Title: Centers for Disease Control and Prevention Global Health Odyssey Museum Tom Harkin Global Communications Center June 6-10, 2011
1Day 2
Teach Epidemiology
Professional Development Workshop
Centers for Disease Control and PreventionGlobal
Health Odyssey MuseumTom Harkin Global
Communications Center
June 6-10, 2011
2(No Transcript)
3Teach Epidemiology
Teach Epidemiology
4Time Check 815 AM
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6Teach Epidemiology
Teach Epidemiology
7Time Check 845 AM
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9Teach Epidemiology
Teach Epidemiology
10Teachers Team-Teaching Teachers (TTTT)
Existing Lesson Team leads other workshop
participants
in
a portion of a selected existing epidemiological
lesson.
Teach Epidemiology
11Epi Grades 6-12
Metacognition
They can then use that ability to think about
their own thinking to grasp
how other people might learn.
They know what
has to come first,
and they can
distinguish between foundational concepts
and elaborations or
illustrations of those ideas. They realize
where people are likely to face
difficulties developing
their own comprehension,
and
they can use that understanding
to
simplify and clarify complex topics for others,
tell the right story, or raise a powerfully
provocative question. Ken Bain, What the Best
College Teachers Do
Teach Epidemiology
12Enduring Epidemiological Understandings
Teach Epidemiology
13Time Check 930 AM
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15Teach Epidemiology
Teach Epidemiology
16Teachers 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.
Teach Epidemiology
17Epi Grades 6-12
Metacognition
They can then use that ability to think about
their own thinking to grasp
how other people might learn.
They know what
has to come first,
and they can
distinguish between foundational concepts
and elaborations or
illustrations of those ideas. They realize
where people are likely to face
difficulties developing
their own comprehension,
and
they can use that understanding
to
simplify and clarify complex topics for others,
tell the right story, or raise a powerfully
provocative question. Ken Bain, What the Best
College Teachers Do
Teach Epidemiology
18Enduring Epidemiological Understandings
Teach Epidemiology
19Time Check 1015 AM
20(No Transcript)
21Teach Epidemiology
Teach Epidemiology
22Time Check 1100 AM
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24Teach Epidemiology
Teach Epidemiology
25Teachers 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 3 EL
Teach Epidemiology
26Epi Grades 6-12
Metacognition
They can then use that ability to think about
their own thinking to grasp
how other people might learn.
They know what
has to come first,
and they can
distinguish between foundational concepts
and elaborations or
illustrations of those ideas. They realize
where people are likely to face
difficulties developing
their own comprehension,
and
they can use that understanding
to
simplify and clarify complex topics for others,
tell the right story, or raise a powerfully
provocative question. Ken Bain, What the Best
College Teachers Do
Teach Epidemiology
27Enduring Epidemiological Understandings
Teach Epidemiology
28Time Check 1015 AM
29(No Transcript)
30Teach Epidemiology
Teach Epidemiology
31Time Check 1030 AM
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33Teach Epidemiology
Teach Epidemiology
34Teachers Team-Teaching Teachers (TTT)
View a News Item from an Epidemiological
Perspective Team leads other workshop
participants
in the analysis of a news item from an
epidemiological perspective.
Teach Epidemiology
35Epi Grades 6-12
Metacognition
They can then use that ability to think about
their own thinking to grasp
how other people might learn.
They know what
has to come first,
and they can
distinguish between foundational concepts
and elaborations or
illustrations of those ideas. They realize
where people are likely to face
difficulties developing
their own comprehension,
and
they can use that understanding
to
simplify and clarify complex topics for others,
tell the right story, or raise a powerfully
provocative question. Ken Bain, What the Best
College Teachers Do
Teach Epidemiology
36Enduring Epidemiological Understandings
Teach Epidemiology
37Time Check 1130 AM
38(No Transcript)
39Teach Epidemiology
Teach Epidemiology
40Time Check 1230 PM
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42Teach Epidemiology
Teach Epidemiology
43http//prezi.com/ghtd8j_zll-w/now-for-something-a-
little-different/
44Epi Grades 6-12
Metacognition
They can then use that ability to think about
their own thinking to grasp
how other people might learn.
