cooperative Agreement Number 5 U38EH from the Centers for Disease Control and Prevention. We would also like to acknowledge those individuals who have provided both scientific and technical assistance with this project without whom our success would not be possible. Center for Health Statistics Katherine Hempstead Maria Baron Kenneth O’Dowd Collette Lamothe-Galette Marie-Carme Franklin Office of Information Technology Services Paul Nicolette Janet Varan Jipsa Patel Data Stewards and Programs DHSS DEP

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking NJ EPHT Portal Screen Shots

NJDHSS Lead and Beyond: April 16, 2010nj.gov/health/ephtNJ Environmental Public Health Tracking