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Transcript of Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach...
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Carnegie Institution for Science1530 P Street, NW
Washington, DC 20005April 18-21, 2011
Teach EpidemiologyProfessional Development Workshop
Day3
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Revised
Teach Epidemiology
Teach Epidemiology
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A picture of the occurrence, the distribution, and the types of the diseases of mankind, in distinct epochs of time and at various
points on the earth's surface, and ... render an account of the relations of those diseases to the external condition.
(Hirsch, 1883)
What is epidemiology?
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The science of the mass phenomena of infectious diseases, or as the natural history of infectious diseases ... an inductive science,
concerned not merely with describing the distribution of the disease, but fitting it into a consistent philosophy.
(Frost, 1927)
What is epidemiology?
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Epidemiology may be defined as the study of the distribution of a disease or condition in a population and of the factors that
influence this distribution.
(Lilienfeld, 1957)
What is epidemiology?
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Epidemiology is defined as the factors determining the frequency and distribution of disease in human populations. For many years the
word covered only and quite specifically, the study of the spread and decline of communicable disease in human populations and
the prophylaxis and control of those diseases ... the scope includes all disease, acute or chronic, physical or mental, communicable or non-
communicable.
(Epidemiology: A Guide to Teaching Methods, 1973)
What is epidemiology?
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Epidemiology is a method of reasoning about disease that deals with the biologic inferences derived from observations of disease
phenomena in population groups.
(Lilienfeld, 1977)
What is epidemiology?
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... 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.
(Gordis, 2009)
What is epidemiology?
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Ecologic Study
Ecological Fallacy
An error in inference due to failure to distinguish between information
obtained from groups versus individuals. An association observed
between variables at a population level does not necessarily hold true
for individual members of these populations.
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Outcome
+ -
+
-
Exposure a
c
b
d
Ecologic Study
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Random Assignment
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Random Assignment
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Healthy PeopleHealthy People
E
Random Assignment
E
O
O
O
O
Blinding
Trial Investigators
Participants
Assessors
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External Data Monitoring Board
Ethical Issues
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Time Check
9:45 AM
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Revised
Teach Epidemiology
Teach Epidemiology
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National Research Council , Learning and Understanding
Teach Epidemiology
Enduring Epidemiological Understandings
Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”
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Association Found Between Coffee and Pancreatic Cancer
Associated
Teach Epidemiology
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What do we mean when we say that there is an association between two things?
Associated
Tied Related
Linked
Things that are associatedare linked in some way that makes them
turn up together.
Associated
Teach Epidemiology
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Things that are associated are linked in some way that makes them turn up
together.
Associated
Teach Epidemiology
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Suicide Higher in Areas with Guns
Smoking Linked to Youth Eating Disorders
Snacks Key to Kids’ TV- Linked Obesity: China Study
Family Meals Are Good for Mental Health
Lack of High School Diploma Tied to US Death
Rate
Study Links
Spanking to
Aggression
Breakfast Each Day May Keep Colds Away
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
Depressed Teens More Likely to Smoke
Associated
Teach Epidemiology
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Epidemiologic studies that are concerned with characterizing the amount and distribution of
health and disease within a population.
Descriptive Epidemiology
Teach Epidemiology
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Epidemiologic studies that are concerned with determinants of disease and the reasons for relatively high or low
frequencies of disease in specific population subgroups.
Analytical Epidemiology
Teach Epidemiology
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Hypothesis
Formulating
Descriptive Epidemiology
Testing
Analytical Epidemiology
An unproven idea, based on observation or reasoning, that can
be supported or refuted through investigation
An educated guess
Hypothesis
Teach Epidemiology
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Hypothesis:
Buprenorphine will stop heroin addicts from using heroin.
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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PopulationTrial 1
Making Group Comparisons and Identifying Associations
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Population
500 Heroin Addicts
Sample 100
Heroin Addicts
10 Weeks
Trial 1
Making Group Comparisons and Identifying Associations
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Population
500 Heroin Addicts
Sample 100
Heroin Addicts
10 Weeks
21 Heroin Addicts Tested Negative for Heroin
Trial 1
Making Group Comparisons and Identifying Associations
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Bupe
Tested Positive for Heroin Total
10021 79
Tested Negative for Heroin
Trial 1
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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When you can measure what you are speaking about, and express it in numbers,
you know something about it.
Lord Kelvin
But when you cannot measure it, when you cannot express it in
numbers, your knowledge is of a meager and unsatisfactory kind.
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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A measure of how often an outcome occurs in a
defined population in a defined period of time. It consists of a
numerator and a denominator.
Risk
The numerator is the number of people in the population or
sample who experienced the outcome and the denominator is the total number of people in the
population or sample.
Population / Sample
Outcome
Denominator
Numerator
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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… the risk of a negative heroin test was 21 / 100 in a 10-week period
21 tested negative for
heroin 100 study subjects
Numerator
Denominator
Risk
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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A measure of how often an outcome occurs in a defined group of people
in a defined period of time.
The likelihood of an outcome occurring.
Risk / Rate
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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Trial 1
Bupe
Tested Positive for Heroin
10021 79
Tested Negative for Heroin
21
100or 21 %
Calculating Risk
Risk of
Negative Heroin
Test
Total
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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Process of predicting from what is observed in a sample to what is true for the entire population.
Inference
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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Trial 1
What does this tell you about the hypothesis?
Buprenorphine will stop heroin addicts from using heroin.
InferenceProbe
Bupe
Tested Positive for Heroin
10021 79
Tested Negative for Heroin
21
100or 21 %
Risk of
Negative Heroin
Test
Total
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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People who participate in a trial, but do not get the treatment.
People whose results are compared to the group that was treated.
Control Group
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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21
100or 21 %1007921
Tested Positive for Heroin
Tested Negative for Heroin
Bupe
Control Group
Extend and label the table to include a control group.
Risk of
Negative Heroin
Test
Total
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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100?
100or ? %No Bupe
Control Group
Making Group Comparisons
21
100or 21 %1007921
Tested Positive for Heroin
Tested Negative for Heroin
Bupe
Risk of
Negative Heroin
Test
Total
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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100?
100or ? %No Bupe
Making Group Comparisons
21
100or 21 %1007921
Tested Positive for Heroin
Tested Negative for Heroin
Bupe
Exposure
Outcome / Disease
a b
c d
Risk of
Negative Heroin
Test
Total
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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21
100or 21 %
Total
1007921Bupe
100?
100or ? %No Bupe
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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A cross-classification of data where categories of one variable
are presented in rows and categories of another variable
are presented in columns
The simplest contingency table is the 2x2 table.
