Spatial Health Assessment Research Program (SHARP)
SHARP provides assistance to a variety of state and local public health agencies upon request. Read more about some recent SHARP projects below:
UNC CPHP Staff Conduct Hurricane Irene Evacuation Behavior Assessment in Beaufort County, North Carolina
On October 7-8, 2011, a team of staff, graduate research assistants and Team Epi-Aid volunteers from the University of North Carolina Center for Public Health Preparedness (UNC CPHP) traveled to Beaufort County, North Carolina, to conduct an assessment of evacuation behavior related to Hurriance Irene.
Hurricane Irene made landfall on the North Carolina coast on August 27, 2011. Though only a Category 1 storm, Hurricane Irene was 290 miles in breadth and caused massage damage due to 8-10 foot storm surges along the Pamlico Sound. In North Carolina alone, 38 counties were declared as major disaster zones on August 31, and more than $54 million in state and federal aid was approved to assist in the recovery process.
The UNC CPHP team traveled to Beaufort County, North Carolina—heavily impacted by Hurricane Irene—to assess evacuation behavior in relation to perceived flood and hazard risk. In preparation for Hurricane Irene, a mandatory evacuation order was enacted for those residents living in low-lying flood-prone areas, while a voluntary evacuation order was in place for all of Beaufort County.
The team sampled residents living within and outside of the 100-year floodplain. The data collection process employed a stratified two-stage random cluster sample methodology. Handheld global positioning system (GPS) units were used to navigate the area, to randomly select survey sites, and to record survey responses.
The assessment yielded some insightful data in relation to evacuation behaviors. Only 35% of the 205 people surveyed correctly identified that their homes were under an evacuation order (either voluntary or mandatory) for Hurricane Irene. Of the 138 people living in a 100-year floodplain, just 37% knew that they were under an evacuation order of any kind, and only 19 residents (14%) knew that they were under a mandatory evacuation order.
Just 28% of the 205 residents surveyed said they evacuated for Hurricane Irene. Of the 72 homes who knew that they were under some type of evacuation order, only 29% evacuated. Assessment results seemed to suggest that knowing about an evacuation order made no difference in a family’s decision to leave their home in preparation for Hurricane Irene.
Even among people who believed that they were at a high risk of flooding, only 39% evacuated. Responses showed an association between perceived risk of flooding and evacuation: those who felt they were at low risk of flooding evacuated the least (24%), while those who felt they had a medium risk evacuated more often than the low risk group but less often than the high risk group (27%).
SHARP Assists with Forsyth County Community Health Survey
Responding to a request for technical assistance and training, the UNC CPHP Spatial Health Assessment and Research Program (SHARP) assisted the Forsyth County Department of Public Health and the Forsyth County Healthy Community Coalition with conducting a community health opinion survey March 31-April 2, 2011.
SHARP staff trained 21 Forsyth County employees, 18 public health students, and other volunteers in survey methodology using handheld GPS units and mobile GIS technology. SHARP staff programmed a digital version of a community health opinion survey recently developed by Healthy Carolinians and provided assistance with digital form design to enable capture of survey results on handheld GPS units.
SHARP provided technical assistance in selecting survey sites using a Survey Site Selection Toolkit developed in collaboration with the North Carolina Division of Public Health and North Carolina Public Health Regional Surveillance Team 5 as part of a public health preparedness community surveying process known as "CASPER" (Community Assessment for Public Health Emergency Response). SHARP staff also provided assistance with field map creation, on-site support and data processing.
The 39 data collectors gathered 231 surveys over 3 days, with a a response rate of 60%. Data collected indicated that just over 20% of respondents felt that low income and poverty was the 1 issue that most affected the quality the life in Forsyth County. Similarly, 20% reported that the availability of employment was the service that needed to be improved the most in their community. When asked which 1 behavior their community needed more information about, answers varied significantly: just over 10% felt their community could use more information about how to prepare for an emergency or disaster, and 8% cited weight management or substance abuse prevention.
Forsyth County will use the information gathered from this survey--along with the results of a recent Youth Risk Behavior Survey, focus groups, and stakeholder interviews--to assist in setting priorities to address major community health issues for the next 4 years.
SHARP will share the digital survey form of the Healthy Carolinians survey developed during this activity with other North Carolina counties. SHARP will be assisting the Granville-Vance Health District with their 2011 Community Health Assessment in June. For more information about the CASPER toolkit or the digital community health survey, please contact SHARPgis@unc.edu.
UNC CPHP Conducts Survey of KI Distribution Around Local Nuclear Power Plant
In September 2010, SHARP assisted with a household survey of potassium iodide (KI) distribution within the 10-mile emergency planning zone (EPZ) around the Shearon Harris nuclear power plant, located 22 miles southwest of Raleigh, NC. In May 2010, KI was made available free of charge to all residents of the 10-mile EPZ, which consists of residents of Wake, Chatham, Harnett, and Lee counties in North Carolina. KI has been shown to protect the thyroid gland in the event that an individual is exposed to radioactive iodine during a nuclear emergency.
