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An Early - and Quick - Orientation to Applied Epidemiology

Posted By Christine Dobson, Friday, December 04, 2015
Updated: Friday, December 04, 2015
The event that would largely shape my introduction to the applied epidemiology field came as I was en route to the CSTE Applied Epidemiology Fellowship Orientation Week. Early in the morning on August 24, 2014, a 6.0-magnitude earthquake struck the San Francisco Bay Area where I live and work. I learned of the earthquake from the East Coast while traveling to orientation in Atlanta. Had I been home, the earthquake would have jolted me awake at 2 in the morning and rocked me for about 20 seconds. The earthquake, which was epicentered approximately 30 miles northeast of San Francisco, caused five residential fires, downed power lines, and resulted in damage to buildings, homes, roadways, and water mains. Suspecting that the California Department of Public Health (CDPH), my host agency, might play a role in its aftermath, I contacted colleagues offering to help with any response effort upon my return to California.

That response effort was a community rapid needs assessment, called a Community Assessment for Preparedness and Emergency Response (CASPER). The Emergency Preparedness Team (EPT) within the Division of Environmental and Occupational Disease Control at CDPH had been asked by the Public Health Division in Napa County, one of the hardest-hit counties, for assistance assessing earthquake-related physical injuries, chronic disease exacerbation, mental health issues, and general emergency preparedness among households in Napa County. A team comprised of epidemiologists, health educators, and physicians from the county and state health departments and the CDC was formed to plan the CASPER event. Using guidance from CDC’s CASPER toolkit, the team worked together to design a 48-question questionnaire for household-based interviews, to select the geographic areas for household sampling, to recruit volunteers to canvass the selected households, and to coordinate myriad logistics for a three-day field sampling event scheduled three weeks after the earthquake. Over those three days, 15 two-person teams of volunteers approached 488 households and successfully completed an interview with a member of 201 of those households.

Although we assessed many different health impacts related to the earthquake, impacts to mental health were a major focus of the CASPER. Just over a quarter of households had a member who experienced a traumatic psychological exposure, which is known to be associated with posttraumatic stress disorder, in the immediate aftermath of the earthquake. Feelings of psychological distress, such as feeling anxious, fearful, or distracted, were experienced in 75% of households. Among all households in which a traumatic or distressing psychological experience occurred, professional help or other emotional support was sought in 41% of households. In response to the data generated by the CASPER, Napa County was able to more effectively reallocate its mental health resources in the immediate aftermath of the earthquake. In addition, the county conducted public training sessions and education campaigns to support those with mental health risks, conducted community social events on the earthquake anniversary date to promote community resilience and earthquake preparedness, and provided psychological first aid training to outreach workers.

The CASPER findings were summarized in a report drafted by the EPT and submitted to Napa County Public Health. We also communicated our findings to a wider public health audience at a number of different meetings through both poster and oral presentation platforms: a webinar sponsored by the Safe States Alliance; poster presentation at the 10th Annual Preparedness Summit (Atlanta, GA); an invited talk at the 2015 CSTE Disaster Epidemiology Subcommittee Workgroup Meeting (Atlanta, GA); and presentations at the 2015 EIS Conference (Atlanta, GA) and the 2015 CSTE Annual Conference (Boston, MA). In addition, our findings specific to mental health needs as a result of the earthquake were presented in a MMWR report.

In addition to the actionable data that were generated, the CASPER, the first large-scale project to which I contributed as a CDC/CSTE fellow, also provided a comprehensive and intensive introduction to the work and workings of local and state health departments. I was part of the collaboration and discussions that occurred among local, state, and federal health officials. I was involved in the development of survey materials, in the training of volunteers in sampling and interviewing methods, in the analysis of our collected data, in the drafting of the report, and in presenting our findings across many forums. From start to finish, the CASPER provided opportunities both for learning and for developing my epidemiologic skills in the applied public health space.

Moreover, the CASPER afforded me the opportunity to meet community members affected by the earthquake. Many wanted to share their stories of the shaking and disorienting chaos that gave way to weeks and months of rebuilding their homes and regaining their physical and emotional health. Yet when asked at the conclusion of the interview what their household was most in need of now, the residents I spoke to most often replied, “nothing.” They were simply grateful that their plight had not been more severe. And so my experience on the frontlines of public health had taught me another important lesson, which was the resiliency of those impacted by disaster.

Christine Dobson, ScD is a CDC/CSTE Applied Epidemiology fellow in the Environmental Health Investigations Branch and Occupational Health Branch at the California Department of Public Health. AEF fellow applications are currently open for prospective fellows until January 13, 2016. If you work at a health agency and would like to host a fellow, HSIP host-site applications must be completed by December 16.

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