Introduction to Public Health Surveillance

Module 1 Overview Context Content Area: Descriptive Epidemiology & Surveillance Essential Question (Generic): How are health-related states or events distributed? Essential Question (Drug Abuse Specific): How is drug abuse distributed? Enduring Epidemiological Understanding: The frequency and distribution of health-related states or events in a population can be determined by systematically collecting, analyzing, and interpreting data. Synopsis In Module 1, students explore how to describe the distribution of health-related states or events. Students begin to uncover and develop the following epidemiological concepts and skills: observing groups of people, counting, the value of a denominator, a case definition, a representative sample, and creating circumstances that encourage truthful responses and protect confidentiality. Lesson 1-1: Counting and Rates Lesson 1-2: Introduction to Surveillance Lesson 1-3: Counting/Describing HIV / AIDS Lesson 1-4: Counting High School Marijuana Use Lesson 1-5: National Survey on Drug Use and Health Lesson 1-6: Other Drug Abuse Surveillance Systems

Module 1 - Descriptive Epidemiology and Surveillance • Lesson 1-2 Introduction to Surveillance • Content • Surveillance in everyday life • Definition of surveillance as it pertains to descriptive epidemiology and to public health • Uses of public health surveillance information • Important considerations in conducting public health surveillance (justification • for surveillance efforts, case definitions, surveillance population, surveillance • methods, quality of the information collected, ethics) • Big Ideas • Surveillance has an important role in describing the public’s health • In order to be useful, surveillance information has to be accurate and representative of the population of interest, collected and used in an ethical manner, and communicated appropriately to all who have a need to know. This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

Where are we? Essential Questions Enduring Understandings

DZ DZ DZ DZ Review - Descriptive Epidemiology Characterizes the amount (counts) and distribution (person, place and time) of health and disease within a population Robert H. Friis and Thomas A. Sellers, Epidemiology for Public Health Practice, 3rd Edition

Descriptive Epidemiology In other words, the descriptive epidemiology describes occurrence of a disease or condition in terms of its counts and rates in different locations and time frames, and by the personal, societal, and environmentally-related characteristics of people who get the disease or have the condition

Examples of Scope of Descriptive Epidemiology US Surveillance Drug Use Surveys Birth Defects Registries State Cancer Registries Many Communicable Diseases (CDC) National Death Index Local Investigation Possible Food Poisoning Suspected Cluster of Childhood Leukemia Legionella Outbreak Global Surveillance Cancer Incidence in Five Continents HIV/AIDS (WHO)

DZ DZ DZ DZ Surveillance This lesson will explain how SURVEILLANCE is one tool for collecting descriptive epidemiologic data

Definition of Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control Webster’s Third International Dictionary

Traffic Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control

Military Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control

Hotel Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control

ATM Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control

Public Health Surveillance The close and continuous observation of one or more persons for the purpose of direction, supervision, or control

Definition of Public Health Surveillance The ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in planning, implementation, and evaluation of public health practice All types of data collected from populations that could be useful in guiding public health activities. closely integrated with the timely dissemination of these data to those who need to know.

Public Health Surveillance: Provides Descriptive Epidemiology Public Health Surveillance Descriptive Epidemiology

Current Uses of Public Health Surveillance Information Assessment of the status of a health condition Establishment of priorities Evaluation of programs Conduct of research

Important Considerations in Public Health Surveillance 1. Significance of Problem 2. Case Definition 3. Surveillance Population 4. Surveillance Methods 5. Quality of Surveillance Information 6. Ethics Is the effort justified? What is the condition under surveillance? Who will be surveyed? How will the surveillance be conducted? What are the strengths and limitations of the surveillance results? Is the information being collected and used in an ethical manner?

1. Significance of Problem Does the health problem justify surveillance? There is a need to identify the high priority health-related events that warrant the effort and cost of surveillance • Frequency • Severity • Cost • Preventability • Communicability • Public Interest

2. Case Definition What is the condition under surveillance? Case Definition A set of standard criteria for deciding whether a person has a particular disease or other health-related condition.

3. Surveillance Population Who will be surveyed?

3. Surveillance Population Sampling Frame The set of people from which the potential survey participants will be selected Probability Sampling A subset of a population from which all individuals have a known chance of being selected

4. Surveillance Methods How will the surveillance be conducted? • New data via a survey? • Sampling • Data collection • Designing questions • Interview techniques • Existing data? • Sources (e.g., hospitals, police records, cancer registries) • Active or passive?

5. Quality of Surveillance Information What are the strengths and limitations of the surveillance results? • Data accuracy? • Clear, non-ambiguous, non-threatening questions • Truthfulness, comfort of participants • Objectivity of researchers • Quality of measurement • Accuracy in data entry and transfer • Data completeness? • Response rate / effective survey logistics • Reasonable length of survey so participants to not give up • Percent of questions answered, response rate • Sample representative of base population?

6. Ethics Is the information being collected and used in an ethical manner? First, what do we mean by “ethics”? • Accepted principles of right and wrong governing the conduct of a group • In human health research, the three main ethical principles are: • Respect for persons • Doing no harm (beneficence) • Justice

6. Ethics 1. Respect for persons - people are autonomous / can make their own decisions, and also, if their autonomy is impaired, they are entitled to protection • Participants should have full information about the study/survey • Often requires an informed consent form that documents what the study participant understands about the study and his/her participation • Participants should know that participation is strictly voluntary - this important principle also stipulates that a participant can withdraw from the study at any time without repercussions

Next Lesson (1-3) HIV / AIDS Surveillance 1. Significance of Problem 2. Case Definition 3. Surveillance Population 4. Surveillance Methods 5. Quality of Surveillance Information 6. Ethics

Introduction to Public Health Surveillance - Descriptive Epidemiology