Centers%20for%20Disease%20Control%20and%20Prevention%20Global%20Health%20Odyssey%20Museum%20Tom%20Harkin%20Global%20Communications%20Center%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20June%207-11,%202010

1
Day 4
Teach Epidemiology
Professional Development Workshop
Centers for Disease Control and PreventionGlobal
Health Odyssey MuseumTom Harkin Global
Communications Center
June 7-11, 2010
2
(No Transcript)
3
Teach Epidemiology
Teach Epidemiology
4
Enduring Epidemiological Understandings
Teach Epidemiology
5
Enduring Epidemiological Understandings
Teach Epidemiology
6
(No Transcript)
7
Making Group Comparisons and Identifying
Associations
Laboratory
7
Teach Epidemiology
8
Making Group Comparisons and Identifying
Associations
Laboratory
8
Teach Epidemiology
9
Making Group Comparisons and Identifying
Associations
Natural Experiment
Naturally occurring circumstances
in
which groups of people within a population
have been exposed to
different levels
of the hypothesized cause of an outcome.
9
Teach Epidemiology
10
Making Group Comparisons and Identifying
Associations
Observational Study
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.
10
Teach Epidemiology
11
Making Group Comparisons and Identifying
Associations
Controlled Trial
An epidemiologic experiment
in
which subjects are assigned into groups
to receive or not receive

a hypothesized beneficial
intervention.
11
Teach Epidemiology
12
Making Group Comparisons and Identifying
Associations
Buprenorphine
Buprenorphine will stop heroin addicts from using
heroin.
Teach Epidemiology
13
Making Group Comparisons and Identifying
Associations
Observational Study of a Natural Experiment
Naturally occurring circumstances
in
which groups of people within a population
have been exposed to
different levels
of the hypothesized cause of an outcome.
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.
13
Teach Epidemiology
14
Making Group Comparisons and Identifying
Associations
14
Teach Epidemiology
15
Making Group Comparisons and Identifying
Associations
15
Teach Epidemiology
16
Making Group Comparisons and Identifying
Associations
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 didnt 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.
Stephen Jay Gould

(survivor of abdominal mesothelioma)
16
Teach Epidemiology
17
Making Group Comparisons and Identifying
Associations
Anecdote
A particular or detached incident or fact
of
an interesting nature a biographical incident or
fragment a single passage of private
life.
17
Teach Epidemiology
18
Making Group Comparisons and Identifying
Associations
Transforming Anecdote to Science
Anecdote
18
Teach Epidemiology
19
Making Group Comparisons and Identifying
Associations
Controlled Trial
Case-Control Study
Cohort Study
Cross-Sectional Study
19
Teach Epidemiology
20
Making Group Comparisons and Identifying
Associations
Controlled Trial
Case-Control Study
b
a
d
c
Cohort Study
Cross-Sectional Study
20
Teach Epidemiology
21
Making Group Comparisons and Identifying
Associations
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 Health Ann
Aschengrau and George R. Seage III
Teach Epidemiology
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Time Check 815 AM
26
(No Transcript)
27
Teach Epidemiology
Teach Epidemiology
28
The Journey
The Journey
Detectives in the Classroom - Investigation 2-6
The Journey
29
Analogy
Detectives in the Classroom - Investigation 2-6
The Journey
30
Epi Talk
Epi Talk
Study Design
Procedures and methods, established beforehand,
that are followed by the investigator conducting
the study.
Detectives in the Classroom - Investigation 2-6
The Journey
31
Timing
Detectives in the Classroom - Investigation 2-6
The Journey
32
Label the Train Tracks
E
DZ



Time
Detectives in the Classroom - Investigation 2-6
The Journey
33
Label the Train Tracks
Study Design
Controlled Trial
E
DZ



Time
Detectives in the Classroom - Investigation 2-6
The Journey
34
Flow Diagram
Flow Diagram
Controlled Trial
Healthy People
Detectives in the Classroom - Investigation 2-6
The Journey
35
Label the Train Tracks
Study Design
Cohort Study



Time
Detectives in the Classroom - Investigation 2-6
The Journey
36
Label the Train Tracks
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
everyones exposures and whether or not they
develop the disease during the journey.
Detectives in the Classroom - Investigation 2-6
The Journey
37
Label the Train Tracks
Study Design
Cohort Study
E
DZ



