Host Site: Houston Department of Health and Human Services, Office of Surveillance and Public Health Preparedness

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1 Host Site: Houston Department of Health and Human Services, Office of Surveillance and Public Health Preparedness Location: Houston, TX Primary Mentor: Marcia Wolverton, MPH Epidemiology Division Manager, Office of Surveillance and Public Health Preparedness Secondary Mentor: Biru Yang, PhD, MS, MPH Epidemiologist Supervisor, Office of Surveillance and Public Health Preparedness Fellow s Workplace Support: The Houston Department of Health and Human Services (HDHHS) is well-positioned to meet and exceed the goals of the Health Systems Integration Program (HSIP). The department is located in the largest medical center in the world, and our programs continually seek to integrate the roles of public health, healthcare, academic, community-based, non-profit, and other organizations in addressing the needs of the Houston community. The projects proposed for the HSIP Fellow build upon many of our existing relationships while providing ample opportunities to form important, new, and lasting partnerships throughout these sectors. Furthermore, the HDHHS has recently begun and expanded initiatives to leverage public health informatics to impact health, which will be expanded and improved through the proposed projects. While being a participant in a large collaboration network will be a valuable experience for the Fellow, specifically leading a new initiative will allow the Fellow to take complete ownership of an impactful project. The Fellow will occupy a cubicle or office with a modern workstation (HP Z420 or Z620 workstation) and an available laptop. Software available includes Oracle and MS SQL Server, ArcGIS, statistical software (including SAS and R), MS Office, and others. The OSPHP has many administrative staff to support the Fellow with paperwork, travel, purchasing, and other clerical and office support functions. The team that the Fellow will work with includes three biostatisticians, four epidemiologists, and one epidemiologist supervisor. These coworkers have a great depth of experience in the types of projects proposed for the fellow. In addition, the Fellow will coordinate with other members of the division as well as information technology resources as needed. Houston Department of Health and Human Services (HDHHS) uses Consilience's Maven for general disease surveillance and case management, ehars for HIV surveillance, Real-time Outbreak and Disease Surveillance for syndromic surveillance, and STD*MIS for STD surveillance activities. All systems will be made available to the Fellow. SAS, R, Epi Info, and ArcGIS are also available for analysis, with experts within the Office of Surveillance and Public Health Preparedness (OSPHP). Furthermore, research databases, such as an HIV testing and treatment history database, the Houston HIV Behavioral Surveillance database, and the Houston Medical Monitoring Project database will be made available to the fellow, if interested and applicable.

2 Community Engagement Partners: Rice University Harris Health System Harris County Healthcare Alliance Project 1 Title: Use of Epidemiological Surveillance to Support the "State of Health for Houston/Harris County" Assessment Currently, the City of Houston produces a triennial community needs assessment (CHNA), entitled the "State of Health for Houston and Harris County". The CHNA requires a high level of collaboration between the HDHHS, other health departments, healthcare organizations, community-based organizations, non-profits, and others. The Fellow will work with these collaborators to utilize epidemiological and other data to contribute to the CHNA. The Fellow will produce assessments on up to five epidemiology components for the upcoming "State of Health" report, including detailed analyses beyond descriptive statistics. These analyses may include geospatial, time-series, co-factor, exploratory, inferential, causal, and other analyses. In the first month of the fellowship, this project will identify up to five epidemiology components to be assessed for the next State of Health report. In the first month of the fellowship, this project will identify relevant stakeholders in the greater-houston area involved with the identified components in order to collaborate on the assessment of the components. In the following 2 months of the fellowship, this project will gather the relevant epidemiological and other data to evaluate the identified components to be assess for the next State of Health report. In the remaining months of the fellowship, this project will produce 2-4 page assessments for all identified components to be included in the next State of Health report. The HDHHS partners with many community-based organizations, non-profits, healthcare, and other partners to conduct their triennial CHNA. Most of these partnerships are maintained through the Harris County Healthcare Alliance, which is a close partner to the HDHHS. These existing partnerships will be leveraged (and new partnerships may be identified and initiated) in order to conduct the assessment of

