Centers for Disease Control and Prevention Global Health Odyssey Museum Tom Harkin Global Communications Center June 7-11, 2010 Teach Epidemiology Professional

Centers for Disease Control and PreventionGlobal Health Odyssey Museum

Tom Harkin Global Communications Center June 7-11, 2010

Teach EpidemiologyProfessional Development Workshop

Day4

2

3Teach Epidemiology

Teach Epidemiology

4Teach Epidemiology

Enduring Epidemiological Understandings

5Teach Epidemiology


6

7

Laboratory

Teach Epidemiology

Making Group Comparisons and Identifying Associations

8

Laboratory

Teach Epidemiology


9

Naturally occurring circumstances in which groups of people within a population have been exposed to different levels of the hypothesized cause of an

outcome.

Natural Experiment

Teach Epidemiology


10

An epidemiologic study of a natural experiment in which the investigator is not involved in the intervention other than to record, classify, count,

and statistically analyze results.

Observational Study

Teach Epidemiology


11

An epidemiologic experiment in which subjects are assigned into groups to receive or not receive

a hypothesized beneficial intervention.

Controlled Trial

Teach Epidemiology


12

Buprenorphine

Buprenorphine will stop heroin addicts from using heroin.

Teach Epidemiology


13

Naturally occurring circumstances in which groups of people within a population have been exposed to different levels of the hypothesized cause of an

outcome.

Observational Study of a Natural Experiment

Epidemiologic studies of natural experiments in which the investigator is not involved in the

intervention other than to record, classify, count, and statistically analyze results.

Teach Epidemiology


14


Teach Epidemiology

15


Teach Epidemiology

16

Stephen Jay Gould (survivor of abdominal mesothelioma)

Absolutely nothing in the available arsenal of anti-emetics worked at all. I was miserable and came to dread the frequent treatments with an almost perverse intensity. I had heard that marijuana often worked well against nausea. I was reluctant to try it because I had never smoked any substance habitually (and didn’t even know how to inhale). Moreover, I had tried marijuana twice (in the 1960s) … and had hated it …. Marijuana worked like a charm …. The sheer bliss of not experiencing nausea - and not having to fear it for all the days intervening between treatments - was the greatest boost I received in all my year of treatment, and surely the most important effect upon my eventual cure.


Teach Epidemiology

17

A particular or detached incident or fact of an interesting nature; a biographical incident or

fragment; a single passage of private life.

Anecdote


Teach Epidemiology

18

Science

Transforming Anecdote to Science


Teach Epidemiology

Anecdote

19

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

Random Assignment

E

DZ

DZ

DZ

DZ

Controlled Trial

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Cohort Study

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Case-Control Study

-

DZ

DZ

E

E

E

E

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Cross-Sectional Study

-

E

E

DZ

DZ


Teach Epidemiology

20

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

Random Assignment

E

DZ

DZ

DZ

DZ

Controlled Trial

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Cohort Study

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Case-Control Study

-

DZ

DZ

E

E

E

E

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


-

E

E

DZ

DZ

d

b

c

a


Teach Epidemiology

The goal of every epidemiological study is to harvest valid and precise information about the

relationship between an exposure and a disease in a population.

The various study designs merely represent different ways of harvesting this information.

Essentials in Epidemiology in Public HealthAnn Aschengrau and George R. Seage III


Teach Epidemiology

22

23

24

25

Time Check

8:15 AM

26

27Teach Epidemiology

Teach Epidemiology

The Journey

The Journey

Detectives in the Classroom - Investigation 2-6: The Journey

Analogy


Epi Talk

Study Design Epi Talk

Procedures and methods, established beforehand, that are followed by the investigator conducting the study.


Timing

When are the passengers identified as exposed or unexposed?

E

When are the passengers identified as sick or not sick?

DZ

Timing

When does the epidemiologist start to observe the journey?

-


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

E DZ

Label the Train Tracks

-


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Study Design:

E DZ


-

Controlled Trial


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

Controlled

Trial

Flow Diagram

Flow Diagram

-

Healthy People

E

Random Assignment

E

DZ

DZ

DZ

DZ


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Study Design:


Cohort Study


Cohort Study

Just as in the controlled trial, the epidemiologist is also on the train during the entire journey. But there is an important difference. The epidemiologist is not telling passengers what to do. Rather, the epidemiologist is just observing them and counting. Passengers are not being told to have or not have an exposure, they are just living their normal lives. The epidemiologist, on the ride for the whole journey, just keeps observing everyone’s exposures and whether or not they develop the disease during the journey.



Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

E DZ


-

Study Design: Cohort Study


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

Cohort

Study

Flow Diagram

Flow Diagram

-

Healthy People

E

E

DZ

DZ

DZ

DZ


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

Cohort

Study

Flow Diagram

Flow Diagram

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Controlled

Trial


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

Cohort

Study

Flow Diagram

Flow Diagram

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Controlled

Trial

Random Assignment


Review

Observational StudiesEpi Talk

Epidemiologic studies of natural experiments in which the investigator is not involved in the intervention other than to record, classify, count, and statistically analyze results.


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Study Design: Case-Control Study


The epidemiologist is not on the journey. Rather, the epidemiologist is waiting at the train station at the end of the journey. As passengers get off the train, the epidemiologist selects sick passengers for the case group and selects passengers who are similar but not sick for the control group. The epidemiologist then asks each person in the case group and control group questions about their exposures during the train ride. The epidemiologist relies on passengers’ memories of their exposures that occurred during the train ride.


Case-Control Study


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

E

DZ


-

Study Design: Case-Control Study


Case-Control

Study

Observational

Study

Flow Diagram

Flow Diagram

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

DZ

-

DZ

E

E

E

E


Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Study Design: Cross-Sectional Study


The epidemiologist, who has not been on the journey, stops the train somewhere during the trip (kind of like a train robbery) and takes a “snapshot” of all the passengers by asking them whether or not they have the exposure and whether or not they have the disease. Then the epidemiologist leaves the train and goes home to analyze the data from that particular day. The journey continues without the epidemiologist.




EDZ

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


-

Study Design: Cross-Sectional Study


Cross-Sectional

Study

Observational

Study

Flow Diagram

Flow Diagram

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

E

E

-

DZ

DZ


Epi Talk

Controlled TrialEpi Talk

An epidemiologic experiment in which subjects are assigned into groups to receive or not receive a hypothesized beneficial intervention.


Epi Talk

Cohort StudyEpi Talk

An analytical epidemiological study design in which the investigator selects a group of exposed individuals and a group of unexposed individuals and follows both groups to compare the frequency with which the disease occurs in each group.


Epi Talk

Case-Control StudyEpi Talk

An analytical epidemiological study design in which the investigator selects a group of individuals with a disease (cases) and a group of similar individuals without the disease (controls) and compares the frequency with which an exposure occurred in the cases versus the controls.


Epi Talk

Cross-Sectional StudyEpi Talk

An analytical epidemiological study design in which the investigator selects a group of individuals and determines the presence or absence of a disease and the presence or absence of an exposure at the same time.


54

Epi Team Challenge

Epi Team ChallengeDetectives in the Classroom - Investigation 2-7: Epi Team Challenge

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

Random Assignment

E

DZ

DZ

DZ

DZ

Controlled Trial

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Healthy People

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Cohort Study

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

-

DZ

DZ

E

E

E

E

Case-Control Study

Time

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

-

E

E

DZ


DZ

What’s My Design?

Detectives in the Classroom - Investigation 2-7: Epi Team Challenge

Epidemiologist is involved during the entire time from exposure to disease.

Assign treatment and control groups.

Follow through time and compare risk of disease in treatment group with risk of disease in control group.

Give exposure to treatment group, but not control group.

What’s My Design?

Practice Clue

Trial



What’s My Design?

Clue 1

Begin Epi Team Challenge

Trial


Observational

Study

Flow Diagram

DZ

-

DZ

E

E

E

E

Clue 2

Case-Control Study

What’s My Design?


Observational

Study

Clue 3

What’s My Design?

Cohort, Case-Control, and Cross-Sectional Studies


Follow through time and compare risk of disease in exposed group with risk of disease in the unexposed group.

Clue 4

Trial and Cohort Study

What’s My Design?




Clue 5

Trial

What’s My Design?



Clue 6


What’s My Design?


Select a group of people with disease and a similar group of people without disease.

Clue 7

Case-Control Study

What’s My Design?


Healthy People

Flow Diagram

-

Healthy People

E

E

Random Assignment

Non-Observational

Study

Clue 8

Trial

What’s My Design?


Observational

Study

Flow Diagram

E

E

-

DZ

DZClue 9

Cross Sectional Study

What’s My Design?


Compare odds of exposure in the two groups.

Clue 10

Case-Control Study

What’s My Design?


Healthy People

Flow Diagram

-

Healthy People

E

E

DZ

DZ

DZ

DZRandom

Assignment

Clue 11

Trial

What’s My Design?


