0 - Environ PH Trckg 2023 Revision SSB

This information collection (IC) does not use any statistical methods to select respondents because all funded state and local health departments (SLHD) recipients submit data as available. This program is authorized under Sections 311 and 317(k) (2) of the Public Health Service Act, [42 U.S.C. Sections 243 and 247b(k)(2)], as amended (see Attachment 1). Funded recipients are required to submit applications and financial reporting.

The sections below describe how the data will be collected. The Tracking Program collects two types of data from funded state and local health departments (SLHD) recipients, under Program Announcement CDC-RFA-EH22-2202 (Attachment 3). The first type is referred to as “Tracking Network Data” and includes data from existing health outcome, exposure, and environmental hazard databases within the recipients’ jurisdiction. The second type is referred to as “Program Data” and includes information provided by the recipients about their program operations such as performance measures, communications plans, and work plans.

Tracking Network Data from unfunded state and local health departments are accepted but not requested.

B.1. Respondent Universe and Sampling Methods

No respondent sampling methods are used. The respondent universe is comprised of funded SLHD that submit Tracking Network and Program Data to the Tracking Program. The emphasis of this IC is on data that the Tracking Program collects from our current 33 funded SLHD. The Tracking program previously funded 26 recipients in 2021. This includes the 7 datasets and metadata listed in this section. We recognize that these data are not nationally representative; rather, our objective with these data is to provide information that can be used by state and local public health practitioners to gain insight on issues that are present at the state and local levels; can inform regional or multi-state public health actions; and can contribute to the evidence available for national public health actions. Additionally, the Tracking Network also includes national-level data that are relevant to environmental health. These data are collected in collaboration with other federal programs and, where appropriate, we indicate that the data are nationally representative.

For all data, we provide detailed information on the measures in several locations. On our main webpage, we provide a link to information for each indicator, “Indicators and Data”, that brings the user to the indicator documentation: https://ephtracking.cdc.gov/showIndicatorPages.

Information is provided:

Data sources
Data and measure limitations
How measures are calculated
Geographic and temporal scale
Geographic and temporal scope
How data should be interpreted

On the data explorer tool, we provide information on the specific data queried via a box in the display window: “About these data” https://ephtracking.cdc.gov/DataExplorer/. The information in “About these data” include:

Footnotes (key information about data source, nature of data, limitations, any data suppression, etc.)
Treatment of blanks or missing data
Stability information (e.g., how unstable data are displayed and should be treated)
Links to the indicator documentation
Data source descriptions
How data should be cited
Why data set was created
How data set was created (e.g., derivation of measure)
Limitations of data set
How data should be used (any use constraints)
Link to metadata records

Each dataset, including individual SLHD data, has a metadata record. This record contains the most detailed information about the how the data were collected and the original data source. Metadata records are connected to the “About these data” on the data explorer tool and also available to search on the main webpage through “Indicators and Data”.

Tracking Network Data

All data used in the Tracking Network are gathered and collected by other federal and state programs. The Tracking Program receives data from its recipients from these existing data:

Attachment 4A - Birth defects prevalence
Attachment 4B - Childhood lead blood levels
Attachment 4C - Drinking water monitoring
Attachment 4D - Emergency department visits
Attachment 4E - Hospitalizations
Attachment 4F - Radon testing
Attachment 4G - Biomonitoring
Attachment 4H - Metadata records

Program Data

The Tracking Program also collects information from its recipients in order to evaluate and monitor the effectiveness of each recipient and the Tracking Program overall. Information collected includes:

Attachment 5A - Work Plan Template
Attachment 5B - Work Plan REDCap Form – non collection
Attachment 5C - Program Accomplishments-Public Health Actions
Attachment 5D - Program Accomplishments-Public Health Actions – (REDCap Form)
Attachment 5E - Performance Measures Report
Attachment 5F - Performance Measures (REDCap Form)
Attachment 5G - PHA Impact Follow Up - (REDCap Form)
Attachment 5H - Communication Plan Template
Attachment 5I - Web Stats Template

Each jurisdiction funded by the Tracking Program receives a template or guidance for each item reported.