Contingency Table
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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Population
500 Heroin Addicts
Sample 100
Heroin Addicts
10 Weeks
21 Heroin Addicts Tested Negative for Heroin
Trial 1
Making Group Comparisons and Identifying Associations
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Trial 2
Total
?
100? %
a b
c d
Bupe
Tested Negative for Heroin
Tested Positive for
Heroin
No Bupe 100
100?
100? %
Risk of
Negative Heroin
Test
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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E
Assigned
E
O
O
O
O
Making Group Comparisons and Identifying Associations
Volunteer Heroin Addicts
Teach Epidemiology
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21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Probe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
Inference: Process of predicting from what is observed in a sample
to what is occurring in the entire population
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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61
When you can measure what you are speaking about, and express it in numbers, you know something about it.
Lord Kelvin
But when you cannot measure it, when you cannot express it in
numbers, your knowledge is of a meager and unsatisfactory kind.
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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The value obtained by dividing one quantity by another
Ratio
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 63: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/63.jpg)
63
21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
Ratio: The value obtained by dividing one quantity by another
Risk Ratio: The ratio of two risks
1
Risk Ratio
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 64: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/64.jpg)
64
21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
Ratio: The value obtained by dividing one quantity by another
Risk Ratio: The ratio of two risks
1
Risk Ratio
Create a formula
a
a + b
c
c + d
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 65: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/65.jpg)
65
21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
1
Risk Ratio
Relative Risk: The ratio of the risk of an outcome among the exposed to the risk of the outcome among the unexposed.
Relative Risk
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 66: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/66.jpg)
66
21
10021%21 79 100 or
a b
c d
Bupe
Trial 2
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
21
10021%21 79 100 or
1
Risk RatioRelative Risk
Inference: Process of predicting from what is observed in a sample
to what is occurring in the entire population
The inference here is that there is no effect of Buprenorphine
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 67: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/67.jpg)
67
Trial 3
?
100? %100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
?
100? %100 or
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 68: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/68.jpg)
68
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 69: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/69.jpg)
69
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
62
10062%62 38 100 or
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 70: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/70.jpg)
70
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
62
10062%62 38 100 or
Inference: Process of predicting from what is observed in a sample
to what is occurring in the entire population
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 71: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/71.jpg)
71
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
62
10062%62 38 100 or
Relative Risk
Relative Risk: The ratio of the risk of an outcome among the exposed to the risk of the outcome among the unexposed.
0.34
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 72: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/72.jpg)
72
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
62
10062%62 38 100 or
Relative Risk
0.34
The heroin addicts who received Bupe were ___ times as likely to test negative for heroin as those who did not receive Bupe.
0.34
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 73: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/73.jpg)
73
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
62
10062%62 38 100 or
Relative Risk
0.34
Inference: Process of predicting from what is observed in a sample
to what is occurring in the entire population.
Trial 3
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 74: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/74.jpg)
74
Trial 4
?
100? %100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
?
100? %100 or
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 75: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/75.jpg)
75
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 76: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/76.jpg)
76
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
6
1006%6 94 100 or
Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 77: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/77.jpg)
77
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
6
1006%6 94 100 or
Relative Risk
Relative Risk: The ratio of the risk of an outcome among the exposed to the risk of the outcome among the unexposed.
3.5
Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 78: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/78.jpg)
78
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
6
1006%6 94 100 or
Relative Risk
3.5
The heroin addicts who received Bupe were ___ times as likely to test negative for heroin as those who did not receive Bupe.
3.5
Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 79: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/79.jpg)
79
21
10021%21 79 100 or
a b
c d
Bupe
No Bupe
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
6
1006%6 94 100 or
Relative Risk
3.5
Inference: Process of predicting from what is observed in a sample
to what is occurring in the entire population.
Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 80: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/80.jpg)
80
21
10021%21 79 100 orBupe
Trial 1
Total
Tested Negative for Heroin
Tested Positive for Heroin
Risk of
Negative Heroin
Test
What do the results tell us about the hypothesis that Buprenorphine will stop heroin addicts from using heroin?
Nothing
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 81: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/81.jpg)
81
Trial 1 Trial 2
Trial 3 Trial 4
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 82: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/82.jpg)
82
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
100
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 83: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/83.jpg)
83
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
100
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 84: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/84.jpg)
84
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
10010021 79
90or 21%
21
100
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 85: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/85.jpg)
85
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
100
1
Bupe is not associated with having a negative test for heroin.
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 86: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/86.jpg)
86
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
100
Bupe is not associated with having a negative test for heroin.
1
10062 3890
or 62%62
100
Bupe is associated with having a positive test for heroin!
.34
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 87: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/87.jpg)
87
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
100
Bupe is not associated with having a negative test for heroin.
1
10062 3890
or 62%62
100
Bupe is associated with having a positive test for heroin!
.34
1006 9490
or 6%6
100
Bupe is associated with having a negative test for heroin.
3.5
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 88: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/88.jpg)
88
Risk of
Negative Heroin
Test
Nothing
Bupe
Total
Trial 1 Trial 2
Trial 3 Trial 4
Bupe
No Bupe
Bupe
No Bupe
Bupe
TotalRelative
Risk
No Bupe
TotalRelative
Risk
Total
Tested Negative
for Heroin
Tested Positive
for HeroinRelative
Risk
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
Risk of
Negative Heroin
Test
Tested Negative
for Heroin
Tested Positive
for Heroin
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
10010021 79
90or 21%
21
100
10021 7990
or 21%21
100
Bupe is not associated with having a negative test for heroin.
1
10062 3890
or 62%62
100
Bupe is associated with having a positive test for heroin!
.34
1006 9490
or 6%6
100
Bupe is associated with having a negative test for heroin.
3.5
Nothing
Compared to what?
