Survey of state health agencies' staff who practice the epidemiology of noninfectious diseases and conditions.

The primary causes of mortality in the United States are noninfectious diseases and conditions. Epidemiologic and intervention activities related to most of these diseases and conditions have increased in most State health agencies over the past decade. Because little was known of the practice of noninfectious disease epidemiology in State health agencies, a mail survey was undertaken in 1991. Persons working in State health agencies who responded to the survey had a graduate degree in epidemiology, biostatistics, or related fields and actively participated in the epidemiology of noninfectious diseases or conditions. Respondents were from 48 States, predominantly male (56 percent) and white (92 percent). On an average, respondents spent roughly half of their time actually doing epidemiology. The focus of noninfectious disease epidemiology has been categorized by risk factors (environment, occupation, nutrition, tobacco, and substance abuse), diseases (diabetes, cancer, and cardiovascular disease), and health conditions (injury, birth defects, and other reproductive conditions). The percentage of respondents who reported epidemiologic activity in any risk factor, disease, or condition varied from 55 percent for environmental epidemiology to 9 percent in nutritional epidemiology. Respondents from 41 States reported activity in environmental epidemiology, those from 18 States reported activity in substance-abuse epidemiology, and those from 13 States reported activity in nutritional epidemiology. Although the practice of noninfectious disease epidemiology appears to be considered important in the majority of States, the extent of practice varies markedly. Those risk factors, diseases, and conditions that are most frequently associated with morbidity and mortality are the least addressed epidemiologically in State health agencies. In addition,when events such as environmental disasters occur, appropriate surveillance systems frequently are not in place to monitor the most important health outcomes. As a result, public health planning and intervention programs may not be driven by solid epidemiologic data.