Curriculum Orientation for Teachers Teacher Orientation to Curriculum Epidemiology and the Energy Balance Equation Updated Feb 20, 2011

Curriculum Orientation for Teachers 2 Provide motivation for students to learn the basics about the science of epidemiology and understand its relevance in their daily lives Give students a background in the methods of epidemiology that allow them to better understand current and future health messages and the scientific evidence (or lack thereof) behind these messages Utilize timely issues about nutrition and physical activity (and related behaviors and health effects) to illustrate the application of epidemiological methods Get students excited about, and engaged in, epidemiology through real-world experience in designing, conducting and interpreting investigations Immediate Goals

Curriculum Orientation for Teachers To become empowered as scientifically literate participants in the democratic decision-making process concerning public health policy. To gain the knowledge to make more informed personal health-related decisions. To increase media literacy and better understand public health messages. To develop an understanding of the basis for determining risk. To improve mathematical and scientific literacy. To expand one’s understanding of scientific methods and develop critical thinking skills. To acquire the tools necessary for exploring important, real world questions about one’s health and the health of others. To uncover an array of career paths related to the public’s health. Top 8 Reasons for Teaching / Learning Epidemiology 3

Curriculum Orientation for Teachers Epidemiology and Public Health – A Global Endeavor 4 Epidemiology is typically taught in college in graduate schools of public health About 10 years ago, the Centers for Disease Control and Prevention (CDC) took the lead in advocating the integration of epidemiology into the K-12 curriculum The CDC argues that learning the science of epidemiology will contribute to the development of many of the attributes of scientific literacy

Curriculum Orientation for Teachers … can ask, find, or determine answers to questions derived from curiosity about everyday experiences. … has the ability to describe, explain, and predict natural phenomenon. … is able to read with understanding articles about science in the popular press and to engage in social conversation about the validity of their conclusions. … can identify scientific issues underlying national and local decisions and express positions that are scientifically and technologically informed. … (is) able to evaluate the quality of scientific information on the basis of its source and the methods used to generate it. … (has) the capacity to pose and evaluate arguments based on evidence and to apply conclusions from such arguments appropriately. Attributes of Scientific Literacy 5

Curriculum Orientation for Teachers Introducing the curriculum to middle school students 6 Epidemiology and the Energy Balance Equation

Curriculum Orientation for Teachers 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 Students Who Bring Their Lunch to School Eat Less Junk Food Higher Risk of Obesity Among Teens with More Video-Game Playing Breakfast Each Day May Keep Colds Away Study Concludes: Movies Influence Youth Smoking Study Links Iron Deficiency to Math Scores Study Links Physical Fitness to Academic Achievement Proximity of Fast Food Restaurants to Schools and Adolescent Obesity Things That Turn Up Together 7

Curriculum Orientation for Teachers 8 Where do you get your information? Are you empowered? Do you rely on other people’s interpretations? Parents, teachers, friends, doctors, nurses, therapists, celebrities, textbooks, advertisements, cell phones, the Internet, newspapers, magazines, television Peer-reviewed published studies in medicine, epidemiology, behavioral science, toxicology, and others Your experience, knowledge, critical thinking, and common sense ? they get from …(with filters) you get from.. (with filters)

Curriculum Orientation for Teachers Energy Balance 9

Curriculum Orientation for Teachers Balance and Equilibrium What does it mean to be “in equilibrium”? 10

Curriculum Orientation for Teachers Which is in Balance? 11

Curriculum Orientation for Teachers A Balanced Diet 12

Curriculum Orientation for Teachers The Energy Balance Equation 13

Curriculum Orientation for Teachers The Subject Matters 14 Increasing incidence of overweight and obesity among children and adolescents, as well as he American population as a whole Increasing health consequences such as Type 2 diabetes, even among young people Some populations are more at risk than others How do we know this? EPIDEMIOLOGY

Curriculum Orientation for Teachers Pre-Course Definition of Epidemiology 15 What is Epidemiology?