Making Group Comparisons and Identifying Associations
Teach Epidemiology
![Page 89: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/89.jpg)
89
Buprenorphine
Buprenorphine & Naloxone
Placebo
Making Group Comparisons and Identifying Associations
Teach Epidemiology
Handout
![Page 90: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/90.jpg)
90
National Research Council , Learning and Understanding
Teach Epidemiology
Enduring Epidemiological Understandings
Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”
![Page 91: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/91.jpg)
91
![Page 92: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/92.jpg)
92
Suicide Higher in Areas with Guns
Smoking Linked to Youth Eating Disorders
Snacks Key to Kids’ TV- Linked Obesity: China Study
Family Meals Are Good for Mental Health
Lack of High School Diploma Tied to US Death
Rate
Study Links
Spanking to
Aggression
Breakfast Each Day May Keep Colds Away
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
Depressed Teens More Likely to Smoke
In the News
![Page 93: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/93.jpg)
93
Total
a b
dc
2 x 2 Table
Suicide Higher in Areas with Guns
![Page 94: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/94.jpg)
94
Total
a b
dc
People who are exposed
a b
2 x 2 Table
Suicide Higher in Areas with Guns
Areas with Guns
No SuicideSuicide
Areas without Guns
![Page 95: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/95.jpg)
95
a b
dc
2 x 2 Table
Total
Kids Who Watch R-Rated Movies More Likely to Drink, Smoke
![Page 96: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/96.jpg)
96
a b
dc
2 x 2 Table
R-Rated Movies
TotalDrink & Smoke
Kids Who Watch R-Rated Movies More Likely to Drink, Smoke
No Drink & Smoke
No R-Rated
Movies
![Page 97: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/97.jpg)
97
a b
dc
People who are exposed and have the outcome
a
2 x 2 Table
R-Rated Movies
TotalDrink & Smoke
Kids Who Watch R-Rated Movies More Likely to Drink, Smoke
No Drink & Smoke
No R-Rated
Movies
![Page 98: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/98.jpg)
98
a b
dc
2 x 2 Table
Family Meals Are Good for Mental Health
Total
![Page 99: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/99.jpg)
99
a b
dc
2 x 2 Table
Family Meals Are Good for Mental Health
Family Meals
TotalMental Health
No Mental Health
No Family
Meals
![Page 100: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/100.jpg)
100
a b
dc
People who are not exposed and do not have the outcome
d
2 x 2 Table
Family Meals Are Good for Mental Health
Family Meals
TotalMental Health
No Mental Health
No Family
Meals
![Page 101: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/101.jpg)
101
a b
dc
2 x 2 Table
Study Links Iron Deficiency to Math Scores
Total
![Page 102: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/102.jpg)
102
a b
dc
2 x 2 Table
Study Links Iron Deficiency to Math Scores
Iron Deficiency
Poor Math
Scores
No Iron
Deficiency
Good Math
Scores Total
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103
a b
dc
People who do not have the outcome and are not exposed
d
2 x 2 Table
Study Links Iron Deficiency to Math Scores
Iron Deficiency
Poor Math
Scores
No Iron
Deficiency
Good Math
Scores Total
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104
a b
dc
2 x 2 Table
Pollution Linked with Birth Defects in US Study
Total
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105
a b
dc
2 x 2 Table
Pollution Linked with Birth Defects in US Study
Pollution
Birth Defects
No Pollution
No Birth
Defects Total
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106
a b
dc
People who are not exposed
dc
2 x 2 Table
Pollution Linked with Birth Defects in US Study
Pollution
Birth Defects
No Pollution
No Birth
Defects Total
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107
a b
dc
2 x 2 Table
Depressed Teens More Likely to Smoke
Total
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108
a b
dc
People who do not have the outcome
d
b
2 x 2 Table
Depressed Teens More Likely to Smoke
Depression
Smoke
No Depression
No Smoke Total
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109
a b
dc
2 x 2 Table
Smoking Linked to Youth Eating Disorders
Total
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110
a b
dc
2 x 2 Table
Smoking Linked to Youth Eating Disorders
Smoke
Eating Disorders
No Smoke
No Eating
Disorders Total
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111
a b
dc
People who are exposed and do not have the outcome
b
2 x 2 Table
Smoking Linked to Youth Eating Disorders
Smoke
Eating Disorders
No Smoke
No Eating
Disorders Total
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112
a b
dc
2 x 2 Table
Total
Study Links Spanking to Aggression
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113
a b
dc
People who have the outcome
a
c
2 x 2 Table
Study Links Spanking to Aggression
Spanking
Aggression
No Spanking
TotalNo
Aggression
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114
a b
dc
2 x 2 Table
Total
Snacks Key to Kids’ TV-Linked Obesity – China Study
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115
a b
dc
2 x 2 Table
Snacks Key to Kids’ TV-Linked Obesity – China Study
Snacks
Obesity
No Snacks
No Obesity Total
People who are not exposed and have the outcome
c
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116
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117
National Research Council , Learning and Understanding
Teach Epidemiology
Enduring Epidemiological Understandings
Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”
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118
Laboratory
Teach Epidemiology
Making Group Comparisons and Identifying Associations
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119
Laboratory
Teach Epidemiology
Making Group Comparisons and Identifying Associations
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120
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
Making Group Comparisons and Identifying Associations
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121
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
Making Group Comparisons and Identifying Associations
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122
An epidemiologic experiment in which subjects are assigned into groups to receive or not receive
a hypothesized beneficial intervention.
Controlled Trial
Teach Epidemiology
Making Group Comparisons and Identifying Associations
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123
Buprenorphine
Buprenorphine will stop heroin addicts from using heroin.
Teach Epidemiology
Making Group Comparisons and Identifying Associations
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124
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
Making Group Comparisons and Identifying Associations
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125
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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126
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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127
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.
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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128
A particular or detached incident or fact of an interesting nature; a biographical incident or
fragment; a single passage of private life.
Anecdote
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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129
Science
Transforming Anecdote to Science
Making Group Comparisons and Identifying Associations
Teach Epidemiology
Anecdote
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130
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
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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131
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
d
b
c
a
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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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
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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133
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134
Ms. Wilson
After-School, Make-Up Homework Hall
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135
Talking too much on a cell phone causes students not to do their homework.
a
c
b
d
Label the 2x2 Table
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136
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
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137
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
Place the data into the 2x2 Table
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138
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
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139
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
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140
Breast Implants
No Breast
Implants
No Connective Tissue Disease
3 1,180 1,183
513 85,805 86,318
Cohort Study – The Nurses’ Health Study (1976)
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
TotalConnective
Tissue Disease
Risk
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141
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
RiskX
Odds
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142
Odds
A ratio of the probability of occurrence of an event to that of its nonoccurrence.
Talking too much on a cell phone causes students not to do their homework.
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143
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
15
5
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
A ratio of the probability of occurrence
of an event to that of its nonoccurrence.
15 to 5 or 3 to 1
Odds
Talking too much on a cell phone causes students not to do their homework.
20
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144
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
15
5
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
Talking too much on a cell phone causes students not to do their homework.
20
Nothing
A ratio of the probability of occurrence
of an event to that of its nonoccurrence.
15 to 5 or 3 to 1
OddsCompared to what?
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145
CompareDivideCount
Talking too much on a cell phone causes students not to do their homework.
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146
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
15
5
Which of the following statements can be made based on the above data:
A: 15 of 20 students, who did not do their homework, had cell phones. B: 15 of 20 students, who had cell phones, did not do their homework.