They know what
has to come first,
and they can
distinguish between foundational concepts
and elaborations or
illustrations of those ideas. They realize
where people are likely to face
difficulties developing
their own comprehension,
and
they can use that understanding
to
simplify and clarify complex topics for others,
tell the right story, or raise a powerfully
provocative question. Ken Bain, What the Best
College Teachers Do
Teach Epidemiology
45Enduring Epidemiological Understandings
Teach Epidemiology
46Enduring Epidemiological Understandings
Teach Epidemiology
47Time Check 115 PM
48(No Transcript)
49Teach Epidemiology
Teach Epidemiology
50Teach Epidemiology
EPI-501
Marian R Passannante, PhD Associate
Professor University of Medicine and Dentistry of
New Jersey New Jersey Medical School School of
Public Health
51Epidemiology
Enduring Epidemiological Understandings
- Descriptive
- concentrates on examining the distribution of
diseases in the population in terms of person,
(who gets the disease), place (where they get the
disease) and time (when they get the disease) - Generates hypotheses
51
Teach Epidemiology
52Descriptive Epidemiology
Enduring Epidemiological Understandings
Source Reported Tuberculosis in the United
States, 2009 http//www.cdc.gov/tb/statistics/surv
/surv2009/slides/surv9.htm
52
Teach Epidemiology
53Descriptive Epidemiology
Enduring Epidemiological Understandings
- Place
- Reference
- Hootman JM, Pan L, Helmick CG, Hannan C.
State-specific trends in obesity prevalence among
adults with arthritis, Behavioral Risk Factor
Surveillance System, 20032009.MMWR
201160(16)509-513.
53
Teach Epidemiology
54Descriptive Epidemiology
Enduring Epidemiological Understandings
source http//www.cdc.gov/chronicdisease/resourc
es/publications/aag/osh.htm
54
Teach Epidemiology
55Epidemiology
Enduring Epidemiological Understandings
55
Teach Epidemiology
56Epidemiologic Study Designs
Enduring Epidemiological Understandings
- What is the relationship between physical
activity and health status among high school
students? - Define outcome and how it will be measured.
- Define the exposure and how it will be measured.
-
-
56
Teach Epidemiology
57Epidemiologic Study Designs
Enduring Epidemiological Understandings
- What is the relationship between physical
activity and health status among high school
students? - Define outcome and how it will be measured.
- Health status absenteeism
- Define the exposure and how it will be measured.
- Physical Activity participation in varsity
sports -
-
57
Teach Epidemiology
58Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ecological Studies
-
- Information is collected on groups, not
individuals - Often called correlation studies
- Easy to perform- data often already available
-
-
58
Teach Epidemiology
59Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ecological Study
-
- High school
- Absenteeism Rate
-
- Number of lost school days due to
- absence /(Number of students) x
- (Number of schooldays) x 100
-
- of high school
- students on varsity sports teams
59
Teach Epidemiology
60Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ecological Studies
- Advantages
- Information is collected on groups, not
individuals - Easy to perform- data often already available
- Disadvantages
- Doesnt control for other factors (confounders)
- Individual associations may not be the same as
group associations -
-
60
Teach Epidemiology
61Epidemiology
Enduring Epidemiological Understandings
- Analytic
- concerned with studying the relationship between
an exposure and an outcome - test hypotheses
- Includes a comparison group
61
Teach Epidemiology
62Analytic Epidemiology
Enduring Epidemiological Understandings
- Outcomes
- Health or Disease outcomes
- Dependent variable
- Y variable
- Exposures
- Risk or Protective Factor
- Independent or Predictor variable
- X variable
62
Teach Epidemiology
63Analytic Epidemiology
Exposure -
A B
- C D
64Epidemiology
Enduring Epidemiological Understandings
- Analytic
- Observational
- Cross-Sectional
- Case-Control
- Cohort
- Experimental
- Behavioral Trials
- Clinical Trials
64
Teach Epidemiology
65Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Cross-Sectional Studies
- Data on possible risk factors and disease
outcomes are collected at the same time. - These studies are sometimes called prevalence
studies since the information collected can be
used to provide prevalence (the proportion in a
population with a particular outcome). -
65
Teach Epidemiology
66Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you measure the exposure and outcome?
