Community Assessment for Public Health Emergency Response (CASPER):

Role of the Epidemiologist

Health Studies Branch, National Center for Environmental HealthDivision of Environmental Hazards and Health Effects

LCDR Sara J. Vagi, PhDU.S. Public Health Service

CASPER Definition Epidemiologic technique designed to

provide quickly and at low cost, household-based information about an affected community’s needs after a disaster in a simple format to decision-makers.

Critical Post-Disaster Needs Water Food Shelter Sanitation Medicine

Solid Waste Electric Power Heat Transportation Communicatio

n

Goals of CASPER Determine the general

and health needs of the community

Produce population- based estimates for decision-makers

Inform response efforts and planning for future disasters

CASPER Methodology Multi-stage probability sample

30 clusters (census blocks) 7 households

Questionnaire development Household-interview Data weighted to obtain population

estimates Report generated within a day or two of

data collection Report shared with partners in response

and recovery efforts

Use of CASPER Man-Made

Deepwater Horizon Gulf Coast Oil Spill, 2010 Hurricanes

Hurricane Ike, Galveston, TX, 2008 Hurricane Katrina, New Orleans, 2005 Hurricanes Charley & Ivan, Florida, 2004 Hurricane Isabel, North Carolina, 2003 Hurricane Andrew, Florida and Louisiana, 1992

Earthquakes/Tsunamis American Samoa, 2009 Izmit, Turkey, 1998

Ice storms Kentucky, 2009 Maine, 1998

Volcanic activity Mexico, 1998

CASPER phases

Prepare for the CASPER Determine objectives Determine assessment area Develop questions and create questionnaires

Conduct the CASPER Select sample Organize and train assessment teams Conduct household interviews

Analyze the data Determine sampling weight Calculate weighted frequencies and percentages

Write the report and share results

The role of the epidemiologist is to bring sound epidemiologic principles and practices into all phases of the

CASPER!

The Preparation Phase

Prepare for the CASPER Determine objectives

• Not always the role of the epi• But epi must see that the appropriate tool is being used to

meet the objectives

Determine assessment area • How do we define the “affected” or “exposed”?• Assumption: All households in sampling frame are similarly

affected

Develop questions and create questionnaires• Household-based • Action-oriented data

Map of sampled area

The Preparation Phase

Prepare for the CASPER Determine objectives

• Not always the role of the epi• But epi must see that the appropriate tool is being used to

meet the objectives

Determine assessment area • How do we define the “affected” or “exposed”?• Assumption: All households in sampling frame are similarly

affected

Develop questions and create questionnaires• Household-based • Action-oriented data• Pilot

Conducting the survey

Conduct the CASPER Select sample

• Obtaining an adequate sample size (n=210)• Avoiding the convenience sample

Organize and train assessment teams

Conduct household interviews• Reducing interviewer bias

Balancing the ideal with the real world situation

Response Rates, Kentucky ice storm

Area I Area II Area III

Area IV

Completed interviews (n)

176 187 190 189

Completion Rate 83.8% 89.1% 90.5% 90.0%Cooperation Rate 95.1% 97.9% 96.9% 95.4%Contact Rate 52.8% 54.4% 62.9% 48.9%

Final phases

Analyze the data Determine sampling weight Calculate weighted frequencies and percentages

Write the report This begins in the preparation phase Know your data and its limitations

Conclusions

Planning early for later steps “Start with your table shells!”

Maintaining sound epidemiology

Balancing the ideal with the real-world situation

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you

National Center for Environmental HealthDivision of Environmental Hazards and Health Effects