Talking too much on a cell phone causes students not to do their homework.
20
Nothing
A ratio of the probability of occurrence
of an event to that of its nonoccurrence.
15 to 5 or 3 to 1
OddsCompared to what?
What did Ms. Wilson do?
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147
Talking too much on a cell phone causes students not to do their homework.
What did Ms. Wilson do?
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148
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
10
30
403 to 1
10 to 30 or 1
to 3
Place the data into the 2x2
Table
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149
What mathematical computation would allow them to complete the statement:
The odds of having a cell phone were ____ times greater among students who had not done their homework compared to students who did do their homework.
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
10
30
403 to 1
10 to 30 or 1
to 3
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What mathematical computation would allow them to complete the statement:
The odds of having a cell phone were ____ times greater among students who had not done their homework compared to students who did do their homework.150
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
10
30
403 to 1
3 / 1 = 3 1 / 3 = .333 / .33 = 9
9
10 to 30 or 1
to 3
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151
Odds Ratio
Ratio of odds in favor of exposure among cases to the odds in favor of exposure among controls.
Talking too much on a cell phone causes students not to do their homework.
Relative Odds
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152
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
35
5
40
Odds Ratio
What mathematical computation would allow them to complete the statement:
The odds of having a cell phone were ____ times greater among students who had not done their homework compared to students who did do their homework.
.43
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153
a
c
b
dDid Not
Have Cell Phone
Did Not Do Homework
Did Homework
Had Cell Phone
Total
Talking too much on a cell phone causes students not to do their homework.
15
5
20
30
10
40
Odds Ratio
What mathematical computation would allow them to complete the statement:
The odds of having a cell phone were ____ times greater among students who had not done their homework compared to students who did do their homework.
1
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154
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Arthur Herbst, et al. “Adenocarcinoma of the Vagina,” New England Journal of Medicine, 284:16, 1971, 878-881
Case-Control Study
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Case-Control Study
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Authentic Assessment
Teach Epidemiology
Epi – Grades 6-12
• Are realistic; simulate the way a person’s understanding is tested in the real world
•Require judgment and innovation to address an unstructured problem, rather than following a set routine
• Ask students to “do” the subject rather than simply recall what was taught
•Replicate the context in which a person would be tested at work, in the community, or at home
• Are messy and murky
• Require a repertoire of knowledge and skill to be used efficiently and effectively
• Allow opportunities for rehearsal, practice, consultation, feedback, and refinement
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Epi Challenge
http://www.teachepidemiology.org/viewSO1.php
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Epi Challenge
http://www.teachepidemiology.org/viewSO2.php
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Think Like an Epidemiologist ChallengeNew Jersey Science Olympiad, March 15, 2011
Thank you for competing in the 3rd Think Like an Epidemiologist Challenge.
You worked with others, developed epidemiologic knowledge and skills, and used judgment and innovation to actually "do" epidemiology under
pressure.
We hope you enjoyed the challenge.
NameSchool
Teach Epidemiology
Robert Wood Johnson Foundation
Detectives in the
Classroom
Special thanks to the Epidemiology Section of the American Public Health Association for allowing us to distribute their Section pins to the student participants in the 2011 Think Like an Epidemiologist Challenge.
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Time Check
10:45 AM
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Revised
Teach Epidemiology
Teach Epidemiology
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Time Check
11:00 AM
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The Journey
The Journey
Detectives in the Classroom - Investigation 2-6: The Journey
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The Journey from Exposure to Disease
Detectives in the Classroom - Investigation 2-6: The Journey
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Analogy
Detectives in the Classroom - Investigation 2-6: The Journey
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Epi Talk
Study Design Epi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
Procedures and methods, established beforehand, that are followed by the investigator conducting the study.
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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?
-
Detectives in the Classroom - Investigation 2-6: The Journey
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
E DZ
Label the Train Tracks
-
Detectives in the Classroom - Investigation 2-6: The Journey
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Study Design:
E DZ
Label the Train Tracks
-
Detectives in the Classroom - Investigation 2-6: The Journey
Controlled Trial
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Healthy People
Controlled
Trial
Flow Diagram
Flow Diagram
Detectives in the Classroom - Investigation 2-6: The Journey
-
Healthy People
E
Random Assignment
E
DZ
DZ
DZ
DZ
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Study Design:
Label the Train Tracks
Detectives in the Classroom - Investigation 2-6: The Journey
Cohort Study
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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.
Label the Train Tracks
Detectives in the Classroom - Investigation 2-6: The Journey
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
E DZ
Label the Train Tracks
-
Detectives in the Classroom - Investigation 2-6: The Journey
Study Design: Cohort Study
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Healthy People
Cohort
Study
Flow Diagram
Flow Diagram
Detectives in the Classroom - Investigation 2-6: The Journey
-
Healthy People
E
E
DZ
DZ
DZ
DZ
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Healthy People
Cohort
Study
Flow Diagram
Flow Diagram
Detectives in the Classroom - Investigation 2-6: The Journey
-
Healthy People
E
E
DZ
DZ
DZ
DZ
Controlled
Trial
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Healthy People
Cohort
Study
Flow Diagram
Flow Diagram
Detectives in the Classroom - Investigation 2-6: The Journey
-
Healthy People
E
E
DZ
DZ
DZ
DZ
Controlled
Trial
Random Assignment
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Review
Observational StudiesEpi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
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.
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Label the Train Tracks
Detectives in the Classroom - Investigation 2-6: The Journey
Study Design: Case-Control Study
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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.
Label the Train Tracks
Case-Control Study
Detectives in the Classroom - Investigation 2-6: The Journey
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
E
DZ
Label the Train Tracks
-
Detectives in the Classroom - Investigation 2-6: The Journey
Study Design: Case-Control Study
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Case-Control
Study
Observational
Study
Flow Diagram
Flow Diagram
Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
DZ
-
DZ
E
E
E
E
Detectives in the Classroom - Investigation 2-6: The Journey
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Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Label the Train Tracks
Detectives in the Classroom - Investigation 2-6: The Journey
Study Design: Cross-Sectional Study
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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.
Label the Train Tracks
Cross-Sectional Study
Detectives in the Classroom - Investigation 2-6: The Journey
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EDZ
Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Label the Train Tracks
-
Detectives in the Classroom - Investigation 2-6: The Journey
Study Design: Cross-Sectional Study
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Cross-Sectional
Study
Observational
Study
Flow Diagram
Flow Diagram
Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
E
E
-
DZ
DZ
Detectives in the Classroom - Investigation 2-6: The Journey
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Epi Talk
Controlled TrialEpi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
An epidemiologic experiment in which subjects are assigned into groups to receive or not receive a hypothesized beneficial intervention.