Over a 3-day period, UNC CPHP staff, along with volunteers from local health departments and Team Epi-Aid, approached 475 households across 30 census blocks and completed 177 interviews with residents of the EPZ. Volunteers asked residents a series of questions assessing their receipt of KI, knowledge and beliefs about KI, and effectiveness of public health messaging about the May 2010 distribution. From extrapolations of the interview data, most EPZ households do not have KI nor are they knowledgeable about how KI may be used during a nuclear emergency.
These and other findings are being prepared to be presented to local Preparedness Coordinators, regional surveillance teams, the Shearon Harris Task Force, and at the 2011 NACCHO Preparedness Summit. These results will be used by Shearon Harris and local health departments to improve future KI distribution and education campaigns. This project was supported by the North Carolina Division of Public Health.
SHARP assists with Durham County Community Health Assessment
Durham County public health officials and the Partnership for a Healthy Durham recently teamed up with NCCPHP’s Spatial Health Assessment and Research Program (SHARP) to conduct the 2011 Community Health Assessment for Durham County. This assessment will help guide strategic public health planning and offered an opportunity for Durham County residents to share their thoughts on the community’s most pressing health needs.
SHARP provided geographic information systems (GIS) and global positioning system (GPS) technical assistance to the Durham County Health Department in conducting the 2-stage cluster sample by designing a digital survey instrument, mapping potential survey sites, creating field maps, and providing on-site training and technical assistance to survey volunteers and staff.
Public health staff and volunteers completed 206 door-to-door surveys June 18-21, 2010, using handheld GPS units supplied by NCCPHP to navigate to pre-determined survey locations and collect the survey responses. Some of the questions asked during the survey included identifying the major health problems in the community and the county, access to healthcare, emergency preparedness, and personal demographics.
Durham County’s 8 current health priorities include access to healthcare, adolescent pregnancy, HIV/STDs, infant mortality, injury prevention, mental health, obesity and chronic illness, and substance abuse. Durham County public health agencies plan to analyze survey results over the next year and release a comprehensive report to the community in early 2012. A public community health forum meeting will follow. At that time, community residents, local leaders, and elected officials will have an opportunity to assist in setting the community health priorities to address major community health issues for the following 4 years.
NCCPHP Conducts Needs Assessment with Women Affected By Recent Georgia Floods
Over 3 days in late October, NCCPHP conducted a reproductive health assessment in 2 counties in Georgia affected by recent flooding. The goal of the assessment was to interview women between the ages of 18 and 44 in the community to determine whether the flooding had led to any problems such as trouble accessing prenatal care or contraceptives, increases in stress, or loss of health insurance.
Staff from NCCPHP, the Cobb-Douglas (Ga) Health District and the Centers for Disease Control and Prevention (CDC) were joined by 20 students from Team Epi-Aid, the UNC Gillings School of Global Health’s volunteer surge capacity group and 12 members of Emory’s Student Outbreak Response Team (SORT). This is the first time that members of Team Epi-Aid have worked with a volunteer team from another school of public health.
Seventy-three interviews were completed during the 3-day project. Fourteen of the women interviewed were either currently pregnant or less than 6 months postpartum, a target group for the assessment. Women surveyed reported flood-related income losses, displacement from their homes due to flooding, and high levels of family-related stress.
Information from this pilot assessment will inform development of a CDC toolkit for use by public health agencies in disaster settings to guide future policy and/or interventions in order to ensure that public health disaster preparedness measures are inclusive of the specific needs of pregnant and postpartum women, in addition to all women of reproductive age.
NCCPHP Assists with Survey of Community Attitudes Toward Influenza Vaccines
NCCPHP recently received funding from the Robert Wood Johnson Foundation to carry out a rapid needs assessment in collaboration with the North Carolina Division of Public Health (NCDPH) to provide evidence-based information on community attitudes towards influenza vaccination in light of concerns about the potential impact of novel influenza A (H1N1) during the fall 2009 flu season.
Over 2 days in mid-August, staff from NCCPHP and its Team Epi-Aid student volunteer group, NCDPH, and the health departments of Orange and Alamance counties, surveyed 207 community members in the 2 counties.
The survey indicated that most people received information about H1N1 from television. A high number of respondents (80%) knew about the H1N1 vaccine, but only 36% were aware of a potential requirement for 2 doses. Approximately 64% of respondents intended to get vaccinated for seasonal and H1N1 influenza. Of those persons surveyed who had children, 61% planned to vaccinate their children. For young adults, just half intended to receive vaccine. Interestingly, for those who did not plan to get vaccinated, reasons cited were perceptions that H1N1 is not a severe illness or that vaccination might be ineffective in preventing infection.
The information from this community-based assessment will be shared with local and state health officials across the country to assist in planning for H1N1 vaccine campaigns this fall. Although this survey suggests that people are aware of and intend to receive H1N1 vaccine, health departments may still need to target persons in identified high-priority groups.