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Article ; Online: Developing a surveillance system of sub-county data: Finding suitable population thresholds for geographic aggregations.

Werner, Angela K / Strosnider, Heather M

Spatial and spatio-temporal epidemiology

2020 Volume 33, Page(s) 100339

Abstract: The Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program created standardized sub-county geographies that are comparable over time, place, and outcomes. Expected census tract-level counts were calculated for ... ...

Abstract	The Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program created standardized sub-county geographies that are comparable over time, place, and outcomes. Expected census tract-level counts were calculated for asthma emergency department visits and lung cancer. Census tracts were aggregated for various total population and sub-population thresholds, then suppression and stability were examined. A total of 5,000 persons was recommended for the more common outcome scheme and a total of 20,000 persons was recommended for the rare outcome scheme. Health outcomes with a median case count of 17.0 cases or higher should produce stable estimates at the census tract level. This project generated recommendations for three sub-county geographies that will be useful for surveillance purposes: census tract, a more common outcome aggregation scheme, and a rare outcome aggregation scheme. This methodology can be applied anywhere to aggregate geographic units and produce stable rates at a finer resolution.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma/epidemiology ; Child ; Child, Preschool ; Female ; Health Status Disparities ; Humans ; Infant ; Lung Neoplasms/epidemiology ; Male ; Middle Aged ; Population Surveillance ; Spatial Analysis ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2020-03-06
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2515896-X
ISSN	1877-5853 ; 1877-5845
ISSN (online)	1877-5853
ISSN	1877-5845
DOI	10.1016/j.sste.2020.100339
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Article ; Online: Feasibility of visualizing cancer incidence data at sub-county level: Findings from 21 National Program of Cancer Registries.

Ellington, Taylor D / Werner, Angela K / Henley, S Jane / Paddock, Lisa E / Agovino, Pamela K

Spatial and spatio-temporal epidemiology

2023 Volume 45, Page(s) 100564

Abstract: Monitoring cancer incidence data by geography is useful for planning public health activities. However, due to anticipated confidentiality and statistical reliability issues, data on cancer incidence and mortality are more often displayed at a national, ... ...

Abstract	Monitoring cancer incidence data by geography is useful for planning public health activities. However, due to anticipated confidentiality and statistical reliability issues, data on cancer incidence and mortality are more often displayed at a national, state, or county level, rather than at more local levels. To address this gap in displaying cancer data at the local level, the CDC's National Environmental Public Health Tracking Program and 21 National Program of Cancer Registries worked together on a pilot project to examine the feasibility of displaying sub-county-level incidence of selected cancer types diagnosed during 2007-2016. The results from this project are important steps for building sub-county cancer displays into data visualizations and using the data in a way that provides meaningful insights. The availability of sub-county cancer data may allow researchers to better examine cancer data at a local level which may help guide public health decisions regarding community-based interventions and screening services.
MeSH term(s)	United States/epidemiology ; Humans ; Incidence ; Pilot Projects ; Feasibility Studies ; National Program of Cancer Registries ; Reproducibility of Results ; Neoplasms/epidemiology ; Registries
Language	English
Publishing date	2023-01-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2515896-X
ISSN	1877-5853 ; 1877-5845
ISSN (online)	1877-5853
ISSN	1877-5845
DOI	10.1016/j.sste.2023.100564
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Article ; Online: Public Perceptions of Environmental Public Health Risks in the United States.

Shin, Mikyong / Werner, Angela K / Strosnider, Heather / Hines, Lisa B / Balluz, Lina / Yip, Fuyuen Y

International journal of environmental research and public health

2019 Volume 16, Issue 6

Abstract: Understanding public perceptions about environmental health hazards, exposures, and health impacts can help environmental public health practitioners to target and prioritize community activities, policy needs, and communication strategies. The online ... ...

Abstract	Understanding public perceptions about environmental health hazards, exposures, and health impacts can help environmental public health practitioners to target and prioritize community activities, policy needs, and communication strategies. The online cross-sectional 2013 summer wave of the
MeSH term(s)	Adult ; Awareness ; Centers for Disease Control and Prevention, U.S. ; Cross-Sectional Studies ; Environmental Exposure ; Environmental Pollutants/toxicity ; Female ; Humans ; Male ; Middle Aged ; Perception ; Public Health ; Risk Assessment ; Surveys and Questionnaires ; United States/epidemiology
Chemical Substances	Environmental Pollutants
Language	English
Publishing date	2019-03-22
Publishing country	Switzerland
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ISSN	1660-4601
ISSN (online)	1660-4601
DOI	10.3390/ijerph16061045
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Article ; Online: Lessons Learned From the Environmental Public Health Tracking Sub-County Data Pilot Project.