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Epi Talk
Cohort StudyEpi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
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.
![Page 232: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/232.jpg)
Epi Talk
Case-Control StudyEpi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
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.
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Epi Talk
Cross-Sectional StudyEpi Talk
Detectives in the Classroom - Investigation 2-6: The Journey
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.
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234
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Epi Teams
Detectives in the Classroom - Investigation 2-6: The Journey
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What’s My Design?
Detectives in the Classroom - Investigation 2-6: The Journey
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
Epi Team
Challenge
Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
-
DZ
DZ
E
E
E
E
Case-Control Study
Time
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
-
E
E
DZ
Cross-Sectional Study
DZ
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Controlled Trial
Epidemiologist is involved during the entire time from exposure and 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?
Detectives in the Classroom - Investigation 2-6: The Journey
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Observational
Study
Flow Diagram
Flow Diagram
-
DZ
DZ
E
E
E
E
Detectives in the Classroom - Investigation 2-6: The Journey
Case-Control Study
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Observational
Study
Detectives in the Classroom - Investigation 2-6: The Journey
What’s My Design?
Cohort, Case-Control, and Cross-Sectional Study
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CDC
Investigation 2-6 has ended.
The Journey
Detectives in the Classroom - Investigation 2-6: The Journey
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241
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Epi Team Challenge
Epi Team ChallengeDetectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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
Cross-Sectional Study
DZ
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Assign treatment and control groups.
What’s My Design?
Clue 1
Begin Epi Team Challenge
Trial
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Observational
Study
Flow Diagram
DZ
-
DZ
E
E
E
E
Clue 2
Case-Control Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Observational
Study
Flow Diagram
Clue 3
What’s My Design?
Cohort, Case-Control, and Cross-Sectional Studies
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 249: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/249.jpg)
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.
Clue 5
Trial
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Epidemiologist is involved during the entire time from exposure to disease.
Clue 6
Trial and Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 251: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/251.jpg)
Select a group of people with disease and a similar group of people without disease.
Clue 7
Case-Control Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 252: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/252.jpg)
Healthy People
Flow Diagram
-
Healthy People
E
E
Random Assignment
Non-Observational
Study
Clue 8
Trial
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Observational
Study
Flow Diagram
E
E
-
DZ
DZClue 9
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Compare percent of exposed people in the two groups.
Clue 10
Case-Control Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Healthy People
Flow Diagram
-
Healthy People
E
E
DZ
DZ
DZ
DZRandom
Assignment
Clue 11
Trial
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Flow Diagram
Clue 12
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Flow Diagram
DZ
DZ
DZ
DZObservational
Study
Clue 13
Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Ask each person about both exposure and disease at that point in time.
What’s My Design?
Clue 14
Cross Sectional Study
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Ask both groups about their exposures in the past.
What’s My Design?
Clue 15
Case-Control Study
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Healthy People
Flow Diagram
-
Healthy People
Random Assignment
Clue 16
Trial
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Flow Diagram
E
E
-
DZ
DZClue 18
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Select a healthy study sample.
Clue 19
Trial (?) and Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Observe who has and has not been exposed.
Clue 20
Cohort and Cross-Sectional Studies
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 265: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/265.jpg)
Clue 21
Give exposure to treatment group, but not control group.
Trial
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Healthy People
Flow Diagram
-
Healthy People
E
EObservational
Study
Clue 22
Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 268: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/268.jpg)
Select a study sample.
Clue 24
Trial, Cohort, Case-Control, and Cross Sectional Studies
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 269: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/269.jpg)
Healthy People
Flow Diagram
-
Healthy People
E
E
DZ
DZ
DZ
DZObservational
Study
Clue 25
Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Epidemiologist gathers data only at that one point in time.
Clue 26
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Flow Diagram
DZ
DZ
DZ
DZ
Clue 27
Trial and Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Follow through time and compare risk of disease in exposed group to risk of disease in unexposed group.
Clue 28
Trial and Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Epidemiologist is involved during the entire time from exposure to disease.
Clue 29
Trial and Cohort Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 274: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/274.jpg)
Flow Diagram
E
E
DZ
DZClue 30
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Flow Diagram
DZ
-
DZ
Clue 31
Case-Control Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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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
Cross Sectional Study
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 277: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/277.jpg)
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?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 278: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/278.jpg)
Epidemiologist is involved during the entire time from exposure to disease.
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?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
![Page 279: Carnegie Institution for Science 1530 P Street, NW Washington, DC 20005 April 18-21, 2011 Teach Epidemiology Professional Development Workshop Day 3.](https://reader031.fdocuments.us/reader031/viewer/2022013101/56649edc5503460f94bec873/html5/thumbnails/279.jpg)
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.
Trial
Clue 35
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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End Epi Team Challenge
What’s My Design?
Detectives in the Classroom - Investigation 2-7: Epi Team Challenge
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Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
Which Design
Is Best?
Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Epi Team ChallengeEpi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Cross-Sectional
CohortCase-
Control Controlled
Trial
Epi Team ChallengeEpi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Which study design is the fastest?
Epi Team ChallengeEpi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Time Consuming
Which study designs are the most time consuming?
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
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
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Most Scientifically Sound
Can Study Rare Diseases
Which study design is best for studying rare diseases?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Most Scientifically Sound
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Which study designs do not identify the time order of exposure and disease?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Which study design gives the least confidence in findings?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Which study design provides the best measure of exposure?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Most Accurate Observational Study
Which study design is the most accurate observational study?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Most Accurate Observational Study
Which study design is the least expensive?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Unethical for Harmful Exposures
Most Accurate Observational Study
Which study design would be unethical for harmful
exposures?
Time Consuming
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Good Measure of Exposure
Which study design provides a good measure of exposure?
Most Accurate Observational Study
Time ConsumingUnethical for Harmful exposures
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Most Expensive
Most Expensive
Most Accurate Observational Study
Which study designs are the most expensive?
Good Measure of Exposure
Time ConsumingUnethical for Harmful exposures
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Relatively Less Expensive and Relatively Fast
Most Accurate Observational Study
Which study design is relatively less expensive and relatively fast?
Time ConsumingUnethical for Harmful exposures
Most Expensive
Most ExpensiveGood Measure of Exposure
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Least Confidence in Findings
Most Scientifically Sound
Best Measure of Exposure
Possible Time-Order Confusion
Possible Time-Order Confusion
Can Study Rare Diseases
Least Expensive
Relatively Less Expensive and Relatively Fast
Possible Error in Recalling Past Exposures
Most Accurate Observational Study
Which study design creates the possibility of error in recalling past exposures?