Curriculum Orientation for Teachers A term derived from the Greek: epi : on, upon demos : the people logos : the study of (Webster's Unabridged Dictionary) Definition of Epidemiology 16

Curriculum Orientation for Teachers DoctorPathologist Epidemiologist Professions in Health 17

Curriculum Orientation for Teachers Criminal Detectives Investigate crimes Look for clues at a crime scene Judge quality of evidence Form hypotheses Identify suspects Present evidence in court Help control crime Epidemiologists Investigate diseases Look for clues in populations Judge quality of evidence Form hypotheses Identify suspected causes Present evidence in scientific journals and at scientific meetings Help control disease All in a Name 18

Curriculum Orientation for Teachers CDCCDC - What is an Epidemiologist? a scientist who specializes in tracking the occurrence and causes of disease... a disease detective

Curriculum Orientation for Teachers 20 What do epidemiologists look like?

Curriculum Orientation for Teachers 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) How Epidemiology Was Defined More Then 100 Years Ago 21

Curriculum Orientation for Teachers A Grown-ups’ Definition of 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. (Gordis, 2004) Epidemiology is the study of populations in order to determine the patterns and causes of health and illness, and to be able to apply the learned information to the control of health problems. A Middle-School- Friendly Definition of Epidemiology Epidemiology helps answer how and why diseases occur among a population in order to control and prevent diseases MedMyst Disease Defenders Epidemiology is the study of patterns of health and illness and associated factors at the population level Wikipedia

Curriculum Orientation for Teachers A Working Definition of the Science of Epidemiology 23 Epidemiology is the study of populations in order to determine the patterns and causes of health and illness, and to be able to apply the learned information to the control of health problems.

Curriculum Orientation for Teachers A Working Definition of the Science of Epidemiology 24 Epidemiology is the study of populations in order to determine the patterns and causes of health and illness, and to be able to apply the learned information to the control of health problems.

Curriculum Orientation for Teachers A Working Definition of the Science of Epidemiology 25 Epidemiology is the study of populations in order to determine the patterns and causes of health and illness, and to be able to apply the learned information to the control of health problems.

Curriculum Orientation for Teachers A Working Definition of the Science of Epidemiology 26 Epidemiology is the study of populations in order to determine the patterns and causes of health and illness, and to be able to apply the learned information to the control of health problems.

Curriculum Orientation for Teachers Control of Health Problems 27 Population patterns in health-related behaviors and in health and illness Possible strategies and actions that can change the patterns of health and illness in populations As related to this definition, here are three areas that epidemiology tries to address (among others) Causes Patterns Causes of health and illness in populations

Curriculum Orientation for Teachers 28 This curriculum concentrates on the first two... Population patterns in health-related behaviors and in health and illness Possible strategies and actions that can change the patterns of health and illness in populations Causes of health and illness in populations Control of Health Problems Causes Patterns

Curriculum Orientation for Teachers Curriculum Organized Into Two Teaching Modules 29 Module 1 DESCRIPTIVE EPIDEMIOLOGY Finding patterns and trends Formulating Hypotheses Module 2 ANALYTICAL EPIDEMIOLOGY Testing hypotheses Finding causes Addresses Causes Addresses Patterns

Hypotheses about associations Generate Descriptive epidemiology Studies patterns of disease and health-related events and behaviors, and used the information to generate hypotheses about why these patterns exist. Test A Bridge: How Study of Patterns and Causes are Related 30 Lesson 2-1: Looking for Associations Analytical Epidemiology Involves testing hypotheses by examining potential connections (associations) between health-related exposures and outcomes.

