Birth and fetal death records and environmental exposures: promising data elements for environmental public health tracking of reproductive outcomes

Lessons Learned From the Environmental Public Health Tracking Sub-County Data Pilot Project

OBJECTIVE

Small area data are key to better understanding the complex relationships between environmental health, health outcomes, and risk factors at a local level. In 2014, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program (Tracking Program) conducted the Sub-County Data Pilot Project with grantees to consider integration of sub-county data into the National Environmental Public Health Tracking Network (Tracking Network).

DESIGN

The Tracking Program and grantees developed sub-county-level data for several data sets during this pilot project, working to standardize processes for submitting data and creating required geographies. Grantees documented challenges they encountered during the pilot project and documented decisions.

RESULTS

This article covers the challenges revealed during the project. It includes insights into geocoding, aggregation, population estimates, and data stability and provides recommendations for moving forward.

CONCLUSION

National standards for generating, analyzing, and sharing sub-county data should be established to build a system of sub-county data that allow for comparison of outcomes, geographies, and time. Increasing the availability and accessibility of small area data will not only enhance the Tracking Network's capabilities but also contribute to an improved understanding of environmental health and informed decision making at a local level.

Factors associated with employment status before and during pregnancy: Implications for studies of pregnancy outcomes

BACKGROUND

Potential confounding or effect modification by employment status is frequently overlooked in pregnancy outcome studies.

METHODS

To characterize how employed and non-employed women differ, we compared demographics, behaviors, and reproductive histories by maternal employment status for 8,343 mothers of control (non-malformed) infants in the National Birth Defects Prevention Study (1997-2007) and developed a multivariable model for employment status anytime during pregnancy and the 3 months before conception.

RESULTS

Sixteen factors were independently associated with employment before or during pregnancy, including: maternal age, pre-pregnancy body mass index, pregnancy intention, periconceptional/first trimester smoking and alcohol consumption, and household income.

CONCLUSIONS

Employment status was significantly associated with many common risk factors for adverse pregnancy outcomes. Pregnancy outcome studies should consider adjustment or stratification by employment status. In studies of occupational exposures, these differences may cause uncontrollable confounding if non-employed women are treated as unexposed instead of excluded from analysis. Am. J. Ind. Med. 60:329-341, 2017. © 2017 Wiley Periodicals, Inc.

A decade of environmental public health tracking (2002-2012): progress and challenges

BACKGROUND

The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin.

OBJECTIVE

To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations.

DESIGN

A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases.

MAIN OUTCOMES

Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development.

CONCLUSIONS

Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.

Data sharing between local health and state health departments: developing and describing a typology of data gaps

CONTEXT

Local health departments (LHDs) and state health agencies (SHAs) require quantitative data to fulfill their obligation to ensure public health. However, data collection and sharing are not straightforward processes in the US public health system. Responsibilities are divided among many actors, jurisdictions overlap, events that can occur elsewhere, and not every public health agency possesses information systems capable of sharing data. Collectively, these characteristics define a system that likely has gaps in data sharing among public health entities.

OBJECTIVE

A data-sharing gap is the inability to transmit, in near real time, data among public health agencies within a state for a specific public health activity. This article presents theoretically and empirically based typology of data-sharing gaps between LHDs and SHAs and describes the extent of data-sharing types for 6 activities. DESIGN, SETTING AND MAIN OUTCOME: Drawing on concepts from network theory, public health responsibilities, and technological capacity, we conceptualize a 9-category data-sharing typology that characterizes the flow of data between SHAs and LHDs. Using existing organizational surveys, we created a sample of LHD-SHA exchange dyads, which we use to describe the distribution of sharing and gaps for immunizations, vital records, reportable conditions, laboratory, well water, and electronic health records. State-level maps describe the prevalence of data-sharing gaps nationwide.

RESULTS

For vital records, reportable conditions, and well-water assessments, gaps in data sharing were the norm. For the other 3 public health activities, a lower portion of the dyads experienced gaps, but gaps were still very common. Most troubling was the relatively infrequent occurrence of truly bidirectional information sharing.

CONCLUSIONS

The data-sharing typology provides a useful basis for the formulations of policies to improve public health information systems and to guide future research.

Assessing the reproductive health of men with occupational exposures

The earliest report linking environmental (occupational) exposure to adverse human male reproductive effects dates back to1775 when an English physician, Percival Pott, reported a high incidence of scrotal cancer in chimney sweeps. This observation led to safety regulations in the form of bathing requirements for these workers. The fact that male-mediated reproductive harm in humans may be a result of toxicant exposures did not become firmly established until relatively recently, when Lancranjan studied lead-exposed workers in Romania in 1975, and later in 1977, when Whorton examined the effects of dibromochloropropane (DBCP) on male workers in California. Since these discoveries, several additional human reproductive toxicants have been identified through the convergence of laboratory and observational findings. Many research gaps remain, as the pool of potential human exposures with undetermined effects on male reproduction is vast. This review provides an overview of methods used to study the effects of exposures on male reproduction and their reproductive health, with a primary emphasis on the implementation and interpretation of human studies. Emphasis will be on occupational exposures, although much of the information is also useful in assessing environmental studies, occupational exposures are usually much higher and better defined.

Mobile phone tracking: in support of modelling traffic-related air pollution contribution to individual exposure and its implications for public health impact assessment

We propose a new approach to assess the impact of traffic-related air pollution on public health by mapping personal trajectories using mobile phone tracking technology in an urban environment. Although this approach is not based on any empirical studies, we believe that this method has great potential and deserves serious attention. Mobile phone tracking technology makes it feasible to generate millions of personal trajectories and thereby cover a large fraction of an urban population. Through analysis, personal trajectories are not only associated to persons, but it can also be associated with vehicles, vehicle type, vehicle speed, vehicle emission rates, and sources of vehicle emissions. Pollution levels can be estimated by dispersion models from calculated traffic emissions. Traffic pollution exposure to individuals can be estimated based on the exposure along the individual human trajectories in the estimated pollution concentration fields by utilizing modelling tools. By data integration, one may identify trajectory patterns of particularly exposed human groups. The approach of personal trajectories may open a new paradigm in understanding urban dynamics and new perspectives in population-wide empirical public health research. This new approach can be further applied to individual commuter route planning, land use planning, urban traffic network planning, and used by authorities to formulate air pollution mitigation policies and regulations.

Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems

OBJECTIVES

Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective.

METHODS

A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality.

RESULTS

Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors.

CONCLUSIONS

For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.