3 the epidemiology components identified by the Fellow. Depending on the Fellow's interests and the components identified, partnership opportunities are expansive. Project 2 Title: Analysis of Population Blood Lead Levels for Targeted Public Health and Healthcare Interventions Currently, the HDHHS possesses a wealth of data on population blood lead levels in Houston. With recent initiatives by the Centers for Disease Control and Prevention and the federal Department of Health and Human Services, using this data to target interventions is crucial. Specifically, identifying important local risk factors, geographic burdens, and barriers to improving population blood lead levels is crucial to addressing and eliminating this problem in the communities we serve. The Fellow will leverage existing data, resources, and partnerships to analyze data and information, disseminate findings, and guide targeted interventions. Fellow s Project Role: Leader The Fellow will be produce materials for data dissemination, including (but not limited to) community education materials, healthcare outreach materials, presentations to the community and healthcare providers, posters, and articles. In the first month of the fellowship, this project will identify the research questions to be answered based on available data and collaborations. In the following month of the fellowship, this project will develop study designs to answer each of the research questions posed. In the following 6 months of the fellowship, this project will leverage existing data, partnerships, and resources in order to fulfill the study designs developed and answer the research questions posed. In the remaining 4 months of the fellowship, this project will disseminate this information through a variety of formats, including community education, healthcare outreach, and publications. The existing partnership with the Harris Health System's Pediatric Lead and Environmental Health Clinic will serve as a resource for designing the study questions, disseminating the findings, and targeting interventions. Other academic and healthcare partnerships exist in the greater-houston area that will also be leveraged for this project.

4 Project 3 Title: Evaluation of the Impact of Environmental Triggers on Asthma-related Emergency Department Visits Previous research conducted with HDHHS and Rice University has identified communities heavily affected by environmental asthma triggers and determined a strong relationship between these triggers and the use of the Houston Fire Department's Emergency Medical Services. Though this research and work has produced strong correlations and findings, an opportunity exists to use more comprehensive information on emergency department (ED) visits to further investigate this issue. The Fellow will use existing data from syndromic surveillance on asthma-related visits and existing data on environmental triggers in order to answer research questions pertaining to the impact of environmental triggers on ED visits. The Fellow will contribute to a journal article with Dr. Ensor, Dr. Raun, and others. Additionally, the Fellow will develop relevant materials for community and stakeholder information dissemination. In the first month of the fellowship, a planning meeting will be held between Rice University and HDHHS stakeholders in order to develop a detailed study design and plan. In the second month, this project will gather the necessary data identified in the study plan from existing sources, including environmental health and syndromic surveillance. In months 3 through 5, this project will conduct analyses in accordance with the study plan. In the remaining months of the fellowship, this project will publish results on the study's findings in a number of formats, including at least one journal article. In months 6 through 12 of the fellowship, this project will disseminate findings through a variety of medias with a long-term desired outcome of informing and affecting policy change. The relationship with Rice University will be crucial for this project, as Dr. Ensor and Dr. Raun specialize in study methods that will be employed in the present project. Project 4 Title: Gaining Experience for Leading the Future of Public Health This project will be based upon observing, interacting with, and participating in the leadership of the OSPHP and HDHHS. The skills needed to become a leader for the future of public health require

5 participation in the leadership process, so the Fellow will be given every opportunity possible to participate in the leadership of the HDHHS. The Fellow will attend all possible leadership meetings in order to gain a thorough understanding of the leadership of public health and the collaborations between public health and community leaders. As meetings arise pertaining to the three preceeding projects, the Fellow will produce agendas, action items, and other documentation necessary for the meetings. Throughout the year-long fellowship, the Fellow will participate in as many monthly OSPHP and HDHHS leadership meetings (as schedules allow). Throughout the year-long fellowship, the Fellow will participate in meetings (as they arise) between the HDHHS/OSPHP and external organization leaders, such as leaders from healthcare, community-based, and non-profit organizations. Throughout the year-long fellowship, the Fellow will organize (under the guidance of mentors) any meetings with internal and external leadership necessary for and pertaining to the previous three projects and activities. The partnerships with Rice University, Harris Health, and other Houston organizations will be crucial in this activity, as it will require collaboration between the leadership of the HDHHS/OSPHP and the leadership of these organizations.