Flow Diagram

Clue 12


What’s My Design?


Flow Diagram

DZ

DZ

DZ

DZObservational

Study

Clue 13

Cohort Study

What’s My Design?


Ask each person about both exposure and disease at that point in time.

What’s My Design?

Clue 14



Ask both groups about their exposures in the past.

What’s My Design?

Clue 15

Case-Control Study


Healthy People

Flow Diagram

-

Healthy People

Random Assignment

Clue 16

Trial

What’s My Design?


Disease risk in exposed group is compared to disease risk in unexposed group.

Clue 17

Trial, Cohort Study, and Cross Sectional Study

What’s My Design?


Flow Diagram

E

E

-

DZ

DZClue 18


What’s My Design?


Select a healthy study sample.

Clue 19

Trial (?) and Cohort Study

What’s My Design?


Observe who has and has not been exposed.

Clue 20

Cohort and Cross-Sectional Studies

What’s My Design?


Clue 21


Trial

What’s My Design?


Healthy People

Flow Diagram

-

Healthy People

E

EObservational

Study

Clue 22

Cohort Study

What’s My Design?


Epidemiologist is involved after disease has occurred and relies on subjects’ memories

to gather information about exposure.

Clue 23

Case-Control Study

What’s My Design?


Select a study sample.

Clue 24

Trial, Cohort, Case-Control, and Cross Sectional Studies

What’s My Design?


Healthy People

Flow Diagram

-

Healthy People

E

E

DZ

DZ

DZ

DZObservational

Study

Clue 25

Cohort Study

What’s My Design?


Epidemiologist gathers data only at that one point in time.

Clue 26


What’s My Design?


Flow Diagram

DZ

DZ

DZ

DZ

Clue 27


What’s My Design?


Follow through time and compare risk of disease in exposed group to risk of disease in unexposed group.

Clue 28


What’s My Design?



Clue 29


What’s My Design?


Flow Diagram

E

E

DZ

DZClue 30


What’s My Design?


Flow Diagram

DZ

-

DZ

Clue 31

Case-Control Study

What’s My Design?


Ask each person about both exposure and disease at that point in time.

Epidemiologist gathers data only at that one point in time.

Disease risk in exposed group is compared to disease risk in unexposed group.

Select a study sample.

Clue 32


What’s My Design?


Epidemiologist is involved after disease has occurred and relies on subjects’ memories to gather information about exposure.

Select a group of people with disease and a similar group of people without disease.

Compare percent of exposed people in the two groups.

Ask both groups about their exposures in the past.

Case-Control Study

Clue 33

What’s My Design?



Select a healthy study sample.

Follow through time and compare risk of disease in exposed group to risk of disease in unexposed group.

Observe who has and has not been exposed.

Cohort Study

Clue 34

What’s My Design?






Trial

Clue 35

What’s My Design?


End Epi Team Challenge

What’s My Design?


Detectives in the Classroom - Investigation 2-8: Which Design Is Best?

Which Design

Is Best?

Which Design Is Best?


Case-Control Study

Cohort Study

Trial

Main WeaknessesMain StrengthsStudy Designs

1 5

62

3 7

84

Epi Team ChallengeEpi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Cross-Sectional

CohortCase-

Control Controlled

Trial




Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Which study design is the fastest?




Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming

Time Consuming

Which study designs are the most time consuming?

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming

Most Scientifically Sound

Which study design is the most scientifically sound?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming


Can Study Rare Diseases

Which study design is best for studying rare diseases?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming


Possible Time-Order Confusion



Which study designs do not identify the time order of exposure and disease?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming

Least Confidence in Findings





Which study design gives the least confidence in findings?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming



Best Measure of Exposure




Which study design provides the best measure of exposure?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Most Accurate Observational Study

Which study design is the most accurate observational study?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive


Which study design is the least expensive?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive

Unethical for Harmful Exposures


Which study design would be unethical for harmful

exposures?

Time Consuming

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive

Good Measure of Exposure

Which study design provides a good measure of exposure?


Time ConsumingUnethical for Harmful exposures

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive

Most Expensive

Most Expensive


Which study designs are the most expensive?



Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive

Relatively Less Expensive and Relatively Fast


Which study design is relatively less expensive and relatively fast?


Most Expensive

Most ExpensiveGood Measure of Exposure

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming







Least Expensive


Possible Error in Recalling Past Exposures


Which study design creates the possibility of error in recalling past exposures?


