1 integrating epidemiology education into your existing curriculum clarion university, february...

1

Integrating Epidemiology Education into Your Existing Curriculum

Clarion University, February 18-20, 2008

Young Epidemiology Scholars Teaching Units

Welcome to the

Professional Development Workshop

3

2

YES Teaching Units Professional Development Workshop


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4



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5

Group

2TV and Aggressive Acts

Pages 1-33

Group

1Testing

Ephedra

“Pages 20-29

Group

3Cross-Sectional

Study Design

Pages 35-39

Teaching the Teaching Units


6

“… to see past the surface features of any problem to the deeper, more fundamental principles of the discipline.”

National Research Council, Learning and Understanding



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8

Group


Pages 1-33

Group

1Testing

Ephedra

“Pages 20-29

Group

3Cross-Sectional

Study Design

Pages 35-39



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10



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Group


Pages 1-33

Group

1Testing

Ephedra

“Pages 20-29

Group

3Cross-Sectional

Study Design

Pages 35-39



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15

Report and Reflection Log


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20YES Teaching Units Professional Development Workshop

Enduring Understandings

23

Associated

Association Found Between Coffee and Pancreatic Cancer


24

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


25

Outcome

Outcome

a b

c d

Exposure

No

Exposure

No Outcome

Exp

osu

re

Things that are associated are linked in some way that makes them turn up

together.

Associated


26

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


Outcome

a b

c d

Exposure

No Exposure

No Outcome

28

A factor that produces a change in another factor

William A. Oleckno, Essential Epidemiology: Principles and Applications, Waveland Press, 2002.

Cause



Cause

31

Diagram

2x2 Table

DZ DZ

X

X

a bc d


Cause

32

DZ DZ

X

X

a bc d

Diagram

2x2 Table


Cause: Types of Causal Relationships

33

Handout


Cause

34

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


Cause: Necessary and Sufficient

35

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


Cause: Necessary but Not Sufficient

36

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


Cause: Not Necessary but Sufficient

37

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+ +

Diagram

2x2 Table


Cause: Not Necessary and Not Sufficient

38

a b

c d

Heart Attack

NoHeart Attack

Lack of Fitness

No Lack of Fitness


Cause

39

a b

c d

Lead Poisoning

NoLead

Poisoning

Lack of Supervision

No Lack of

Supervision


Cause


Cause

41

New York Times March

29, 2002


Cause

42




Rate

Study Links

Spanking to

Aggression


Youth Smoking

Study Links Iron

Deficiency to Math

Scores

Snacks Key to Kids’ TV- Linked Obesity: China

Study

Depressed Teens More

Likely to Smoke

Association is not necessarily causation.


Possible Explanations for Finding an Association

Cause

Confounding

Bias

Chance

Reverse Time Order

1.

2.

3.

4.

5.

43

1.

2.

3.

4.

5.



... 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, 2004)

Cause

Confounding

Bias

Chance

Reverse Time Order

45




Rate

Study Links

Spanking to

Aggression


Youth Smoking

Study Links Iron

Deficiency to Math

Scores


1. Cause

2.

3.

4.

5.


StudyDepressed Teens More

Likely to Smoke




47

1. Cause

2. Confounding

3.

4.

5.



48




Rate

Study Links

Spanking to

Aggression


Youth Smoking

Study Links Iron

Deficiency to Math

Scores


1. Cause

2. Confounding

3. Bias

4.

5.



Likely to Smoke




49

Confounding

Confounding is an alternate explanation for Confounding is an alternate explanation for an observed association of interest.an observed association of interest.

Exposure Outcome

Confounder

50

CHD and Baldness

Hypothetical cohort studyHypothetical cohort study Confounding moduleConfounding module 20,000 men followed for 10 years20,000 men followed for 10 years

51

CHD and Baldness

CHD+CHD+ CHD-CHD-

BaldBald 775775 9,2259,225 10,00010,000

Not baldNot bald 190190 9,8109,810 10,00010,000

965965 19,03519,035 20,00020,000

RR=(775/10,000)/(190/10,000) ~ 4

52

Confounding

Confounding is an alternate explanation for Confounding is an alternate explanation for an observed association of interest.an observed association of interest.

Baldness CHD

Age

53

CHD and Baldness

Is baldness associated with age?Is baldness associated with age? Is age associated with CHD?Is age associated with CHD? If I look only among the older men, would If I look only among the older men, would

CHD be associated with baldness?CHD be associated with baldness? If I look only among the younger men, If I look only among the younger men,

would CHD be associated with baldness?would CHD be associated with baldness?