Time ConsumingUnethical for Harmful exposures
Most Expensive
Most ExpensiveGood Measure of Exposure
Epi Team Challenge
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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Cross-Sectional Study
Case-Control Study
Cohort Study
Trial
Main WeaknessesMain StrengthsStudy Designs
1 5
62
3 7
84
Fastest
Time Consuming
Most Scientifically Sound
Best Measure of Exposure
Can Study Rare Diseases
Least Expensive
Relatively Less Expensive and Relatively Fast
Possible Error in Recalling Exposures
Most Accurate Observational Study
Which Design Is Best?
Which Design Is Best?
Time Consuming
Unethical for Harmful exposuresMost Expensive
Most Expensive
Possible Time-Order Confusion
Possible Time-Order Confusion
Least Confidence in Findings
Good Measure of Exposure
It depends ….
Detectives in the Classroom - Investigation 2-8: Which Design Is Best?
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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?
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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
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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
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
Eb
Flow Diagram 2x2 Table
Healthy PeopleHealthy People
E
E
DZ
DZ
DZ
DZ
Random Assignment
Where do these people “fit” in the 2x2 table?
Controlled Trial
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
c
Flow Diagram 2x2 TableFlow Diagram
Healthy PeopleHealthy People
E
E
DZ
DZ
DZ
DZ
Random Assignment
Where do these people “fit” in the 2x2 table?
Controlled Trial
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
d
2x2 TableFlow Diagram
Healthy PeopleHealthy People
E
E
DZ
DZ
DZ
DZ
Random Assignment
Where do these people “fit” in the 2x2 table?
Controlled Trial
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
c
Flow Diagram 2x2 Table
Where are these people in the flow diagram?
Cohort Study
Healthy PeopleHealthy People
E
E
DZ
DZ
DZ
DZ
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
Ea
2x2 Table
Where are these people in the flow diagram?
Flow Diagram
Cohort Study
Healthy People
E
E
DZ
DZ
DZ
DZ
Healthy People
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
d
Flow Diagram 2x2 Table
Where are these people in the flow diagram?
Cohort Study
Healthy People
E
E
DZ
DZ
DZ
DZ
Healthy People
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
Eb
Flow Diagram 2x2 Table
Where are these people in the flow diagram?
Cohort Study
Healthy People
E
E
DZ
DZ
DZ
DZ
Healthy People
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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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
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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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
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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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
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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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
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E aFlow Diagram
2x2 Table
Where do these
people go in the
2x2 table?
Cross-Sectional Study
E
E
DZ
DZ
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
c
Flow Diagram
2x2 Table
Where do these
people go in the
2x2 table?
Cross-Sectional Study
E
E
DZ
DZ
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
E
d
Flow Diagram
2x2 Table
Where do these
people go in the
2x2 table?
Cross-Sectional Study
E
E
DZ
DZ
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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DZ DZ
E
Eb
Flow Diagram
2x2 Table
Where do these
people go in the
2x2 table?
Cross-Sectional Study
E
E
DZ
DZ
Detectives in the Classroom – Investigation 2-9: Designs, Diagrams, and Tables
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319
National Research Council , Learning and Understanding
Teach Epidemiology
Enduring Epidemiological Understandings
Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”
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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
Making Group Comparisons and Identifying Associations
Teach Epidemiology
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321
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322
Revised
Teach Epidemiology
Teach Epidemiology
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Teach Epidemiology Workshop—Day 3Diane Marie M St. George, PhDUniversity of MD School of MedicineDept of Epidemiology and Public Health
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EU7: One possible explanation for EU7: One possible explanation for finding an association is that the finding an association is that the exposure causes the outcome. exposure causes the outcome. Because studies are complicated by Because studies are complicated by factors not controlled by the observer, factors not controlled by the observer, other explanations also must be other explanations also must be considered, including confounding, considered, including confounding, chance, and bias.chance, and bias.
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EU8: Judgments about whether an exposure EU8: Judgments about whether an exposure causes a disease are developed by causes a disease are developed by examining a body of epidemiologic examining a body of epidemiologic evidence, as well as evidence from other evidence, as well as evidence from other scientific disciplines.scientific disciplines.
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EU9: While a given exposure may be EU9: While a given exposure may be necessary to cause an outcome, the necessary to cause an outcome, the presence of a single factor is seldom presence of a single factor is seldom sufficient. Most outcomes are caused sufficient. Most outcomes are caused by a combination of exposures that may by a combination of exposures that may include genetic make-up, behaviors, include genetic make-up, behaviors, social, economic, and cultural factors social, economic, and cultural factors and the environment. and the environment.
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Reasons for associations
Confounding Bias Reverse causality Sampling error (chance) Causation
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Confounding in our lives
MAP tests measure academic growth over time, independent of grade level or age.
Age- and gender-specific growth charts Age-adjusted rates of… Rates of lung cancer adjusted for smoking Computer exposure may cause illness
(absence), but it actually may just be the football game
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Osteoporosis risk is higher among women who live alone than among women who live with others.
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Confounding
Confounding is an alternate explanation for an observed association of interest.
Number of persons in the
homeOsteoporosis
Age
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Confounding
Confounding is an alternate explanation for an observed association of interest.
Exposure Outcome
Confounder
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Controlling confounding
Study design phaseMatchingRestrictionRandom assignment
Study analysis phaseStratificationStatistical adjustment
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Reasons for associations
Confounding Bias Reverse causality Sampling error (chance) Causation
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Bias
Errors are mistakes that are:randomly distributednot expected to impact the MA less modifiable
Biases are mistakes that are:not randomly distributedmay impact the MAmore modifiable
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Types of bias
Selection biasThe process for selecting/keeping subjects
causes mistakes Information bias
The process for collecting information from the subjects causes mistakes
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Selection bias People who are working are likely to be
healthier than non-workers People who participate in a study may
be different from people who do not People who drop out of a study may be
different from those who stay in the study
Hospital controls may not represent the source population for the cases
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Information bias
Misclassification, e.g. non-exposed as exposed or cases as controls
Cases are more likely than controls to recall past exposures
Interviewers probe cases more than controls (exposed more than unexposed)
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Birth defects and diet
In a study of birth defects, mothers of children with and without infantile cataracts are asked about dietary habits during pregnancy.
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Pesticides and cancer mortality
In a study of the relationship between home pesticide use and cancer mortality, controls are asked about pesticide use and family members are asked about their loved ones’ usage patterns.