Most Expensive

Most ExpensiveGood Measure of Exposure

Epi Team Challenge



Case-Control Study

Cohort Study

Trial


1 5

62

3 7

84

Fastest

Time Consuming




Least Expensive


Possible Error in Recalling Exposures




Time Consuming

Unethical for Harmful exposuresMost Expensive

Most Expensive





It depends ….


It depends on ….

• Regulations

• Time urgency

• How much is known about the association

• Money

• Whether the exposure is believed to be beneficial


DZ DZ

E

E

db

ca

Flow Diagram 2x2 Table

Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables

&

“fit”

Designs, Diagrams, and Tables

Healthy People

-

Healthy People

E

E

DZ

DZ

DZ

DZ

DZ DZ

E

Ea

2x2 Table

Where do these people “fit” in the 2x2 table?

Flow Diagram

Controlled Trial

Healthy PeopleHealthy People

E

E

DZ

DZ

DZ

DZ

Random Assignment


DZ DZ

E

Eb



E

E

DZ

DZ

DZ

DZ

Random Assignment


Controlled Trial


DZ DZ

E

E

c

Flow Diagram 2x2 TableFlow Diagram


E

E

DZ

DZ

DZ

DZ

Random Assignment


Controlled Trial


DZ DZ

E

E

d

2x2 TableFlow Diagram


E

E

DZ

DZ

DZ

DZ

Random Assignment


Controlled Trial


DZ DZ

E

E

c


Where are these people in the flow diagram?

Cohort Study


E

E

DZ

DZ

DZ

DZ


DZ DZ

E

Ea

2x2 Table


Flow Diagram

Cohort Study

Healthy People

E

E

DZ

DZ

DZ

DZ

Healthy People


DZ DZ

E

E

d



Cohort Study

Healthy People

E

E

DZ

DZ

DZ

DZ

Healthy People


DZ DZ

E

Eb



Cohort Study

Healthy People

E

E

DZ

DZ

DZ

DZ

Healthy People


DZ DZ

E

Ea

Where do these

people go in the

2x2 table?

2x2 Table Flow Diagram

Case-Control Study

DZ

DZ

E

E

E

E


DZ DZ

E

E

c

Where do these

people go in the

2x2 table?

Flow Diagram2x2 Table

Case-Control Study

DZ

DZ

E

E

E

E


Flow Diagram

DZ DZ

E

E b

2x2 Table

Where do these

people go in the

2x2 table?

Case-Control Study

DZ

DZ

E

E

E

E


Flow Diagram

DZ DZ

E

E

d

2x2 Table

Where do these

people go in the

2x2 table?

Case-Control Study

DZ

DZ

E

E

E

E


DZ DZ

E

E aFlow Diagram

2x2 Table

Where do these

people go in the

2x2 table?


E

E

DZ

DZ


DZ DZ

E

E

c

Flow Diagram

2x2 Table

Where do these

people go in the

2x2 table?


E

E

DZ

DZ


DZ DZ

E

E

d

Flow Diagram

2x2 Table

Where do these

people go in the

2x2 table?


E

E

DZ

DZ


DZ DZ

E

Eb

Flow Diagram

2x2 Table

Where do these

people go in the

2x2 table?


E

E

DZ

DZ


132

National Research Council , Learning and Understanding

Teach Epidemiology


Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

The goal of every epidemiological study is to harvest valid and precise information about the

relationship between an exposure and a disease in a population.

The various study designs merely represent different ways of harvesting this information.

Essentials in Epidemiology in Public HealthAnn Aschengrau and George R. Seage III


Teach Epidemiology

134

135

Hypothesis

Total Risk Relative Risk

a b

c d

or %

or %Exposure Outcome

?Turned Up Together

Healthy People

-

Healthy People

E

E

DZ

DZ

DZ

DZ

Teach Epidemiology

Where are we?



Teach Epidemiology

Explaining Associations and Judging Causation

1. Cause

2. Confounding

3. Reverse Time Order

4. Chance

5. Bias

Teach Epidemiology


Coffee and Cancer of the Pancreas

139

140

Guilt or Innocence?Causal or Not Causal?

Does evidence from an aggregate of studies support a cause-effect relationship?

Teach Epidemiology


141

Sir Austin Bradford Hill “The Environment and Disease:

Association or Causation?” Proceedings of the Royal Society of Medicine

January 14, 1965

Teach Epidemiology


Handout

142

“In what circumstances can we pass from this observed association

to a verdict of causation?”

