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Academic-Practice Partnerships:a Multidisciplinary Approach
Mary A. FoxResearch Director
JHU Center of Excellence in Environmental Public Health Tracking
National Tracking ConferenceApril 2005
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JHU Center Mission Areas
• Support, Assist, Advise
• Applied Research, Synthesis, Translation
• Information Dissemination, Outreach, Advocacy
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Hopkins Tracking Center Goals
1. Provide technical and research support to our state and local partners
2. Strengthen the environmental public health workforce through education, training, and technical assistance
3. Advance research to investigate the potential links between health effectsand the environment
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Developing scientific methods for an emerging field
• Selecting and refining tracking endpoints • Developing reliable and adaptable measures• Supporting environmental epidemiology• Advancing biomonitoring• Data quality and presentation• Communication and translation• Responsive to communities and susceptible
populations• Improved geographic and temporal resolution• Links to policy and prevention
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Hopkins Activities
• Tracking Applications• Accomplishments: Linkage case studies, Indicators • Ongoing: Develop practical applications
• Education and Training• Accomplishments: Tracking Methods Course, Data
Display and Dissemination Course• Ongoing: Core Competencies for Tracking
• Research and Methods Development• Accomplishments:, Student Fellowships, Policy
Assessment• Ongoing: Epidemiological Study, Methods Research
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Faculty Fellowship program
• Builds on core faculty expertise• Support the Tracking Center’s technical
assistance efforts to students and state and local tracking grantees in areas of – Data linkage– Environmental health surveillance analysis
and visualization techniques– Methods related to communicating
surveillance analysis findings
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Faculty Fellows
Frank
Curriero
Francesca
Dominici
Janet
DiPietro
Norma
Kanarek
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Faculty Fellows’ ExpertiseFrank Curriero
Biostatistics
Geographic Information Systems
Francesca Dominici
Biostatistics
Environmental Epidemiology
Janet DiPietro
Developmental psychology
Neurobehavioral functioning
Norma Kanarek
Cancer epidemiology
Methods for state/local analyses
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Core Faculty
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Core Faculty Expertise Tom Burke
Epidemiology
Environmental health surveillance
Beth Resnick
Public Health Practice
Environmental health
Mary Fox
Environmental health policy
Risk assessment
Eliseo Guallar
Epidemiology
Cardiovascular disease
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Faculty Fellows’ Contributions
• Training• Consultation• Research and applications development
– National air pollution policy– State and local practice
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Training and Consultation
• Training– Student research support– National conference training
• Consultation with states– PHASE project – time series analysis– Interpretation of low birth weight as health
indicator
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Research: Ozone project background
• Results of the National Morbidity Mortality Air Pollution Study (1987-2000) have found an association between daily changes in ozone and increased risk of all cause mortality
• Need to extend methods for estimating exposure-response curve to investigate whether there is a threshold
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NationalMorbidityMortalityAir PollutionStudy1987—2000
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Main Result of Bell et al 2004 JAMA
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Research: Ozone project• Problem
– There are several cities in the US that have non-overlapping ranges of ozone levels
• Purpose– Develop new statistical
approach for estimating national-average exposure-response that accounts for non-overlapping ranges of exposure
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Research: Ozone project
• Products: – Broadly applicable methods for estimating
exposure-response– Ozone case study to inform national policy– Results, software, data, methods
disseminated via Internet– Prior work available:
www.ihapss.jhsph.edu
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Applications for local tracking
• Problem– Addressing apparent local disease excesses
• Purpose– Create a framework for analysis integrating
epidemiological and statistical tools– Support proactive response
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Applications for local tracking
• Products – Investigation plan applicable to any endpoint – Analytical methods “linked” to plan– Multi-county Maryland pilot project– Plan and methods available via Tracking Center
• Prior community health work http://www.communityphind.net/index.html
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Applications: Project development
• Selected cancers in subset of Maryland counties
• Working with the health officers• Collaboration within Center
– Statistical methods– Exposure and risk
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Applications: Investigation questions for local tracking
• Is there a local excess?• What is the context of this excess?
– Temporal and geographic pattern– Local health profile
• What do we already know about disease?– Natural history
• Preventable• Detectable early• Quality care• Risk factors• Latency• Susceptible population
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Applications: Investigation questions for local tracking
• What do we already know about exposures in community?– Unique disease?
• Sentinel events• Special hazards
– Local characteristics• Ambient exposures• Other disease with similar risk factors• Community concerns• At-risk populations
• What follow-up?– Local health activities
• Intervention• Additional data or monitoring
– Research activities• Unique exposure present in other localities?• Etiologic studies
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Local Areas
CurrentLocal
Excess
NoCurrentExcess
Is there alocal excess?
Chronic
Intermittent
Increasing
What is the contextof this excess?
HighestAmong
AdjacentCounties
IsolatedHigh Area
Adjacent toother higher
areas
What do wealready know
about the disease?
Detectable Early?
Quality Care?
Preventable?
Risk Factors?
Latency?
SusceptiblePopulation?
What do we alreadyknow about potentialunusual exposuresin the community?
Sentinel Events
Early, more severeor unique disease
Special Hazards(potential)
AmbientEnvironmental
Exposures
Disease with similarrisk factors
Voiced CommunityConcerns
Continued DiseaseMonitoring
What follow-upis recommended?
Additional Data
FurtherInvestigation
of Cases
All Cancers
Lung Disease
HeartDisease
Diabetes
InfectiousDisease
Other
LaunchInterventions
Injuries
Natural History
LocalPopulation
Health Profile
Time Pattern
UniqueDisease
Local HealthActivities
At-RiskPopulations
GeographicPatterns
LocalCharacteristics
Investigation ofunique exposures insimilar local areas
Etiologic Studies
MethodDevelopment
ResearchActivities
Algorithm for Real-Time Monitoringof Cancer in Local Areas
Investigation Plan
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Meeting the challenges
• Our multidisciplinary team – Addressing CDC and partner priorities– Developing the “toolbox”
• New methods• Practical applications
– Offering expertise on emerging issues• Biomonitoring• Child development• Cumulative risk