Current Epidemiology Projects
at the Baltimore City Health Department
Elizabeth Toure, MPH Candidate 2016
Preceptor: Dr. Darcy Phelan-Emrick, Chief Epidemiologist
Background
• 6 month internship at the Baltimore City Health
Department (BCHD)
• Epidemiology Services
• Epidemiology potpourri
• 3 major projects
• Side projects
Outline
• Background
• Healthy Baltimore 2015
• 2016 Neighborhood Health Profiles
• Syndromic surveillance of synthetic cannabinoids
• Conclusion
Healthy Baltimore 2015
• Set targets for10 priority areas
2011
Healthy Baltimore 2015
2011
1)
Promote Access to Quality Health Care for All
2)
Be Tobacco Free
3)
Redesign Communities to Prevent Obesity
4)
Promote Heart Health
5)
Stop the Spread of HIV and Other STIs
6)
Recognize and Treat Mental Health Needs
7)
Reduce Drug Use and Alcohol Abuse
8)
Encourage Early Detection of Cancer
9)
Promote Healthy Children and Adolescents
10) Create Health Promoting Neighborhoods
Healthy Baltimore 2015
• Set targets for10 priority areas
• 35 goals & indicators
• Decrease percent of adults who are
obese by 15%
• Decrease percent of teens who
currently smoke by 20%
2011
Healthy Baltimore 2015
2011 2013
Healthy Baltimore 2015
• 2015 data not yet available
• Trends from 2010-2014
• Summary for each indicator
• Highlighting work underway
2011 2013 2016
Healthy Baltimore 2015
Healthy Baltimore 2015
Healthy Baltimore 2015 - RESULTS
• 11/35 indicators met or exceeded targets
Healthy Baltimore 2015 - RESULTS
• 11/35 indicators met or exceeded targets
 Health insurance coverage
 New HIV cases
 Rates of adolescent gonorrhea and chlamydia
 Infant mortality rate among black infants
Healthy Baltimore 2015 - RESULTS
• 11/35 indicators met or exceeded targets
• Some surprising/alarming results
Healthy Baltimore 2015 - RESULTS
• 11/35 indicators met or exceeded targets
• Some surprising/alarming results
 Rate of syphilis
 Infant morality rate among white infants
 Emergency Department visits for chronic conditions
Stay tuned for
Healthy Baltimore
2020
Outline
• Background
• Healthy Baltimore 2015
• 2016 Neighborhood Health Profiles
• Syndromic surveillance of synthetic cannabinoids
• Conclusion
Neighborhood Health Profiles
• Collection of 55 reports
• Neighborhood – level health indicators
• Demographics
• Socio/economic factors
• Built and social environment
2008
• Health outcomes
Neighborhood Health Profiles
2008
2011
Neighborhood Health Profiles
2016
Neighborhood
Health
Profiles
2008
2011
2016
Neighborhood Health Profiles
• Indicator selection
• Research other cities’ neighborhood indicators
• Avoid duplication from Baltimore Neighborhood Indicators
Alliance Vital Signs
• Internal and external stakeholder input
• Data availability
Neighborhood Health Profiles
• Preliminary indicators (30)
• Percent of uninsured residents
• Rate of 311 calls for rodents
• Percent of neighborhood covered by green space
• Percent of neighborhood in a food desert
• Motor vehicle traffic mortality rate
Neighborhood Health Profiles
• Next steps
• Finish collecting data
• Draft reports and report layout
• Approval within BCHD and Mayor’s Office
• Community engagement & rollout
Outline
• Background
• Healthy Baltimore 2015
• 2016 Neighborhood Health Profiles
• Syndromic surveillance of synthetic cannabinoids
• Conclusion
Synthetic cannabinoids
Synthetic cannabinoids
The current outbreak of illnesses associated with synthetic cannabinoid
use in Mississippi is part of a larger multistate outbreak. To date, this is
the largest outbreak of synthetic cannabinoid-associated
adverse events ever recorded.
Synthetic cannabinoids
Synthetic cannabinoids
Synthetic cannabinoids
Synthetic cannabinoids
Synthetic cannabinoids
Synthetic cannabinoids
Synthetic cannabinoids
• Syndromic surveillance dashboard
Synthetic cannabinoids
• Syndromic surveillance dashboard
• Maryland Poison Control (MPC) – weekly call data
Synthetic cannabinoids
• Syndromic surveillance dashboard
• Maryland Poison Control (MPC)
• Twitter Tracker using R software
Synthetic cannabinoids
• Syndromic surveillance dashboard
• Maryland Poison Control (MPC)
• Twitter Tracker using R software
Synthetic cannabinoids – MPC results
• 31 weeks of data
• 95 cases
• 48 (50.5%) with moderate or major clinical effects
• Only 85 cases had treatment data
• 66 (78%) were treated in ED
• 11 (13%) were admitted
Number of Cases
Weekly Exposure Calls for Synthetic Cannabinoids in
Baltimore City
13
12
11
10
9
8
7
6
5
4
3
2
1
0
(Aug. 30, 2015 - April 9, 2016)
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
Synthetic cannabinoids
• Next steps
• Continue weekly surveillance – find additional data sources
• Monitor for changes after new Baltimore law banning sale of
synthetic drugs
• Establish plan for how to respond to outbreaks
Outline
• Background
• Healthy Baltimore 2015
• 2016 Neighborhood Health Profiles
• Syndromic surveillance of synthetic cannabinoids
• Conclusion
Conclusion – lessons learned
• Fast-paced environment at the city-level: be flexible
• Carefully record data sources and methods to ensure
reproducibility
• Difficulty sharing data
Acknowledgements
Darcy Phelan-Emrick
Chris Fuller
Jonathan Gross
Paulani Mui
Beth Resnick
Thank you all very much for your support, mentorship and
encouragement throughout out this internship.
Thank You!
Elizabeth Toure
MPH Candidate, 2016
etoure1@jhmi.edu
Questions?