Time
Detectives in the Classroom - Investigation 2-6
The Journey
38
Flow Diagram
Flow Diagram
Cohort Study
Healthy People
Detectives in the Classroom - Investigation 2-6
The Journey
39
Flow Diagram
Flow Diagram
Controlled Trial
Cohort Study
Healthy People
Detectives in the Classroom - Investigation 2-6
The Journey
40
Flow Diagram
Flow Diagram
Controlled Trial
Cohort Study
Random Assignment
Healthy People
Detectives in the Classroom - Investigation 2-6
The Journey
41
Review
Epi Talk
Observational Studies
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.
Detectives in the Classroom - Investigation 2-6
The Journey
42
Label the Train Tracks
Study Design
Case-Control Study



Time
Detectives in the Classroom - Investigation 2-6
The Journey
43
Label the Train Tracks
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.
Detectives in the Classroom - Investigation 2-6
The Journey
44
Label the Train Tracks
Study Design
Case-Control Study
DZ
E



Time
Detectives in the Classroom - Investigation 2-6
The Journey
45
Flow Diagram
Flow Diagram
Case-Control Study
Observational Study
Detectives in the Classroom - Investigation 2-6
The Journey
46
Label the Train Tracks
Study Design
Cross-Sectional Study



Time
Detectives in the Classroom - Investigation 2-6
The Journey
47
Label the Train Tracks
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.
Detectives in the Classroom - Investigation 2-6
The Journey
48
Label the Train Tracks
Study Design
Cross-Sectional Study



Time
Detectives in the Classroom - Investigation 2-6
The Journey
49
Flow Diagram
Flow Diagram
Cross-Sectional Study
Observational Study
Detectives in the Classroom - Investigation 2-6
The Journey
50
Epi Talk
Epi Talk
Controlled Trial
An epidemiologic experiment in which subjects are
assigned into groups to receive or not receive a
hypothesized beneficial intervention.
Detectives in the Classroom - Investigation 2-6
The Journey
51
Epi Talk
Epi Talk
Cohort Study
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.
Detectives in the Classroom - Investigation 2-6
The Journey
52
Epi Talk
Epi Talk
Case-Control Study
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.
Detectives in the Classroom - Investigation 2-6
The Journey
53
Epi Talk
Epi Talk
Cross-Sectional Study
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.
Detectives in the Classroom - Investigation 2-6
The Journey
54
(No Transcript)
55
Epi Team Challenge
Epi Team Challenge
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
56
Whats My Design?
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
57
Whats My Design?
Practice Clue
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
58
Whats My Design?
Begin Epi Team Challenge
Clue 1
Assign treatment and control groups.
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
59
Whats My Design?
Clue 2
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
60
Whats My Design?
Clue 3
Observational Study
Cohort, Case-Control, and Cross-Sectional Studies
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
61
Whats My Design?
Clue 4
Follow through time and compare risk of disease
in exposed group with risk of
disease in the unexposed group.
Trial and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
62
Whats My Design?
Clue 5
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
63
Whats My Design?
Clue 6
Epidemiologist is involved during
the entire time from
exposure to disease.
Trial and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
64
Whats My Design?
Clue 7
Select a group of people with disease
and a similar group of
people without disease.
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
65
Whats My Design?
Clue 8
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
66
Whats My Design?
Clue 9
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
67
Whats My Design?
Clue 10
Compare odds of exposure in the two groups.
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
68
Whats My Design?
Clue 11
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
69
Whats My Design?
Clue 12
Flow Diagram
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
70
Whats My Design?
Clue 13
Flow Diagram
Observational Study
Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
71
Whats My Design?
Clue 14
Ask each person about both exposure and disease
at that point in time.
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
72
Whats My Design?
Clue 15
Ask both groups about their exposures in the past.
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
73
Whats My Design?
Clue 16
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
74
Whats My Design?
Clue 17
Disease risk in exposed group
is compared
to disease risk in unexposed group.
Trial, Cohort Study, and Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
75
Whats My Design?
Clue 18
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
76
Whats My Design?
Clue 19
Select a healthy study sample.
Trial (?) and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
77
Whats My Design?
Clue 20
Observe who has and has not been exposed.
Cohort and Cross-Sectional Studies
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
78
Whats My Design?
Clue 21
Give exposure to treatment group, but not control
group.
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
79
Whats My Design?
Clue 22
Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
80
Whats My Design?
Clue 23
Epidemiologist is involved after disease has
occurred and relies on subjects memories