-
- Physical Activity Health Status
66
Teach Epidemiology
67Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you measure the exposure and outcome?
-
- Physical Activity Health Status
- 1. Participation in organized sports 1. Days
Absent - 2. Amount of daily/weekly exercise 2. Body Mass
Index - 3. Amount of vigorous exercise 3. Blood Pressure
67
Teach Epidemiology
68Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cross sectional study of
-
- Physical Activity Health Status
- among high school students? Health
Status (BMI)
Physical Activity Obese - Non-Obese
High A B
- Low C D
68
Teach Epidemiology
69Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cross sectional study of
-
- Physical Activity Health Status
- among high school students? Obesity
- Conduct a Survey asking
- questions about current
- Physical activity, height and
- Body weight.
Physical Activity -
A B
- C D
69
Teach Epidemiology
70Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cross sectional study of
-
- Physical Activity Health Status
- among high school students?
- Obesity
- Conduct a Survey
- Calculate Prevalence of Health Outcome
- In both Physical Activity Groups
- A/AB and C/CD
- Calculate a Prevalence Ratio to compare groups
- (A/AB)/(C/CD)
Physical Activity -
A B
- C D
70
Teach Epidemiology
71Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cross sectional study of
- Physical Activity Health Status
- among high school students?
- Advantages
- Good for generating prevalence Obese
- Can be done over a short period of time
- Disadvantages
- Survey data difficult to verify
- Can not provide information on causal
associations - Unclear whether exposure or disease came first
- (e.g. Are students obese because they are less
physically - active or are they less physically active
because they are - obese?)
Physical Activity -
A B
- C D
71
Teach Epidemiology
72Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a case-control study of
-
- Physical Activity Health Status
- among high school students?
- Obesity
- 1) Identify cases and controls
- 2) Interview cases and control to ask
- about physical activity during the past
- 4 years
- 3) Fill in the 2 x 2 table and calculate
- The Odds Ratio
Physical Activity case - control
A B
- C D
72
Teach Epidemiology
73What is an odds ratio?
- A measure of association used to quantify the
relationship between an exposure and an outcome.
It is also called the cross-products ratio. - Outcome obesity
- Exposure physical activity
- The ratio of the odds that cases (obese) were
exposed to a particular risk factor (physical
activity) as compared with the odds that the
controls (non-obese) were exposed to that same
risk factor (physical activity). - In a case-control study the odds ratio
- Odds that a case was exposed / Odds that a
control was exposed
74What is an odds ratio?
- Can be calculated using a simple 2-by-2
contingency table. - Odds of that a case was exposed a/c
- Odds of that a control was exposed b/d
- Ratio of the odds or Odds Ratio (a/c)/(b/d)
- ad/bc (cross-products ratio)
- Outcome
- Exposure Case Control
- yes a b
- no c d
-
-
75Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a case-control study of
- Physical Activity Health Status
- among high school students?
-
- Identify those with high and low health status
- ( of cases and controls may or may not be the
same) - Ask them questions about prior physical activity
level - Calculate a measure of risk Odds Ratio
- A x D 12 x 178 2136 .507
- B x C 183 x 23 4209
- Odds that obese students were physically active
were about 50 lower than the odds that
non-obese students were physically activity.
Physical Activity Case Obese Controls Non-obese
A 12 B 23
- C 183 D 178
75
Teach Epidemiology
76Interpretation of the Odds Ratio source
modified from Jekel et al. Epidemiology,
Biostatistics and Preventive Medicine, pg 93.