Hypothesis Module 1 Descriptive Epidemiology Module 2 Analytical Epidemiology An Example About the Energy Balance Equation Description of the increase in teenage overweight Description of increases in teenagers eating junk food Hypothesis: Eating junk food can cause teenagers to become overweight Scientific studies of the association between teenagers eating junk food and their weight status 31 Lesson 2-1: Looking for Associations Hypotheses about associations Generate Test

Curriculum Orientation for Teachers 32 Disease Detectives and the Energy Balance Equation

Curriculum Orientation for Teachers 33 Curriculum of two modules suitable for middle or high school students, being tested in middle school learning environments Premise is to teach epidemiology with the use of examples from the science around nutrition and physical activity as examples and as the basis for realistic epidemiology experiences for students Immediate goals: – Provide a grounding in epidemiology methods that allows students to better understand current /future health messages and the scientific evidence (or lack thereof) behind the messages – Utilize timely issues about nutrition and physical activity and related topics to illustrate the application of epidemiological methods – Get students excited and engaged about epidemiology through real- world experience in designing, conducting and interpreting investigations, helping them to grasp the understandings needed to think like an epidemiologist Quick Summary of Curriculum

Curriculum Orientation for Teachers Pedagogical Principles Enduring Understandings The big ideas that reside at the heart of a discipline and have lasting value outside the classroom 34

Curriculum Orientation for Teachers 35 Enduring Understandings (EU) 1.Health and disease are not distributed haphazardly in a population. There are patterns to their occurrence that can be identified through surveillance. Analysis of the patterns of health and disease distribution can provide clues for formulating hypotheses about their possible causes. 2.Causal hypotheses can be tested by conducting investigations of the exposures and outcomes of selected groups of people as they go about their lives. Information from these observational studies can be used to determine if an exposure and an outcome are associated. Because observational studies are complicated by factors not controlled by the observer, other explanations also must be considered.

Curriculum Orientation for Teachers Pedagogical Principles Enduring Understandings (EU) The big ideas that reside at the heart of a discipline and have lasting value outside the classroom Essential Questions The questions, that when answered, create the enduring understandings 36

Curriculum Orientation for Teachers 37 Examples of Essential Questions What are the patterns of eating and physical activity behaviors among our classmates? What are the possible causes and/or consequences of patterns in eating and physical activity? EU 1: What are the patterns of health-related events or behaviors in populations? EU 2: What may have caused these patterns to occur? Energy Balance Questions General Questions

Curriculum Orientation for Teachers Pedagogical Principles Enduring Understandings The big ideas that reside at the heart of a discipline and have lasting value outside the classroom Essential Questions The questions, that when answered, create the enduring understandings Authentic Assessments Real-world experiences designed to assess students’ grasp of the Enduring Understanding(s) 38

Curriculum Orientation for Teachers Authentic assessments should be able to elicit acceptable evidence of students’ comprehension of the Enduring Understandings Authentic epidemiology assessments are designed to capture students’ attention and challenge their scientific reasoning The goal is to have students learn, do, and get excited about epidemiology Application of Authentic Assessment* Model * From: Understanding by Design by Wiggins and McTighe 39

Curriculum Orientation for Teachers Are realistic; simulate the way a person’s understanding is tested in the real world Ask students to “do” the subject rather than simply recall what was taught Require judgment and innovation to address an unstructured problem, rather than following a set routine Require a repertoire of knowledge and skill be used efficiently and effectively Are messy and murky Allow opportunities for rehearsal, practice, consultation, feedback, and refinement Characteristics of Authentic Assessments* * From: Understanding by Design by Wiggins and McTighe 40

Curriculum Orientation for Teachers 41 A Continuum of Assessments* Performance tasks Informal checks for understanding Observations and dialogues Tests and quizzes Academic prompts * From: Understanding by Design by Wiggins and McTighe