54

CHD and Baldness (younger)

CHD+CHD+ CHD-CHD-

BaldBald 2525 2,4752,475 2,5002,500

Not baldNot bald 9090 8,9108,910 9,0009,000

115115 11,38511,385 11,50011,500

RR=(25/2,500)/(90/9,000) = 1

55

CHD and Baldness (older)

CHD+CHD+ CHD-CHD-

BaldBald 750750 6,7506,750 7,5007,500

Not baldNot bald 100100 900900 1,0001,000

850850 7,6507,650 8,5008,500

RR=(750/7,500)/(100/1,000) = 1

56

Baldness and CHD stratified by AgeOLDEROLDER CHD+CHD+ CHD-CHD-

Bald+Bald+ aa bb

Bald-Bald- cc dd

RR = 1.0RR = 1.0

YOUNGERYOUNGER CHD+CHD+ CHD-CHD-

Bald+Bald+ aa bb

Bald-Bald- cc dd

RR = 1.0RR = 1.0

OLDEROLDER CHD+CHD+ CHD-CHD-

Bald+Bald+ aa bb

Bald-Bald- cc dd

RR = 4.1RR = 4.1

YOUNGERYOUNGER CHD+CHD+ CHD-CHD-

Bald+Bald+ aa bb

Bald-Bald- cc dd

RR = 4.1RR = 4.1

57

Conditions for confounding

Confounder related to exposure (Is age Confounder related to exposure (Is age associated with baldness?)associated with baldness?)

Confounder related to outcome (Is age Confounder related to outcome (Is age associated with CHD?)associated with CHD?)

Ratio measure of association changes after Ratio measure of association changes after adjusting for the confounder (Is the adjusting for the confounder (Is the unadjusted RR different from the age-unadjusted RR different from the age-adjusted RR?)adjusted RR?)

59

1. Cause

2. Confounding

3. Bias

4. Chance

5.



60

Population

All the people in a particular group

Chance


Sample

A selection of people from a population

Inference

Process of predicting from what is observed in a sample to what is not observed in a population

61

Deck of

100 cards


Chance

62

a

25 cards

b

25 cards

c

25 cards

25 cards

d


Chance

63

=

Population

a

25 cards

b c d

25 cards25 cards25 cards

=a b

c d

Odd #

Even #

No Marijuana

No Marijuana Total


Chance

64

=

Population

a

25 cards

b c d


= 2525

25 25

50

50

Total

Odd #

Even #

No Marijuana

No Marijuana


Chance

65

=

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


Odd #

Even #

No Marijuana

No Marijuana


Chance

66

=

Population

=

2525

25 25

50

50

Total

a

25 cards

b c d


Risk

25 / 50 or 50%

25 / 50 or 50%

Odd #

Even #

No Marijuana

No Marijuana


Chance

67

=

Population

a

25 cards

b c d


=

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


Chance

68

25 cards

25 cards

25 cards

25 cards


Chance


Chance

71

Population

Sample

b

Sample

of

20 cards25 cards25 cards25 cards25 cards


Chance

72

Population

Sample

b

Sample

of


10

10

Total

55

5 5Odd #

Even #

No Marijuana

No Marijuana


Chance

73

Population

Sample

b

Sample

of


10

10

Total

55

5 5

Risk

5 / 10 or 50 %

5 / 10 or 50 %Odd #

Even #

No Marijuana

No Marijuana


Chance

74

Population

Sample

b

Sample

of


10

10

Total

55

5 5

Risk

5 / 10 or 50 %

5 / 10 or 50 %Odd #

Even #

No Marijuana

No Marijuana

Relative Risk

50 % / 50% = = 150 %

50 %

____


Chance

75

b

Sample

of

20 cards

TotalRisk

5 / 10 = 50 %

5 / 10 = 50 %

50 1

Relative Risk

By Chance

% ___

%

=Odd #

Even #

No Marijuana

No Marijuana


Chance

76

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

By ChanceYES Teaching Units Professional Development Workshop

Chance

77

Less than 1

Relative Risks


Chance

Greater than 1Less than 1

78

Study Links Having an Odd Address to Marijuana Use


Chance

79

Less than 1

Relative Risks


Chance


80

Study Links Having an Even Address to Marijuana Use


Chance

81

Relative Risks

1

By ChanceBy Chance

25 cards25 cards25 cards25 cards


Chance


82




Rate

Study Links

Spanking to

Aggression


Youth Smoking

Study Links Iron

Deficiency to Math

Scores


1. Cause

2. Confounding

3. Bias

4. Chance

5.