-
- - 4.0 (4/1)
-
- - 2.0 (2/1)
-
- ----------------1.0 (1/1) equal odds in two
groups -
- - 0.5 (1/2)
-
- - 0.25 (1/4)
77Interpretation of the Odds Ratio source
modified from Jekel et al. Epidemiology,
Biostatistics and Preventive Medicine, pg 93.
-
- - 4.0 (4/1) Odds that cases were exposed are 4
times higher than - the odds that controls were
exposed - - 2.0 (2/1) (the exposure is positively
related to the disease) -
- ----------------1.0 (1/1) equal odds in two
groups - (the exposure is not related to the disease
) - - 0.5 (1/2)
-
- - 0.25 (1/4) Odds that cases were exposed
are - 25 as high or 75
lower - l than the odds that controls were exposed
- (the exposure is negatively
related to the disease)
78Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a case-control study of
-
- Physical Activity Health Status
- among high school students?
- Obesity
- Advantages
- Good for studying rare outcomes
- Do not need very large sample
- Disadvantages
- Can not calculate incidence rates
- Must estimate relative risk using the odds ratio
- Estimates may be affected by recall bias
Physical Activity -
A B
- C D
78
Teach Epidemiology
79Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cohort study of
-
- Physical Activity Health Status
- among high school students? Obesity
Physical Activity -
A B
- C D
79
Teach Epidemiology
80Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cohort study of
- Physical Activity Obesity
- among high school students?
Obesity - 1) Identify students with high and low activity
level - who are not obese at the start of high school
- 2) Follow them over time and calculate BMI
- 3) Calculate Incidence of obesity in both
exposure groups - 4) Calculate Relative Risk (incidence in exposed
group - divided by incidence in unexposed group)
- (A/ AB) / (C/CD) 10/500
.50 -
20/500 - The risk of obesity is 50 lower in those who had
high levels of physical activity compare d to
those who did not.
Physical Activity -
A 10 B 490
- C 20 D 480
80
Teach Epidemiology
81Interpretation of the Relative Risksource
modified from Jekel et al. Epidemiology,
Biostatistics and Preventive Medicine, pg 93.
-
- - 4.0 (4/1) Risk of outcome is 4 times higher
among those with the - factor as compared to those without the
factor - - 2.0 (2/1)
-
- ----------------1.0 (1/1) equal risk in two
groups -
- - 0.5 (1/2)
-
- - 0.25 (1/4) Risk of outcome is 25 as high or
75 lower among - those with the factor as compared to those
without the factor
82Epidemiologic Study Designs
Enduring Epidemiological Understandings
- How would you design a cohort study of
- Physical Activity Health Status
- among high school students?
- Advantages Health Status
- Allow for the direct calculation of incidence
rates - Good for studying rare exposures
- Allows investigators to assess the progression
from exposure - to disease
- Disadvantages
- Need a large sample
- Can take a long time to complete the study
- More costly and labor intensive than other
studies - Those who are lost to follow-up can bias the
outcome
Physical Activity -
A B
- C D
82
Teach Epidemiology
83Epidemiologic Study Designs Experimental
Enduring Epidemiological Understandings
- How would you design a behavioral trial of
- Physical Activity Health Status
- among high school students? Health Status
Physical Activity -
A B
- C D
83
Teach Epidemiology
84Epidemiologic Study DesignsExperimental
Enduring Epidemiological Understandings
- How would you design a behavioral trial of
- Physical Activity Health Status
- among high school students?
- Obesity
- Random assignment of normal weight students
- to different activity level
- 2) Follow groups over time to calculate
incidence of - health status outcome (blind evaluation)
- Calculate Relative Risk (incidence in exposed
group - divided by incidence in unexposed group)
- Would this be ethical?