to gather information about exposure.
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
81
Whats My Design?
Clue 24
Select a study sample.
Trial, Cohort, Case-Control, and Cross Sectional
Studies
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
82
Whats My Design?
Clue 25
Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
83
Whats My Design?
Clue 26
Epidemiologist gathers data only at that one
point in time.
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
84
Whats My Design?
Clue 27
Trial and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
85
Whats My Design?
Clue 28
Follow through time and compare risk of disease
in exposed group to risk of disease in unexposed
group.
Trial and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
86
Whats My Design?
Clue 29
Epidemiologist is involved
during the entire
time from exposure to disease.
Trial and Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
87
Whats My Design?
Clue 30
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
88
Whats My Design?
Clue 31
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
89
Whats My Design?
Clue 32
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
90
Whats My Design?
Clue 33
Case-Control Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
91
Whats My Design?
Clue 34
Cohort Study
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
92
Whats My Design?
Clue 35
Trial
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
93
Whats My Design?
End Epi Team Challenge
Detectives in the Classroom - Investigation 2-7
Epi Team Challenge
94
(No Transcript)
95
Which Design Is Best?
Which Design Is Best?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
96
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
97
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
98
Epi Team Challenge
Fastest
Which study design is the fastest?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
99
Fastest
Which study designs are the most time consuming?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
100
Most Scientifically Sound
Time Consuming
Time Consuming
Fastest
Which study design is the most scientifically
sound?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
101
Most Scientifically Sound
Time Consuming
Time Consuming
Can Study Rare Diseases
Fastest
Which study design is best for studying rare
diseases?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
102
Most Scientifically Sound
Time Consuming
Time Consuming
Can Study Rare Diseases
Fastest
Which study designs do not identify
the time order of exposure and disease?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
103
Time Consuming
Most Scientifically Sound
Time Consuming
Possible Time-Order Confusion
Can Study Rare Diseases
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Which study design gives the least confidence
in findings?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
104
Time Consuming
Most Scientifically Sound
Best Measure of Exposure
Time Consuming
Possible Time-Order Confusion
Can Study Rare Diseases
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Which study design provides the best measure of
exposure?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
105
Time Consuming
Most Scientifically Sound
Best Measure of Exposure
Most Accurate Observational Study
Time Consuming
Possible Time-Order Confusion
Can Study Rare Diseases
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Which study design is the most accurate
observational study?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
106
Time Consuming
Most Scientifically Sound
Best Measure of Exposure
Most Accurate Observational Study
Time Consuming
Possible Time-Order Confusion
Can Study Rare Diseases
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Least Expensive
Which study design is the least expensive?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
107
Time Consuming
Most Scientifically Sound
Unethical for Harmful Exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Possible Time-Order Confusion
Can Study Rare Diseases
Fastest
Possible Time-Order Confusion
Least Confidence in Findings
Least Expensive
Which study design
would be unethical for harmful
exposures?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
108
Time Consuming
Most Scientifically Sound
Unethical for Harmful exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Good Measure of Exposure
Possible Time-Order Confusion
Can Study Rare Diseases
Fastest
Possible Time-Order Confusion
Least Confidence in Findings
Least Expensive
Which study design
provides a good measure of exposure?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
109
Most Scientifically Sound
Time Consuming
Unethical for Harmful exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Good Measure of Exposure
Possible Time-Order Confusion
Can Study Rare Diseases
Fastest
Possible Time-Order Confusion
Least Expensive
Least Confidence in Findings
Which study designs are the most expensive?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
110
Most Scientifically Sound
Time Consuming
Unethical for Harmful exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Good Measure of Exposure
Can Study Rare Diseases
Possible Time-Order Confusion
Relatively Less Expensive and Relatively Fast
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Least Expensive
Which study design is
relatively less expensive and
relatively fast?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
111
Time Consuming
Most Scientifically Sound
Unethical for Harmful exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Good Measure of Exposure
Possible Time-Order Confusion
Can Study Rare Diseases
Possible Error in Recalling Past
Exposures
Relatively Less Expensive and Relatively Fast
Possible Time-Order Confusion
Fastest
Least Confidence in Findings
Least Expensive
Which study design creates the possibility of
error in recalling
past exposures?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
112
Which Design Is Best?
Time Consuming
Most Scientifically Sound
Unethical for Harmful exposures
Best Measure of Exposure
Time Consuming
Most Accurate Observational Study
Good Measure of Exposure
It depends .
Possible Time-Order Confusion
Can Study Rare Diseases
Relatively Less Expensive and Relatively Fast
Possible Error in Recalling Exposures
Fastest
Possible Time-Order Confusion
Least Expensive
Least Confidence in Findings
Which Design Is Best?
Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
113
It depends on .