Teach Epidemiology


143

“Here then are nine different viewpoints from all of which we should study association

before we cry causation.”

Teach Epidemiology


Does evidence from an aggregate of studies support a cause-effect relationship?

1. What is the strength of the association between the risk factor and the disease?

2. Can a biological gradient be demonstrated?

3. Is the finding consistent? Has it been replicated by others in other places?

4. Have studies established that the risk factor precedes the disease?

5. Is the risk factor associated with one disease or many different diseases?

6. Is the new finding coherent with earlier knowledge about the risk factor and the m disease?

7. Are the implications of the observed findings biologically sensible?

8. Is there experimental evidence, in humans or animals, in which the disease has m been produced by controlled administration of the risk factor?

Teach Epidemiology


Handout

Teach Epidemiology


Timeline

Cohort Study

Randomized Controlled Trial

Timeline

Case-Control Study

Timeline


Timeline

E

E

O

O

O

O

E

E

E

E


E

Random Assignment

E

O

O

O

O


E

E

O

O

O

O

Teach Epidemiology


Teach Epidemiology


Handout

148

Stress causes ulcers.

Helicobacter pylori causes ulcers.

Teach Epidemiology


149

*

*

*

**

*

*

*

*

Teach Epidemiology




151

152

Epidemiology

Epidemiology

... the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems.

Leon Gordis, Epidemiology, 3rd Edition, Elsevier Saunders, 2004.

153

Outcome

If an association was causal, ….

Hypothesized Exposure XX

… and you avoided or eliminated the hypothesized cause, what would happen to the outcome?

causal, ….

?

Control of Health Problems

154

Outcome

If the association was found due to confounding, ….

Hypothesized Exposure

Unobserved Exposure

X… and you avoided or eliminated the hypothesized cause, what would

happen to the outcome?

?

found due to confounding, ….


155


Outcome

If an association was found due to reversed time-order, ….found due to reversed time order, ….



?


156

Outcome

If an association was found due to chance, ….


found due to chance, ….



?


157

Outcome

If an association was found due to bias, ….


?

found due to bias, ….




158

Outcome

If an association was causal, ….

Hypothesized Exposure XX

… and you avoided or eliminated the hypothesized cause, what would happen to the outcome?

causal, ….



159

1. Cause

2. Confounding


4. Chance

5. Bias



160

Suicide Higher in Areas with Guns

Family Meals Are Good for Mental Health

Lack of High School Diploma Tied to US Death

Rate

Study Links

Spanking to

Aggression

Study Concludes: Movies Influence

Youth Smoking

Study Links Iron

Deficiency to Math

Scores

Kids Who Watch R-Rated Movies More Likely to Drink, Smoke

Pollution Linked with Birth Defects in US Study

1. Cause

2. Confounding


4. Chance

5. Bias

Snacks Key to Kids’ TV- Linked Obesity: China

Study

Depressed Teens More

Likely to Smoke

Ties, Links, Relationships, and Associations



162

163

Time Check

9:45 AM

164


Teach Epidemiology

166

Time Check

10:15 AM

167


Teach Epidemiology

169

Time Check

10:30 AM

170


Teach Epidemiology

172

Time Check

11:00 AM

173


Teach Epidemiology

175

Time Check

11:30 AM

176


Teach Epidemiology

178

Time Check

12:30 PM

179


Teach Epidemiology


Teachers Team-Teaching Teachers (TTT)

Teach Existing Epidemiological Lessons (EL) (4 Groups)

Team leads other workshop participants in a portion of a selected existing epidemiological lesson.

TTTT

12EL



183

Time Check

1:00 PM

184


Teach Epidemiology

Teach Epidemiology




TTTT

13EL



188

Time Check

1:30 PM

189


Teach Epidemiology

Teach Epidemiology




TTTT

14EL



193

Time Check

2:00 PM

194


Teach Epidemiology

View a News Item from an Epidemiological Perspective (NI) (4 Groups)

Team leads other workshop participants in the analysis of a news item from an epidemiological perspective.

Teach Epidemiology


TTTT

15NI



198

Time Check

2:45 PM

199


Teach Epidemiology

201

Time Check

3:00 PM

202


Teach Epidemiology


Tours

205

Broadcast Studios

Teach Epidemiology

Tours

206

Emergency Operation Center

Teach Epidemiology

Tours

207

Time Check

4:00 PM

Documents

Centers for Disease Control and Prevention Global Health Odyssey Museum Tom Harkin Global Communications Center June 7-11, 2010 Teach Epidemiology Professional