Werner, Angela K / Strosnider, Heather / Kassinger, Craig / Shin, Mikyong

Journal of public health management and practice : JPHMP

2017 Volume 24, Issue 5, Page(s) E20–E27

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Data Systems ; Environmental Monitoring/methods ; Environmental Monitoring/standards ; Florida ; Geographic Mapping ; Humans ; Information Dissemination ; Local Government ; Maine ; New York ; Pilot Projects ; Public Health/methods ; Public Health/standards ; Public Health/trends ; Washington ; Wisconsin
Language	English
Publishing date	2017-12-18
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2027860-3
ISSN	1550-5022 ; 1078-4659
ISSN (online)	1550-5022
ISSN	1078-4659
DOI	10.1097/PHH.0000000000000686
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Article ; Online: Examination of Child and Adolescent Hospital Admission Rates in Queensland, Australia, 1995-2011: A Comparison of Coal Seam Gas, Coal Mining, and Rural Areas.

Werner, Angela K / Watt, Kerrianne / Cameron, Cate / Vink, Sue / Page, Andrew / Jagals, Paul

Maternal and child health journal

2018 Volume 22, Issue 9, Page(s) 1306–1318

Abstract: Objectives At present, coal seam gas (CSG) is the most common form of unconventional natural gas development occurring in Australia. Few studies have been conducted to explore the potential health impacts of CSG development on children and adolescents. ... ...

Abstract	Objectives At present, coal seam gas (CSG) is the most common form of unconventional natural gas development occurring in Australia. Few studies have been conducted to explore the potential health impacts of CSG development on children and adolescents. This analysis presents age-specific hospitalisation rates for a child and adolescent cohort in three study areas in Queensland. Methods Three geographic areas were selected: a CSG area, a coal mining area, and a rural area with no mining activity. Changes in area-specific hospital admissions were investigated over the period 1995-2011 in a series of negative binomial regression analyses for 19 International Classification of Diseases (ICD) chapters, adjusting for sociodemographic factors. Results The strongest associations were found for respiratory diseases in 0-4 year olds (7% increase [95% CI 4%, 11%] and 6% increase [95% CI 2%, 10%] in the CSG area relative to the coal mining and rural areas, respectively) and 10-14 year olds (9% increase [95% CI 1%, 18%] and 11% increase [95% CI 1%, 21%] in the CSG area compared to the coal mining and rural areas, respectively). The largest effect size was for blood/immune diseases in 5-9 year olds in the CSG area (467% increase [95% CI 139%, 1244%]) compared to the rural area with no mining activity. Conclusions for Practice Higher rates of hospitalisation existed in the CSG area for certain ICD chapters and paediatric age groups, suggesting potential age-specific health impacts. This study provides insights on associations that should be explored further in terms of child and adolescent health.
MeSH term(s)	Adolescent ; Australia ; Child ; Child, Preschool ; Coal Industry/statistics & numerical data ; Environmental Exposure/adverse effects ; Female ; Hospitalization/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Natural Gas ; Oil and Gas Fields ; Queensland/epidemiology ; Rural Population ; Young Adult
Chemical Substances	Natural Gas
Language	English
Publishing date	2018-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339905-6
ISSN	1573-6628 ; 1092-7875
ISSN (online)	1573-6628
ISSN	1092-7875
DOI	10.1007/s10995-018-2511-4
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Article ; Online: Is Increasing Coal Seam Gas Well Development Activity Associated with Increasing Hospitalisation Rates in Queensland, Australia? An Exploratory Analysis 1995-2011.

Werner, Angela K / Cameron, Cate M / Watt, Kerrianne / Vink, Sue / Jagals, Paul / Page, Andrew

International journal of environmental research and public health

2017 Volume 14, Issue 5

Abstract: The majority of Australia's coal seam gas (CSG) reserves are in Queensland, where the industry has expanded rapidly in recent years. Despite concerns, health data have not been examined alongside CSG development. This study examined hospitalisation rates ...