B.2. Procedures for the Collection of Information

Tracking Network Data

In collaboration with SLHD and federal partners, the Tracking Program identifies priority environmental health issues and evaluates the utility and quality of existing data for informing or addressing that issue. When data are available nationally or publicly (for example, through another federal program or a public website), the Tracking Program obtains data from those national or public sources, placing no burden on recipients or other SLHD. When data are not available nationally or publicly, the Tracking Program relies on recipients or unsolicited, volunteer SLHD to obtain these data from the original data stewards and submit them to the National Tracking Network.

Data from recipients or other SLHD are submitted once a year in a standardized XML format to CDC using a secure web-based file transfer system during either a fall or spring data call. Recipients receive a notification letter 60 days prior to the data call which describes the data requested. Standardized extraction, formatting, and submission processes are developed in collaboration between CDC and recipients for each dataset. Guidance documentation with step-by-step instructions for extracting and formatting the data are provided. Each recipient works with the data owners in their respective jurisdictions to extract the necessary data elements from existing electronic data systems and format the data for submission. Tracking branch data management processes are detailed in Attachment 10.

Additions or modifications to these standardized datasets are also developed collaboratively as needed to improve the accuracy, completeness, efficiency, or utility of data submitted to CDC. Such changes occur at most once a year. Examples of these changes to data processes include (1) addition of new variables or outcomes, (2) updates to case definitions, (3) modifications to temporal or spatial aggregation, and (4) changes in formatting for submission. Datasets have been established in such a way that most changes are not difficult to implement, involving only modifications to existing code or scripts for extracting, processing, and submitting the data. As required, the Tracking Network will submit future additions and modifications as nonsubstantive change requests.

Tracking Network data submitted annually by recipients and other SLHD to the Tracking Program include (1) birth defects prevalence, (2) childhood lead blood levels,¹ (3) drinking water monitoring, (4) emergency department visits, (5) hospitalizations, (6) radon testing, and (7) biomonitoring. These seven datasets are the only Tracking Network data currently provided by SLHD to Tracking. All other datasets are provided by national partners as described in attachment 10. Each dataset contains aggregated data at the county or sub-county level and either day, month, or year as the temporal resolution. The data collection forms are Attachments 4A-4H of this document. A metadata record, a file describing the original source and collection procedures for the data being submitted, is also submitted with each Tracking Network data using the Tracking Program’s metadata creation tool. A blank metadata template can be found in Attachment 4H.

Once data are received, they are validated by the Tracking Program to ensure accuracy and completeness. Data are then aggregated and analyzed to generate measures such as rates and percents. Any small numbers are suppressed to protect confidentiality and unstable rates are flagged. Suppression rules are established in collaboration with SLHD and data stewards. Relative standard errors (RSEs) greater than or equal to 30% are flagged as unstable. More information can be found in the Technical Notes: https://ephtracking.cdc.gov/showTechnicalNotes and in Tracking Program’s data re-release plan: http://ephtracking.cdc.gov/showLibrary. Measures and corresponding metadata are then integrated into the Tracking Network and disseminated to the public via the Tracking Network’s National Public Portal at http://ephtracking.cdc.gov. On average, the time from data submission to measure dissemination is 4 to 6 months. Tracking Program staff also analyze the data to advance the science of environmental public health tracking.

Program Data

In addition to standard reporting required by CDC’s Office of Grants Services (OGS), CDC’s Tracking Program also collects information from recipients for the purposes of program evaluation and monitoring. Data collection forms are provided to assist recipients in gathering the necessary information (Attachments 5A-5I). Each of these forms are collected at varying intervals throughout the year, from once a year to quarterly. Less frequent collection of these performance measures would negatively impact the program’s ability to make necessary adjustments to ensure program success; demonstrate utility of data; to document program impact on environmental-related disease burden; and to be accountable to CDC leadership and appropriators.