Likely to Smoke




84

1. Cause

2. Confounding

3. Bias

4. Chance

5. Reverse Time Order



85

A situation in which the hypothesized time order of an exposure and an outcome is reversed

and the “outcome” actually came before the “exposure.”

Reverse Time Order


86

Time

Healthy PeopleHealthy People

E

Random Assignment

E

DZ

DZ

DZ

DZ

Controlled Trial

Time


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


Reverse Time Order


Reverse Time Order

89

Violent Video Games

No Violent Video Games

Aggression

No Aggression

Cross Sectional Study

Violent Video

Games Can

Increase

Aggression

Time

Playing violent

video games

often may well

cause increases

in aggressive

behavior.

Violent Video Games

Aggression

It could be that … highly aggressive individuals are especially attracted to violent video games.


Reverse Time Order

90




Rate

Study Links

Spanking to

Aggression


Youth Smoking

Study Links Iron

Deficiency to Math

Scores


1. Cause

2. Confounding

3. Bias

4. Chance




Likely to Smoke




92


(Gordis, 2004)

… the control of health problems.


93

Outcome

If an association was causal, ….

Hypothesized Exposure XX

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

causal, ….

?



94

Outcome

If the association was found due to confounding, ….

Hypothesized Exposure

Unobserved Exposure


X… and you avoided or eliminated the hypothesized

cause, what would happen to the outcome?

?

found due to confounding, ….


95


Outcome

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




?


96

Outcome

If an association was found due to chance, ….


found due to chance, ….




?


97

Outcome

If an association was found due to bias, ….


?

found due to bias, ….





98

Outcome

If an association was causal, ….

Hypothesized Exposure XX

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

causal, ….




99

1. Cause

2. Confounding

3. Bias

4. Chance




102

Time


E

Random Assignment

E

DZ

DZ

DZ

DZ

Controlled Trial

Time


E

E

DZ

DZ

DZ

DZ

Cohort Study

Time

Case-Control Study

DZ

DZ

E

E

E

E

Time


E

E

DZ

DZ


4 Basic Study Designs

103

Associated


Outcome

a b

c d

Exposure

No

Exposure

No Outcome

104

1. Cause

2. Confounding

3. Bias

4. Chance




105


(Gordis, 2004)


… the control of health problems.

106

Guilt or Innocence?Causal or Not Causal?

Weight of the Evidence

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


107

Association Found Between Coffee and Pancreatic Cancer



Handout

108

Sir Austin Bradford Hill “The Environment and Disease:

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

January 14, 1965



109

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 biological 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?

Cause-Effect Criteria Questions


110

Stress causes ulcers.

Helicobacter pylori causes ulcers.



111

*

*

*

**

*

*

*

*



114



115



116

Acceptable Risk Considerations

… more than scientific evidence.


117

All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing

knowledge. That does not confer upon us the freedom to ignore the

knowledge we already have, or to postpone the action that it appears to demand at a given time.


… more than scientific evidence.

118



119

Timeline


E

E

O

O

O

O

Cohort Study


E

Random Assignment

E

O

O

O

O

Randomized Controlled Trial

Timeline

O

O

E

E

E

E

Case-Control Study

Timeline

E

E

O


O

Timeline

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

Study Designs

120



122



*

123




Welcome to the


3


124

Challenges and Solutions




125

Challenges / Barriers Parking Lot



126

Identify and

Prioritize Challenges

Group

2

Group

1

Group

3


Identify and


Identify and



128



*

130



*

131

Everett M. Rogers, Diffusion of Innovations



132

Innovation

… an idea, practice or object that is perceived as new by an individual or other unit of adoption.




133

Diffusion

The process by which an innovation is communicated through certain channels over time among the members of a social system

(with the aim being to maximize the exposure and reach of innovations, strategies, or programs.)




134

A set of statements or principles devised to explain a group of facts or phenomena,

especially one that has been repeatedly tested or is widely accepted and can be used

to make predictions about natural phenomena http://www.answers.com/topic/theory

Theory



135

1. Innovation Development

All the decisions and activities and their impacts that occur from the early stage of an idea

through to its development and production

5 Stages of Diffusion



136

2. Dissemination

An activity approach for knowledge transfer from the resource system to the user system




137

3. Adoption

The uptake of the program by the target audience, which requires moving through the stages of

knowledge of innovation, persuasion or attitude development, decision, implementation, and confirmation




138

4. Implementation

The initial use of the program in practice




139

5. Maintenance

The ongoing implementation or continued use of the innovation in practice




140

1. Innovation Development

2. Dissemination

3. Adoption

4. Implementation

5. Maintenance





142

Key Determinants of the Speed and Extent of the Diffusion of an

Innovation



143

1. Relative Advantage

The degree to which an innovation is perceived as better than the idea it supersedes


Innovation

Is the innovation better than what is in place?