• Regulations
• Time urgency
• How much is known about the association
• Money
• Whether the exposure is believed to be
  beneficial

Detectives in the Classroom - Investigation 2-8
Which Design Is Best?
114
(No Transcript)
115
Designs, Diagrams, and Tables

Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
116
Controlled Trial
Where do these people fit in the 2x2 table?
DZ
DZ
E
a
E
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
117
Controlled Trial
Where do these people fit in the 2x2 table?
DZ
DZ
E
b
E
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
118
Controlled Trial
Where do these people fit in the 2x2 table?
DZ
DZ
E
E
c
2x2 Table
Flow Diagram
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
119
Controlled Trial
Where do these people fit in the 2x2 table?
DZ
DZ
E
E
d
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
120
Cohort Study
Where are these people in the flow diagram?
DZ
DZ
E
Healthy People
Healthy People
E
c
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
121
Cohort Study
Where are these people in the flow diagram?
DZ
DZ
E
Healthy People
Healthy People
a
E
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
122
Cohort Study
Where are these people in the flow diagram?
DZ
DZ
E
Healthy People
Healthy People
E
d
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
123
Cohort Study
Where are these people in the flow diagram?
DZ
DZ
E
Healthy People
Healthy People
b
E
2x2 Table
Flow Diagram
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
124
Case-Control Study
Where do these people go in the 2x2 table?
DZ
DZ
E
a
E
Flow Diagram
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
125
Case-Control Study
Where do these people go in the 2x2 table?
DZ
DZ
E
E
c
Flow Diagram
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
126
Case-Control Study
Where do these people go in the 2x2 table?
DZ
DZ
E
b
E
Flow Diagram
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
127
Case-Control Study
Where do these people go in the 2x2 table?
DZ
DZ
E
E
d
Flow Diagram
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
128
Cross-Sectional Study
Where do these people go in the 2x2 table?
DZ
DZ
Flow Diagram
E
a
E
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
129
Cross-Sectional Study
Where do these people go in the 2x2 table?
DZ
DZ
Flow Diagram
E
E
c
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
130
Cross-Sectional Study
Where do these people go in the 2x2 table?
DZ
DZ
Flow Diagram
E
E
d
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
131
Cross-Sectional Study
Where do these people go in the 2x2 table?
DZ
DZ
Flow Diagram
E
b
E
2x2 Table
Detectives in the Classroom Investigation 2-9
Designs, Diagrams, and Tables
132
Enduring Epidemiological Understandings
Knowledge that is connected and organized, and
conditionalized to specify the context in
which it is applicable.
National Research Council , Learning and
Understanding
Teach Epidemiology
133
Making Group Comparisons and Identifying
Associations
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 Health Ann
Aschengrau and George R. Seage III
Teach Epidemiology
134
134
135
Where are we?
135
Teach Epidemiology
136
Enduring Epidemiological Understandings
Teach Epidemiology
137
Explaining Associations and Judging Causation
Teach Epidemiology
138
Explaining Associations and Judging Causation
Coffee and Cancer of the Pancreas
1.
Cause
2.
Confounding
3.
Reverse Time Order
Chance
4.
5.
Bias
Teach Epidemiology
139
139
140
Explaining Associations and Judging Causation
Does evidence from an aggregate of studies
support a cause-effect relationship?
Guilt or Innocence?
Causal or Not Causal?
140
Teach Epidemiology
141
Explaining Associations and Judging Causation
Handout
Sir Austin Bradford Hill
The Environment and Disease
Association or Causation?
Proceedings of the Royal Society of Medicine
January 14, 1965
Teach Epidemiology
142
Explaining Associations and Judging Causation
In what circumstances can we pass
from this observed association
to a verdict of causation?
142
Teach Epidemiology
143
Explaining Associations and Judging Causation