The Tracking Program will utilize an electronic data capture system (EDCS) to collect information from the CDC-RFA-EH22-2202 recipients. The EDCS provides an innovative and collaborative approach to address data quality and reduce burden hours and costs. REDCap is an example of an EDCS. REDCap is an easy-to-use, free software tool useful for programmatic deliverable management and data capture. Included in this package are 5 forms utilizing CDC’s REDCap platform to capture programmatic data for NOFO No. CDC-RFA-EH22-2202.

B.3. Methods to Maximize Response Rates and Deal with No Response

Tracking Network Data

The data used by the Tracking Program are administrative, registry, or regulatory monitoring data collected by other programs. Response rate does not apply as data from this collection are not intended to be generalizable or nationally representative. Twenty-six funded SLHDs provided both Tracking Network data and program data to the Tracking Program as part of their cooperative agreement. In some cases, one or more of the funded 26 SLHDs did not respond to one or more form because data were not available; for example, their state does not have a birth defects registry. Additionally, a few unfunded SLHD have responded, unsolicited, because of their interest in having their data in the Tracking Network. In this ICR, we are increasing the number of recipients from 26 to 33 SLHDs.

Program Data

We request the program data items from each funded SLHD. If a recipient hasn’t provided necessary information, we will send them email reminders until they do.

B.4. Test of Procedures or Methods to be Undertaken

Tracking Network Data

A major function of the Tracking Network is to compile a core set of nationally consistent health and environmental data and measures (NCDMs). The NCDMs have been developed or adopted for the Tracking Network through collaboration with partners and data stewards at the national, state, and local levels (Attachment 9). The process of developing an NCDM involves defining the environmental public health question, reviewing the applicability and limitations of existing data, drafting guidelines for creating the NCDM, piloting the creation of the NCDM, and then finalizing the NCDM guidelines and documentation.

Once established, the creation of NCDM begins by extracting the correct data from an existing data source. SLHD extract the necessary data and format the data for submission to the Tracking Program. The Tracking Program then uses the data, as well as data provided by national partners, to calculate the NCDM measures for the public portal. These measures are the tabulation of data into summary statistics such as count, rate (both crude and age adjusted), percent, or concentration over geography and time.

In addition to creating measures for the National Public Portal, the Tracking Program frequently conducts descriptive and trend analyses using methods various statistical tests and regression modeling techniques. The method chosen for each analysis depends on the research question and the available data. Tracking Program staff use the data to conduct analyses that:

Assess temporal and spatial trends in health, exposure, and environmental hazards
Monitor known or suspected associations between health and environment
Generate hypotheses about the association between health and environment
Develop and test new methods and tools for surveillance
Facilitate and conduct surveillance summaries and descriptive analyses

Data received during the past three years

Data form	Fall 2019	Fall 2020	Fall 2021
Birth defects prevalence	19 recipients	18 recipients	17 recipients
Emergency department visits	22 recipients	22 recipients, 1SLHD	24 recipients, 1 SLHD
Hospitalizations	25 recipients, 1 SLHD	24 recipients, 1 SLHD	25 recipients, 2 SLHD
Metadata	25 recipients, 1 SLHD	25 recipients, 1 SLHD	25 recipients, 2 SLHD
Data Form	Spring 2019	Spring 2020	Spring 2021
Drinking water monitoring	24 recipients, 1 SLHD	13 recipients, 1 SLHD	24 recipients, 1 SLHD
Childhood lead blood levels	0 recipients	0 recipients	0 recipients
Radon	7 recipients	8 recipients	10 recipients, 1 SLHD
Metadata	25 recipients, 1 SLHD	24 recipients	25 recipients, 1 SLHD

Program Data

The Environmental Public Health Tracking Work Plan Template (Attachment 5A) and the Program Accomplishments-Public Health Actions Report (Attachment 5C) were developed in-house with funded SLHD review and feedback. Over the last 3 years, all funded SLHD submitted an annual EPHT Work Plan, and have used the PA/PHA to submit over 600 Public Health Actions for review. The Performance Measure Report (Attachment 5E) was developed by the program with support from evaluation specialists and feedback from funded SLHD. One hundred percent of funded SLHD used this document to report their progress annually to CDC. The Communication Plan template was developed by the Tracking Program based on industry standards. All funded SLHD have submitted annual Communication Plans. Recommended web stats template (Attachment 5I) was developed in collaboration with funded SLHD. All funded SLHD have submitted an annual web stats template.