-
Physical Activity -
A B
- C D
84
Teach Epidemiology
85Epidemiologic Study DesignsExperimental
Enduring Epidemiological Understandings
- How would you design a clinical trial of
- Vitamin C Health Status
- among high school students?
- Health Status
- Random assignment of healthy to Vitamin C
- Follow groups over time to calculate incidence of
- health status outcome (blind evaluation)
- Calculate Relative Risk (incidence in exposed
group - divided by incidence in unexposed group)
- Would this be ethical?
-
Vitamin C -
A B
- C D
85
Teach Epidemiology
86Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Minimizing Risks and Maximizing Benefits
- Informed Consent
- Confidentiality of information
- Respect for Human Rights
- Scientific Integrity
86
Teach Epidemiology
87Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Minimizing Risks and Maximizing Benefits
- Physical
- Emotional
- Especially in vulnerable populations
87
Teach Epidemiology
88Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Informed Consent
- Investigators must provide clear and complete
information regarding a research project so that
potential participants area able to decide
whether or not to be part of the study.. - Source Coughlin S, Ethical issues in
epidemiologic research and public health practice
. Emerging Themes in Epidemiology 2006, 316
open access
88
Teach Epidemiology
89Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Confidentiality of Information
- Limiting access to study data
- Study records locked away
- Limit/delete identifying information on data
collection forms and in computer files - Encrypting of computer databases
- Limit geographic detail
- Source Coughlin S, Ethical issues in
epidemiologic research and public health practice
. Emerging Themes in Epidemiology 2006, 316
open access
89
Teach Epidemiology
90Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Confidentiality of Information
- Certificate of Confidentiality Certificates
protect against compulsory legal demands, such as
court orders and subpoenas, for identifying
information or identifying characteristics of a
research participant. - Source http//grants.nih.gov/grants/policy/coc/fa
qs.htm
90
Teach Epidemiology
91Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Respect for Human Rights
- Individual rites
- Right of the Population
91
Teach Epidemiology
92Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- Scientific Integrity
- Research sponsorship
- Appearance of conflict of interest
- Possible conflict of interest
- Conducting and reporting research honestly
92
Teach Epidemiology
93Epidemiologic Study Designs
Enduring Epidemiological Understandings
- Ethical Issues
- The institutional review board system (IRB)
- United States, federal regulations to protect
human research subjects (45 CFR 46) have
resulted in a complex IRB system. Similar
safeguards exist in many other countries. - We recommend that students doing epidemiologic
research - Login to the NIH Protecting Human Research
Participants training modules (http//phrp.nihtrai
ning.com/users/login.php). - Complete three of the seven training modules
History, Codes and Regulations, and Respect for
Persons. - Source Coughlin S, Ethical issues in
epidemiologic research and public health practice
. Emerging Themes in Epidemiology 2006, 316
open access
93
Teach Epidemiology
94Epidemiologic Study DesignsBreak
Enduring Epidemiological Understandings
94
Teach Epidemiology
95Enduring Epidemiological Understandings
Analytic Observational Study Type Main Feature Outcome Measure
Cross-sectional Exposure and outcome assessed at the same time Prevalence Prevalence Ratio
Case-Control Assemble Cases and Controls Ask about prior exposure Odds Ratio
Cohort Assemble cohort based on exposure All free of outcome at beginning Follow over time to assess outcome Incidence Rate Relative Risk
95
Teach Epidemiology
96Epidemiologic Measures of Morbidity
Identifying Patterns of Health and Disease and
Formulating Hypotheses
- Incidence refers to the occurrence of new cases
of disease or injury in a population over a
specified period of time.
- Prevalence refers to the proportion of persons in
a population who have a particular disease or
attribute at a specified point in time or over a
specified period of time.
Teach Epidemiology
Source of Definitions Principles of Epidemiology
in Public Health Practice Third Edition , U.S.