Curriculum Orientation for Teachers “Inquiry is a multifaceted activity that involves making observations; posing questions; examining books and other sources of information to see what is already known; planning investigations; reviewing what is already known in light of experimental evidence; using tools to gather, analyze, and interpret data; proposing answers, explanations, and predictions; and communicating the results. Inquiry requires identification of assumptions, use of critical and logical thinking, and consideration of alternative explanations. Students will engage in selected aspects of inquiry as they learn the scientific way of knowing the natural world, but they should also develop the capacity to conduct complete inquiries.” National Committee on Science Education Standards and Assessment, National Research Council Copyright National Academy of Sciences, 1996, National Science Education Standards Excerpted from: Perspectives and Terms in the National Science Standards Value 42

Curriculum Orientation for Teachers 43 Authentic Assessments What are the patterns of eating and physical activity behaviors among our classmates? What are the possible causes and/or consequences of patterns in eating and physical activity? Cross-sectional studies of health-related exposures and outcomes Module 1 – EU 1 DESCRIPTIVE EPIDEMIOLOGY Finding patterns and trends Formulating Hypotheses Module 2 – EU 2 ANALYTICAL EPIDEMIOLOGY Testing hypotheses Finding causes Surveillance studies of health-related behaviors

Curriculum Orientation for Teachers Lessons: 1-1 Introduction to Curriculum 1-2 Surveillance 1-3 Patterns and Hypotheses 1-4 Describing Health-Related Behaviors in Youth 1-5 Creating a Surveillance Question 1-6 Respect – Part I 1-7 Surveillance Studies – In Class 1-8 Surveillance Studies – In School Module 1 Lessons Teaching to the Assessment 44

Curriculum Orientation for Teachers Authentic Assessment for Module 1 of the Epidemiology and the Energy Balance Equation Curriculum Students will conduct and interpret a descriptive epidemiological survey among students in their class and again among students outside their class. Working in teams, students will have the opportunity to demonstrate their abilities to request informed consent, ask questions about a health-related behavior, accurately record responses, calculate prevalence of the behavior, make accurate statements about the prevalence of the behavior among their classmates, look for patterns, and formulate hypotheses based on the patterns they observe. Deliverables will include either written reports or presentations about the surveys. Specific performance criteria will be used to help ensure that the experiences allow a genuine, realistic, and fair assessment of students’ comprehension of the Module 1 Enduring Epidemiological Understanding. 45

Curriculum Orientation for Teachers Lessons: 2-1 Looking for Associations 2-2 Cross-Sectional Studies 2-3 Developing Hypothesis and Study Questions 2-4 Respect – Part II 2-5 Planning Study Conduct 2-6 Cross-Sectional Study - In Class 2-7 Cross-Sectional Study – In School Module 2 Lessons Teaching to the Assessment 46

Authentic Assessment for Module 2 of the Epidemiology and the Energy Balance Equation Curriculum 47 Students will conduct, analyze, and interpret observational, cross- sectional studies among students in their class and then among students outside their class. Working in teams, students will have the opportunity to demonstrate their abilities to select a reasonable hypothesis of interest to them, design study questions about exposure and outcome, obtain informed consent, collect and manage data, calculate and compare prevalence rates, make accurate statements about whether their data support that hypothesis, and consider alternate explanations for what they observed. Reporting of results will be required, such as a written report, an item for the school newspaper, or an oral presentation or poster for students, teachers, and/or parents. Specific performance criteria will be used to help ensure that the experiences allow a genuine, realistic, and fair assessment of students’ comprehension of the Module 2 Enduring Epidemiological Understanding. Curriculum Orientation for Teachers

Epidemiology and the Energy Balance Long-Range Goals 48 To increase students’ scientific literacy and abilities in science in general and epidemiology in particular To increase students’ potential to apply what they have learned in this curriculum to future health issues, both in their personal lives and as responsible health policy decision-makers in a democracy. To increase students’ understanding of some critical health issues, thereby leading them to be more likely to make informed personal health choices Curriculum Orientation for Teachers

Give a man a fish, he has food for a day, Teach a man how to fish, he has food for a lifetime. Remember... 49