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Minimize bias
Can only be done in the planning and implementation phase
Standardized processes for data collection Masking Clear, comprehensive case definitions Incentives for participation/retention
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Reasons for associations
Confounding Bias Reverse causality Sampling error (chance) Causation
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Reverse causality
Suspected disease actually precedes suspected cause
Pre-clinical disease Exposure DiseaseFor example: Memory deficits Reading
cessation Alzheimer’s Cross-sectional study
For example: Sexual activity/Marijuana
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Minimize effect of reverse causality
Done in the planning and implementation phase of a study
Pick study designs in which exposure is measured before disease onset
Assess disease status with as much accuracy as possible
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Reasons for associations
Confounding Bias Reverse causality Sampling error (chance) Causation
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Sampling error/chance
E and D are associated in a sample, but not in the population from which the sample was drawn.
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RR in the populationRR in the population
D+D+ D-D-
E+E+ 5050 5050 100100
E-E- 5050 5050 100100
100100 100100 200200
RR = (24 / 718) / (281 / 8566) = 1.0
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RR in sample 1RR in sample 1
D+D+ D-D-
E+E+ 2525 2525 5050
E-E- 2525 2525 5050
5050 5050 100100
RR = (24 / 718) / (281 / 8566) = 1.0
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RR in sample 2RR in sample 2
D+D+ D-D-
E+E+ 4545 55 5050
E-E- 1515 3535 5050
5050 5050 100100
RR = (24 / 718) / (281 / 8566) = 1.0
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RR in sample 3RR in sample 3
D+D+ D-D-
E+E+ 2020 3030 5050
E-E- 3030 2020 5050
5050 5050 100100
RR = (24 / 718) / (281 / 8566) = 1.0
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Minimize sampling error (chance)
Random Selection
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351
Time Check
12:30 PM
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352
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353
Revised
Teach Epidemiology
Teach Epidemiology
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354
Time Check
1:30 PM
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356
Revised
Teach Epidemiology
Teach Epidemiology
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357
Time Check
2:00 PM
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358
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359
Revised
Teach Epidemiology
Teach Epidemiology
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360
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361Teach Epidemiology
Enduring Epidemiological Understandings
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362
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
Ties, Links, Relationships, and Associations
Snacks Key to Kids’ TV- Linked Obesity: China
Study
Depressed Teens More
Likely to Smoke
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363
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
Snacks Key to Kids’ TV- Linked Obesity: China
Study
Depressed Teens More
Likely to Smoke
Ties, Links, Relationships, and Associations
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364
1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Possible Explanations for Finding an Association
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365
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.
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366
1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Possible Explanations for Finding an Association
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367
Cause
A factor that produces a change in another factor.
William A. Oleckno, Essential Epidemiology: Principles and Applications, Waveland Press, 2002.
Possible Explanations for Finding an Association
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Sample of 100
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369
Sample of 100, 25 are Sick
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370
Diagram
2x2 Table
DZ DZ
X
X
a bc d
Types of Causal Relationships
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371
DZ DZ
X
X
a bc d
Diagram
2x2 Table
Types of Causal Relationships
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372
Handout
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373
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374
X1
X1
X1
X1
X1
X1
X1
X1
X1 X1
X1
X1X1X1
X1X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1 DZ
DZ DZ
X1
X1
a bc d
Diagram
2X12 Table
Necessary and Sufficient
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X1
375
DZ DZ
a bc d
X1 DZX2 X3+ +X1
X1
X1
X1
X1
X1
X1
X1
X1 X1
X1
X1X1X1
X1X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1X1
Diagram
2X12 Table
Necessary but Not Sufficient
X1
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X1
376
X1
X1
X1
X1
X1
X1
X1
X1 X1
X1
X1X1
X1
X1
X1
X1
DZ DZ
a bc d
X2 DZ
X1
X3
Diagram
2X12 Table
Not Necessary but Sufficient
X1
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X1
377
DZ DZ
a bc d
X1
X1
X1
X1
X1
X1
X1 X1
X1X1X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1
X1X1
X4
X1
X7
DZX5 X6+ +
X2 X3+ +
X8 X9+ +
Not Necessary and Not Sufficient
Diagram
2X12 Table
X1
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378
X
X
X
X
X
X
X
X
X X
X
XXX
XX
X
X
X
X
X
X
X
X
X
X DZ
DZ DZ
X
X
a bc d
X
Diagram
2x2 Table
Necessary and Sufficient
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379
DZ DZ
X
X
a bc d
X DZX X+ +
X
X
X
X
X
X
X
X
X
X X
X
XXX
XX
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
XX
Diagram
2x2 Table
Necessary but Not Sufficient
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380
X
X
X
X
X
X
X
X X
X
XX
X
X
X
X
DZ DZ
X
X
a bc d
X
X DZ
X
X
Diagram
2x2 Table
Not Necessary but Sufficient
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381
DZ DZ
X
X
a bc d
X
X
X
X
X
X
X
X X
XXX
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
XX
X
X
X
DZX X+ +
X X+ +
X X+ +
Not Necessary and Not Sufficient
Diagram
2x2 Table
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382
a b
c d
Heart Attack
NoHeart Attack
Lack of Fitness
No Lack of Fitness
Lack of fitness and physical activity causes heart attacks.
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383
a b
c d
Lead Poisoning
NoLead
Poisoning
Lack of Supervision
No Lack of
Supervision
Lack of supervision of small children causes lead poisoning.
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384
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385
Is the association causal?
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386
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
Ties, Links, Relationships, and Associations
1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Snacks Key to Kids’ TV- Linked Obesity: China
Study
Depressed Teens More
Likely to Smoke
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387Teach Epidemiology
Enduring Epidemiological Understandings
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388
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389
1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Possible Explanations for Finding an Association
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390
All the people in a particular group.
Population
Possible Explanations for Finding an Association
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391
A selection of people from a population.
Sample
Possible Explanations for Finding an Association
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392
Inference
Process of predicting from what is observed in a sample to what is not observed in a population.
To generalize back to the source population.
Possible Explanations for Finding an Association
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393
Sample
Population
Process of predicting from what is observed
to what is not observed.