DHHS, CDC
97Cross-Sectional Studies
- Data on exposure and outcome are collected at
the same time. - Prevalence Ratio
- Prevalence of Outcome among those who have the
exposure - A/AB
- Prevalence of the Outcome among those who did not
have the exposure C/CD - Calculate a Prevalence Ratio to compare groups
(A/AB)/(C/CD)
Outcome Outcome -
Exposure A B
Exposure - C D
98Outcome measures
- Case-Control Study
- Odds Ratio A x D
- B x C
- aka Cross-Products Ratio
- Cohort study
- Relative Risk
Exposure Case Control
Yes A B
No C D
Exposure Disease No Disease
Yes A B
No C D
99Analytic Epidemiology
Enduring Epidemiological Understandings
99
Teach Epidemiology
100Analytic Epidemiology
Enduring Epidemiological Understandings
100
Teach Epidemiology
101Analytic Epidemiology
Enduring Epidemiological Understandings
- Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
101
Teach Epidemiology
102Analytic Epidemiology
Enduring Epidemiological Understandings
- Answer A and E
- Experimental Clinical Trial
102
Teach Epidemiology
103Analytic Epidemiology
Enduring Epidemiological Understandings
- Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
103
Teach Epidemiology
104Analytic Epidemiology
Enduring Epidemiological Understandings
- Answer A and E
- Experimental Clinical Trial
104
Teach Epidemiology
105Analytic Epidemiology
Enduring Epidemiological Understandings
- Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
105
Teach Epidemiology
106Analytic Epidemiology
Enduring Epidemiological Understandings
- Answer B and C
- Observational Cohort Study
106
Teach Epidemiology
107Analytic Epidemiology
Enduring Epidemiological Understandings
Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
107
Teach Epidemiology
108Analytic Epidemiology
Enduring Epidemiological Understandings
108
Teach Epidemiology
109Analytic Epidemiology
Enduring Epidemiological Understandings
109
Teach Epidemiology
110Analytic Epidemiology
Enduring Epidemiological Understandings
- OR (32x60) 12
- (8 x 20)
- Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
Storage Case Control
inside 32 20
- outside 8 60
110
Teach Epidemiology
111Analytic Epidemiology
Enduring Epidemiological Understandings
- What is the appropriate measure of risk?
- Calculate this measure.
- Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
111
Teach Epidemiology
112Analytic Epidemiology
Enduring Epidemiological Understandings
- Relative Risk
- Incidence of illness in exposed group (those
who ate cake) 50/53 .943 6.1 - Incidence of illness in
non-exposed group (did not eat cake) 4/26
.154 - Source Principles of Epidemiology in Public
Health Practice Third Edition , U.S. DHHS, CDC
112
Teach Epidemiology
113Analytic Epidemiology
Enduring Epidemiological Understandings
- A cross-sectional study was conducted among
1000 high school students. Students were asked to
provide information on their gender and whether
they had smoked more than 1 cigarette during the
past week. The study data are provided in the
table below. - What is the prevalence of smoking
- Among males? Among Females?
- Calculate a Prevalence Ratio.
Gender Smoked Didnt smoke
Male 40 380
Female 30 570
Teach Epidemiology
114Analytic Epidemiology
Enduring Epidemiological Understandings
- A cross-sectional study was conducted among
1000 randomly selected high school students.
Students were asked to provide information on
their gender and whether they had smoked more
than 1 cigarette during the past week. The study
data are provided in the table. - What is the prevalence of smoking
- Among males? 40/400 10
- Among Females? 30/600 5
- Prevalence Ratio 10/5 2
Gender Smoked Didnt smoke
Male 40 360
Female 30 570
Teach Epidemiology
115Time Check 245 PM
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117Teach Epidemiology
Teach Epidemiology
118Time Check 300 PM
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120Teach Epidemiology
Teach Epidemiology
121Tours
Teach Epidemiology
122Tours
Broadcast Studios
Teach Epidemiology
123Tours
Emergency Operation Center
Teach Epidemiology
124Time Check 400 PM
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126Extra Slides
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