Here then are nine different viewpoints
from all of which we should study association
before we cry causation.
143
Teach Epidemiology
144
Explaining Associations and Judging Causation
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
145
Explaining Associations and Judging Causation
Handout
Teach Epidemiology
146
Explaining Associations and Judging Causation
Case-Control Study
Randomized Controlled Trial
Cohort Study
Cross-Sectional Study
Teach Epidemiology
147
Explaining Associations and Judging Causation
Handout
Teach Epidemiology
148
Explaining Associations and Judging Causation
Stress causes ulcers.
Helicobacter pylori causes ulcers.
Teach Epidemiology
149
Explaining Associations and Judging Causation
Teach Epidemiology
150
Explaining Associations and Judging Causation
Teach Epidemiology
151
(No Transcript)
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.
152
153
Control of Health Problems
If an association was causal, .
?
Outcome
Hypothesized Exposure
X
153
154
Control of Health Problems
If the association was found due to confounding,
.
?
Outcome
Hypothesized Exposure
154
155
Control of Health Problems
If an association was found due to reversed
time-order, .
?
Hypothesized Exposure
Outcome
155
156
Control of Health Problems
If an association was found due to chance, .
found due to chance, .
?
Outcome
Hypothesized Exposure
156
157
Control of Health Problems
If an association was found due to bias, .
found due to bias, .
?
Outcome
Hypothesized Exposure
157
158
Control of Health Problems
... 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.
158
159
Control of Health Problems
... 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.
1.
Cause
2.
Confounding
3.
Reverse Time Order
Chance
4.
5.
Bias
159
160
Ties, Links, Relationships, and Associations
Suicide Higher in Areas with Guns
Family Meals Are Good for
Mental Health
1.
Cause
Study Concludes Movies Influence
Youth Smoking
Study Links Iron
Deficiency to Math
Scores
2.
Confounding
Lack of High School Diploma Tied to
US Death Rate
Study Links Spanking
to Aggression
3.
Reverse Time Order
Chance
4.
Depressed Teens More Likely to Smoke
Snacks Key to Kids TV- Linked Obesity China
Study
5.
Bias
Pollution Linked with Birth Defects in US Study
Kids Who Watch R-Rated Movies More Likely to
Drink, Smoke
160
161
Enduring Epidemiological Understandings
Teach Epidemiology
162
(No Transcript)
163
Time Check 945 AM
164
(No Transcript)
165
Teach Epidemiology
Teach Epidemiology
166
Time Check 1015 AM
167
(No Transcript)
168
Teach Epidemiology
Teach Epidemiology
169
Time Check 1030 AM
170
(No Transcript)
171
Teach Epidemiology
Teach Epidemiology
172
Time Check 1100 AM
173
(No Transcript)
174
Teach Epidemiology
Teach Epidemiology
175
Time Check 1130 AM
176
(No Transcript)
177
Teach Epidemiology
Teach Epidemiology
178
Time Check 1230 PM
179
(No Transcript)
180
Teach Epidemiology
Teach Epidemiology
181
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 12 EL
Teach Epidemiology
182
Enduring Epidemiological Understandings
Teach Epidemiology
183
Time Check 100 PM
184
(No Transcript)
185
Teach Epidemiology
Teach Epidemiology
186
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 13 EL
Teach Epidemiology
187
Enduring Epidemiological Understandings
Teach Epidemiology
188
Time Check 130 PM
189
(No Transcript)
190
Teach Epidemiology
Teach Epidemiology
191
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 14 EL
Teach Epidemiology
192
Enduring Epidemiological Understandings
Teach Epidemiology
193
Time Check 200 PM
194
(No Transcript)
195
Teach Epidemiology
Teach Epidemiology
196
Teachers Team-Teaching Teachers (TTT)
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.
TTTT 15 NI
Teach Epidemiology
197
Enduring Epidemiological Understandings
Teach Epidemiology
198
Time Check 245 PM
199
(No Transcript)
200
Teach Epidemiology
Teach Epidemiology
201
Time Check 300 PM
202
(No Transcript)
203
Teach Epidemiology
Teach Epidemiology
204
Tours
Teach Epidemiology
205
Tours
Broadcast Studios
Teach Epidemiology
206
Tours
Emergency Operation Center
Teach Epidemiology
207
Time Check 400 PM