Observed
Not Observed
Inference
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394
Deck of
100 cards
Population
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395
a
25 cards
b
25 cards
c
25 cards
25 cards
d
Population
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396
=
Population
a
25 cards
b c d
25 cards25 cards25 cards
=a b
c d
Odd #
Even #
No Marijuana
No Marijuana
Population
Total
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397
=
Population
a
25 cards
b c d
25 cards25 cards25 cards
= 2525
25 25
50
50
Total
Odd #
Even #
No Marijuana
No Marijuana
Population
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398
=
Population
=M&M’s
No M&M’s
FluNo
Flu
2525
25 25
50
50
Total
=
2525
25 25
50
50
Total
a
25 cards
b c d
25 cards25 cards25 cards
Odd #
Even #
No Marijuana
No Marijuana
Population
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399
=
Population
=
2525
25 25
50
50
Total
a
25 cards
b c d
25 cards25 cards25 cards
Risk
25 / 50 or 50%
25 / 50 or 50%
Odd #
Even #
No Marijuana
No Marijuana
Population
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400
=
Population
a
25 cards
b c d
25 cards25 cards25 cards
=
2525
25 25
50
50
Total Risk Relative Risk
25 / 50 or 50 %
25 / 50 or 50 %50 % / 50% = = 1
50 %
50 %
____Odd #
Even #
No Marijuana
No Marijuana
Population
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401
25 cards
25 cards
25 cards
25 cards
Population
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402
To occur accidentally.
To occur without design.
Chance
A coincidence.
Possible Explanations for Finding an Association
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403
Chance
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404
Chance
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405
Population
Sample
b
Sample
of
20 cards25 cards25 cards25 cards25 cards
Sample
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406
Population
Sample
b
Sample
of
20 cards25 cards25 cards25 cards25 cards
10
10
Total
55
5 5Odd #
Even #
No Marijuana
No Marijuana
Sample
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407
Population
Sample
b
Sample
of
20 cards25 cards25 cards25 cards25 cards
10
10
Total
55
5 5
Risk
5 / 10 or 50 %
5 / 10 or 50 %Odd #
Even #
No Marijuana
No Marijuana
Sample
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408
Population
Sample
b
Sample
of
20 cards25 cards25 cards25 cards25 cards
10
10
Total
55
5 5
Risk
5 / 10 or 50 %
5 / 10 or 50 %Odd #
Even #
No Marijuana
No Marijuana
Sample
Relative Risk
50 % / 50% = = 150 %
50 %
____
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409
b
Sample
of
20 cards
TotalRisk
5 / 10 = 50 %
5 / 10 = 50 %
50 1
Relative Risk
By Chance CDC
% ___
%
=Odd #
Even #
No Marijuana
No Marijuana
Sample
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410
10
10
Total
55
5 5
Risk
5 / 10 or 50 %
5 / 10 or 50 %
Relative Risk
How many students picked a sample with 5 people in each cell?
= 150 %
50 %
____
Odd #
Even #
No Marijuana
No Marijuana
Chance
By Chance
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411
Relative Risks
Greater than 1 Less than 1
Chance
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412
Study Links Having an Odd Address to Marijuana Use
Ties, Links, Relationships, and Associations
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413
Relative Risks
Greater than 1 Less than 1
Possible Explanations for Finding an Association
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414
Study Links Having an Even Address to Marijuana Use
Ties, Links, Relationships, and Associations
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415
Relative Risks
Greater than 1 Less than 1
1
By ChanceBy Chance
25 cards25 cards25 cards25 cards
Chance
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416
b
Sample
of
20 cards
TotalRisk
5 / 10 = 50 %
5 / 10 = 50 %
50
Relative Risk
50
%___
%
=Odd #
Even #
No Marijuana
No Marijuana
Different Sample Sizes
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417
Relative Risks
Greater than 1 Less than 1
1
By ChanceBy Chance
25 cards25 cards25 cards25 cards
Chance
50 cards
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418
b
Sample
of
20 cards
TotalRisk
5 / 10 = 50 %
5 / 10 = 50 %
50
Relative Risk
75
%___
%
=Odd #
Even #
No Marijuana
No Marijuana
Different Sample Sizes
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419
Relative Risks
Greater than 1 Less than 1
1
By ChanceBy Chance
25 cards25 cards25 cards25 cards
Chance
75 cards
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420
b
Sample
of
20 cards
TotalRisk
5 / 10 = 50 %
5 / 10 = 50 %
50 1
Relative Risk
99
%___
%
=Odd #
Even #
No Marijuana
No Marijuana
Different Sample Sizes
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421
Relative Risks
Greater than 1 Less than 1
1
By ChanceBy Chance
25 cards25 cards25 cards25 cards
Chance
99 cards
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422
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
1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Snacks Key to Kids’ TV- Linked Obesity: China
Study
Depressed Teens More
Likely to Smoke
Association is not necessarily causation.
Ties, Links, Relationships, and Associations
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423Teach Epidemiology
Enduring Epidemiological Understandings
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424
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425
Revised
Teach Epidemiology
Teach Epidemiology
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426
Time Check
3:30 PM
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427
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428Teach Epidemiology
Enduring Epidemiological Understandings
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Teach Epidemiology
Explaining Associations and Judging Causation
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1. Cause
2. Confounding
3. Reverse Time Order
4. Chance
5. Bias
Teach Epidemiology
Explaining Associations and Judging Causation
Coffee and Cancer of the Pancreas
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431
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432
Guilt or Innocence?Causal or Not Causal?
Does evidence from an aggregate of studies support a cause-effect relationship?
Teach Epidemiology
Explaining Associations and Judging Causation
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433
Sir Austin Bradford Hill “The Environment and Disease:
Association or Causation?” Proceedings of the Royal Society of Medicine
January 14, 1965
Teach Epidemiology
Explaining Associations and Judging Causation
Handout
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434
“In what circumstances can we pass from this observed association
to a verdict of causation?”
Teach Epidemiology
Explaining Associations and Judging Causation
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435
“Here then are nine different viewpoints from all of which we should study association
before we cry causation.”
Teach Epidemiology
Explaining Associations and Judging Causation
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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
Explaining Associations and Judging Causation
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Handout
Teach Epidemiology
Explaining Associations and Judging Causation
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Timeline
Cohort Study
Randomized Controlled Trial
Timeline
Case-Control Study
Timeline
Cross-Sectional Study
Timeline
E
E
O
O
O
O
E
E
E
E
Healthy PeopleHealthy People
E
Random Assignment
E
O
O
O
O
Healthy PeopleHealthy People
E
E
O
O
O
O
Teach Epidemiology
Explaining Associations and Judging Causation
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Teach Epidemiology
Explaining Associations and Judging Causation
Handout
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440
Stress causes ulcers.
Helicobacter pylori causes ulcers.
Teach Epidemiology
Explaining Associations and Judging Causation
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441
*
*
*
**
*
*
*
*
Teach Epidemiology
Explaining Associations and Judging Causation
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442Teach Epidemiology
Explaining Associations and Judging Causation
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443
Time Check
4:30 PM
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444