Abstract	The majority of Australia's coal seam gas (CSG) reserves are in Queensland, where the industry has expanded rapidly in recent years. Despite concerns, health data have not been examined alongside CSG development. This study examined hospitalisation rates as a function of CSG development activity in Queensland, during the period 1995-2011. Admissions data were examined with CSG well numbers, which served as a proxy for CSG development activity. Time series models were used to assess changes in hospitalisation rates for periods of "low", "medium", "high", and "intense" activity compared to a period of "very low" activity, adjusting for covariates. "All-cause" hospitalisation rates increased monotonically with increasing gas well development activity in females (324.0 to 390.3 per 1000 persons) and males (294.2 to 335.4 per 1000 persons). Hospitalisation rates for "Blood/immune" conditions generally increased for both sexes. Female and male hospitalisation rates for "Circulatory" conditions decreased with increasing CSG activity. Hospitalisation rates were generally low for reproductive and birth outcomes; no clear associations were observed. This study showed some outcomes were associated with increasing CSG development activity. However, as a condition of data access, the population and outcomes were aggregated to a broad geographic study area rather than using higher geographic resolution data. Higher resolution data, as well as other data sources, should be explored. Further research should be conducted with an expanded time period to determine if these trends continue as the industry grows.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Coal ; Female ; Hospitalization/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Models, Theoretical ; Oil and Gas Fields ; Queensland ; Young Adult
Chemical Substances	Coal
Language	English
Publishing date	2017-05-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph14050540
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Article ; Online: Environmental health impacts of unconventional natural gas development: a review of the current strength of evidence.

Werner, Angela K / Vink, Sue / Watt, Kerrianne / Jagals, Paul

The Science of the total environment

2015 Volume 505, Page(s) 1127–1141

Abstract: Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the ... ...

Abstract	Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the strength of evidence in scientific reporting of environmental hazards from UNGD activities associated with adverse human health outcomes. Studies were drawn from peer-reviewed and grey literature following a systematic search. Five databases were searched for studies published from January 1995 through March 2014 using key search terms relevant to environmental health. Studies were screened, ranked and then reviewed according to the strength of the evidence presented on adverse environmental health outcomes associated with UNGD. The initial searches yielded >1000 studies, but this was reduced to 109 relevant studies after the ranking process. Only seven studies were considered highly relevant based on strength of evidence. Articles spanned several relevant topics, but most focussed on impacts on typical environmental media, such as water and air, with much of the health impacts inferred rather than evidenced. Additionally, the majority of studies focussed on short-term, rather than long-term, health impacts, which is expected considering the timeframe of UNGD; therefore, very few studies examined health outcomes with longer latencies such as cancer or developmental outcomes. Current scientific evidence for UNGD that demonstrates associations between adverse health outcomes directly with environmental health hazards resulting from UNGD activities generally lacks methodological rigour. Importantly, however, there is also no evidence to rule out such health impacts. While the current evidence in the scientific research reporting leaves questions unanswered about the actual environmental health impacts, public health concerns remain intense. This is a clear gap in the scientific knowledge that requires urgent attention.
MeSH term(s)	Environmental Exposure/statistics & numerical data ; Environmental Health ; Extraction and Processing Industry ; Humans ; Natural Gas ; Public Health
Chemical Substances	Natural Gas
Language	English
Publishing date	2015-02-01
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2014.10.084
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Article: Environmental health impacts of unconventional natural gas development: A review of the current strength of evidence

Werner, Angela K / Sue Vink / Kerrianne Watt / Paul Jagals

Science of the total environment. 2015 Feb. 01, v. 505

2015

Abstract	Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the strength of evidence in scientific reporting of environmental hazards from UNGD activities associated with adverse human health outcomes. Studies were drawn from peer-reviewed and grey literature following a systematic search. Five databases were searched for studies published from January 1995 through March 2014 using key search terms relevant to environmental health. Studies were screened, ranked and then reviewed according to the strength of the evidence presented on adverse environmental health outcomes associated with UNGD. The initial searches yielded >1000 studies, but this was reduced to 109 relevant studies after the ranking process. Only seven studies were considered highly relevant based on strength of evidence. Articles spanned several relevant topics, but most focussed on impacts on typical environmental media, such as water and air, with much of the health impacts inferred rather than evidenced. Additionally, the majority of studies focussed on short-term, rather than long-term, health impacts, which is expected considering the timeframe of UNGD; therefore, very few studies examined health outcomes with longer latencies such as cancer or developmental outcomes. Current scientific evidence for UNGD that demonstrates associations between adverse health outcomes directly with environmental health hazards resulting from UNGD activities generally lacks methodological rigour. Importantly, however, there is also no evidence to rule out such health impacts. While the current evidence in the scientific research reporting leaves questions unanswered about the actual environmental health impacts, public health concerns remain intense. This is a clear gap in the scientific knowledge that requires urgent attention.
Keywords	air ; databases ; environmental hazards ; environmental health ; health hazards ; human health ; leaves ; natural gas ; neoplasms
Language	English
Dates of publication	2015-0201
Size	p. 1127-1141.
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2014.10.084
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: All-age hospitalization rates in coal seam gas areas in Queensland, Australia, 1995-2011.