144

2. Compatibility

The degree to which an innovation is perceived as being consistent with existing values,

past experiences, and needs of potential adopters

Does the innovation fit with the intended audience?


Innovation



145

3. Complexity

The degree to which an innovation is perceived as difficult to understand and use


Innovation

Is the innovation easy to use?



146

4. Trialability

The degree to which an innovation may be experienced on a limited basis


Innovation

Can the innovation be tried before making a decision to adopt?



147

5. Observability

The degree to which the results of an innovation are visible to others


Innovation

Are the results of the innovation observable and easily measurable?



148

Perceived Attributes of Innovation

1. Relative Advantage

2. Compatibility

3. Complexity

4. Trialability

5. Observability



Innovation



149

Additional Key Determinants of the Speed and Extent of the Diffusion of

an Innovation



150

6. Impact on Social Relationships

Does the innovation have a disruptive effect on the social environment?


an Innovation



151

7. Reversibility

Can the innovation be reversed or discontinued easily?


an Innovation



152

8. Communicability

Can the innovation be understood clearly and easily?


an Innovation



153

9. Time

Can the innovation be adopted with a minimal investment in time?


an Innovation



154

10. Risk and Uncertainty Level

Can the innovation be adopted with minimal risk and uncertainty?


an Innovation



155

11. Commitment

Can the innovation be used effectively with only modest commitment?


an Innovation



156

12. Modifiability

Can the innovation be updated and modified over time?


an Innovation



157

6. Impact on social relationships

7. Reversibility

8. Communicability

9. Time

10. Risk and uncertainty level

11. Commitment

12. Modifiability



an Innovation



158


7. Reversibility

8. Communicability

9. Time


11. Commitment

12. Modifiability

12 Key Determinants of the Speed and Extent of the Diffusion of an

Innovation1. Relative Advantage

2. Compatibility

3. Complexity

4. Trialability

5. Observability



159

Report Out

Group

2

Group

1

Group

3


Report Out Report Out


160


7. Reversibility

8. Communicability

9. Time


11. Commitment

12. Modifiability

12 Key Determinants of the Speed and Extent of the Diffusion of an

Innovation1. Relative Advantage

2. Compatibility

3. Complexity

4. Trialability

5. Observability



161

Group

2

Group

1

Group

3


Challenges and Solutions


163

Goals

Infuse epidemiology education into curricula

in grades 6-12

Improve scientific literacy

Increase the number of students preparing for careers in public health

Epidemiology Education Movement

164

Goals


in grades 6-12



Create new curricula and

enhance existing curricula.

Implement teacher training workshops in a

variety of venues.

Develop cadre of epidemiology

curriculum developers.

Obtain support of stakeholders (educators, epidemiologists, public health community, professional

organizations, scientific journals, government).

Develop mechanisms to focus and coordinate efforts of many interested but busy stakeholders.

Assess Short and Long Term Goals

Create Demand

Prepare Teachers

Develop Curricula


Maintain Momentum

Implement demonstration projects in a

variety of school and non-school

venues. Evaluate curricula.

Infuse into educational structure (state / national standards, standardized testing, textbooks).

Develop mechanisms to make people aware of the efforts of others (web site, newsletter, list serve).

165

Goals


in grades 6-12



Create new curricula and

enhance existing curricula.

Implement teacher training workshops in a

variety of venues.

Develop cadre of epidemiology

curriculum developers.

Obtain support of stakeholders (educators, epidemiologists, public health community, professional

organizations, scientific journals, government).

Develop mechanisms to focus and coordinate efforts of many interested but busy stakeholders.

Assess Short and Long Term Goals

Create Demand

Prepare Teachers

Develop Curricula


Maintain Momentum

Implement demonstration projects in a

variety of school and non-school

venues. Evaluate curricula.

Infuse into educational structure (state / national standards, standardized testing, textbooks).

Develop mechanisms to make people aware of the efforts of others (web site, newsletter, list serve).

167



*


Post-Workshop Assessment


Workshop Process Evaluation

170

Report and Reflection Logs



3-Month Post-Workshop Assessment


6-Month Post-Workshop Assessment

173




Thank You


1 integrating epidemiology education into your existing curriculum clarion university, february...

Documents

teaching unitsreport

aggressive actspages

testing ephedrapages

surface features

fundamental principles

national research council

epidemiology education