B.5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data

Tracking Network Data

Recipients or the data stewards will be extracting the data from their original database. Recipients will format and submit data to CDC. Recipients will be responsible for analyzing data within their jurisdiction.

Analysis and interpretation of the combined data will be conducted by the following CDC Tracking Program staff:

Table 1. Personnel Responsible for Analysis of Information - Tracking Network Data

Name	Title	Affiliation	Phone	Email
Fuyuen Yip	Branch Chief	CDC	770.488.3719	[email protected]
Patrick Wall	Section Chief (Acting)	CDC	770.488.3819	[email protected]
Michele Monti	Epidemiologist	CDC	770.488.3994	[email protected]
Gonza Namulanda	Associated Service Fellow	CDC	770.488.3831	[email protected]
Mikyong Shin	Senior Service Fellow	CDC	770.488.7715	[email protected]
Emily Prezzato	Health Scientist	CDC	404.498.5521	[email protected]
Angela Werner	Team Lead	CDC	404.498.1693	[email protected]
Komal Peer	Prevention Effectiveness Fellow	CDC	404.498.0141	[email protected]
Nicholas Skaff	Senior Service Fellow	CDC	404.498.3285	[email protected]
Ryan Babadi	Prevention Effectiveness Fellow	CDC		[email protected]
Mitra Kashani	ORISE Fellow	ORISE	404.718.3527	[email protected]
Aaron Vinson	Health Scientist (contractor)	Hite Consulting	404.498.2373	[email protected]
TJ Pierce	Health Scientist (contractor)	Hite Consulting	404.498.3252	[email protected]
Mackenzie Malone	Data Mgt	CDC	770.488.1465	[email protected]

Program Data

Funded SLHD collect relevant data, complete the corresponding templates, and submit them to CDC. Recipients will be responsible for analyzing data within their jurisdiction.

Table 2. Personnel Responsible for Analysis of Information - Program Data

Name	Title	Affiliation	Phone	Email
Fuyuen Yip	Branch Chief	CDC	770.488.3719	[email protected]
Patrick Wall	Section Chief (Acting)	CDC	770.488.3827	[email protected]
Joe Ralph	Team Lead	CDC	770.488.0539	[email protected]
Chad Curtiss	ORISE Fellow	CDC	404-639-1819	[email protected]
Shannon Dewitt	Team Lead (Acting)	CDC	770.488.3819	[email protected]
Holly Wilson	Health Communication Specialist	CDC	770.488.3841	[email protected]
Preston Burt	Health Communication Specialist	CDC	770.488.3820	[email protected]
Jena Anna Losch	Health Communication Specialist	CDC	770.488.3834	[email protected]
Ann Ussery-Hall	Public Health Advisor	CDC	404.498.3861	[email protected]
Erica Barton	ORISE Fellow	CDC		[email protected]
Robert Kennedy	Public Health Advisor	CDC	770.488.3840	[email protected]
Brandon Rohrig	Public Health Advisor	CDC	404.718.1312	[email protected]
Aaron Grober	Public Health Advisor	CDC	770.488.0787	[email protected]
Kristin LaBar	Public Health Advisor	CDC	404.639.7743	[email protected]

1 Collected from recipients that do not already report to CDC’s Lead Poisoning Program (under the Blood Lead Surveillance System (BLSS) - OMB Control No. 0920-0931, expiration date 7/31/2024]).

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0 - Environ PH Trckg 2023 Revision SSB