Werner, Angela K / Watt, Kerrianne / Cameron, Cate M / Vink, Sue / Page, Andrew / Jagals, Paul

BMC public health

2016 Volume 16, Page(s) 125

Abstract: Background: Unconventional natural gas development (UNGD) is expanding globally, with Australia expanding development in the form of coal seam gas (CSG). Residents and other interest groups have voiced concerns about the potential environmental and ... ...

Abstract	Background: Unconventional natural gas development (UNGD) is expanding globally, with Australia expanding development in the form of coal seam gas (CSG). Residents and other interest groups have voiced concerns about the potential environmental and health impacts related to CSG. This paper compares objective health outcomes from three study areas in Queensland, Australia to examine potential environmentally-related health impacts. Methods: Three study areas were selected in an ecologic study design: a CSG area, a coal mining area, and a rural/agricultural area. Admitted patient data, as well as population data and additional factors, were obtained for each calendar year from 1995 through 2011 to calculate all-age hospitalization rates and age-standardized rates in each of these areas. The three areas were compared using negative binomial regression analyses (unadjusted and adjusted models) to examine increases over time of hospitalization rates grouped by primary diagnosis (19 ICD chapters), with rate ratios serving to compare the within-area regression slopes between the areas. Results: The CSG area did not have significant increases in all-cause hospitalization rates over time for all-ages compared to the coal and rural study areas in adjusted models (RR: 1.02, 95 % CI: 1.00-1.04 as compared to the coal mining area; RR: 1.01, 95 % CI: 0.99-1.04 as compared to the rural area). While the CSG area did not show significant increases in specific hospitalization rates compared to both the coal mining and rural areas for any ICD chapters in the adjusted models, the CSG area showed increases in hospitalization rates compared only to the rural area for neoplasms (RR: 1.09, 95 % CI: 1.02-1.16) and blood/immune diseases (RR: 1.14, 95 % CI: 1.02-1.27). Conclusions: This exploratory study of all-age hospitalization rates for three study areas in Queensland suggests that certain hospital admissions rates increased more quickly in the CSG study area than in other study areas, particularly the rural area, after adjusting for key sociodemographic factors. These findings are an important first step in identifying potential health impacts of CSG in the Australian context and serve to generate hypotheses for future studies.
MeSH term(s)	Adolescent ; Adult ; Aged ; Agriculture/statistics & numerical data ; Child ; Coal Industry/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Natural Gas ; Oil and Gas Industry/statistics & numerical data ; Queensland/epidemiology ; Regression Analysis ; Spatial Analysis ; Young Adult
Chemical Substances	Natural Gas
Language	English
Publishing date	2016-02-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-016-2787-5
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Article ; Online: Timing of State and Territorial COVID-19 Stay-at-Home Orders and Changes in Population Movement - United States, March 1-May 31, 2020.

Moreland, Amanda / Herlihy, Christine / Tynan, Michael A / Sunshine, Gregory / McCord, Russell F / Hilton, Charity / Poovey, Jason / Werner, Angela K / Jones, Christopher D / Fulmer, Erika B / Gundlapalli, Adi V / Strosnider, Heather / Potvien, Aaron / García, Macarena C / Honeycutt, Sally / Baldwin, Grant

MMWR. Morbidity and mortality weekly report

2020 Volume 69, Issue 35, Page(s) 1198–1203

Abstract: SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is thought to spread from person to person primarily by the respiratory route and mainly through close contact (1). Community mitigation strategies can lower the risk for disease ... ...

Abstract	SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is thought to spread from person to person primarily by the respiratory route and mainly through close contact (1). Community mitigation strategies can lower the risk for disease transmission by limiting or preventing person-to-person interactions (2). U.S. states and territories began implementing various community mitigation policies in March 2020. One widely implemented strategy was the issuance of orders requiring persons to stay home, resulting in decreased population movement in some jurisdictions (3). Each state or territory has authority to enact its own laws and policies to protect the public's health, and jurisdictions varied widely in the type and timing of orders issued related to stay-at-home requirements. To identify the broader impact of these stay-at-home orders, using publicly accessible, anonymized location data from mobile devices, CDC and the Georgia Tech Research Institute analyzed changes in population movement relative to stay-at-home orders issued during March 1-May 31, 2020, by all 50 states, the District of Columbia, and five U.S. territories.* During this period, 42 states and territories issued mandatory stay-at-home orders. When counties subject to mandatory state- and territory-issued stay-at-home orders were stratified along rural-urban categories, movement decreased significantly relative to the preorder baseline in all strata. Mandatory stay-at-home orders can help reduce activities associated with the spread of COVID-19, including population movement and close person-to-person contact outside the household.
MeSH term(s)	COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Humans ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Population Dynamics/statistics & numerical data ; Public Health/legislation & jurisprudence ; Time Factors ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-09-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm6935a2
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