1. Do Now ① Cigarette use ② Facebooking ③ Getting the flu shot ④ Drinking energy drinks ① Migraines ② H1N1 ③ Alzheimer’s Disease ④ Lung Cancer Write down similarities and differences between the two lists below: List 1List 2 BEHAVIORS!CONDITIONS! 3 min

2. Recall: DoctorsBOTHEpidemiologists Who: individual patients How: take medical histories & conduct physical exams Identify a problem (by collecting data) Who: entire populations (small or large) How: surveillance systems or descriptive epidemiological studies Data used to make a diagnosis Create a Hypothesis (using data & inferences) Data used to generate hypotheses about the relationships between exposure and disease Test diagnosis by conducting additional diagnostic studies or tests (ex: biopsy or MRI) Test the Hypothesis (choose a study design) Test hypothesis by analytical studies such as cohort or case-control studies Prescribe medical treatment to patient Take ActionCreate a community intervention to end the health problem and prevent its recurrence 1

3. Steps to Identifying the Problem: 1)Choose health-related outcome 2)Clearly define the outcome (“case”) 3)Choose a population 4)Describe the problem (descriptive study) 2 min

4. Step 1: Choose a health-related outcome When epidemiologists ask a questions it is often in the form: Does _____________ cause _____________? (Risk Factor)(Outcome) Do diesel exhaust fumes from school buses cause asthma? Does eating chocolate cause acne? Are males at higher risk of automobile accidents? Does immunization with the flu shot prevent H1N1? Does acupuncture result in pain relief? YOU think of an example! 4 min

5. Step 1: Choose a health-related outcome Does _____________ cause _____________? (Risk Factor)(Outcome) can be: Medical conditions: Infectious: H1N1 Noncommunicable: Asthma Chronic: Lung cancer Acute: Ear infection Event-related: Injuries: Workplace Disasters: 9/11 Psychological: Stress Behaviors: Protective: Exercise Harmful: Smoking 2 min

6. Step 1: Choose a health-related outcome Does _____________ cause _____________? (Risk Factor)(Outcome) Let’s Pick: Medical conditions: Event-related: Injuries from fires Behaviors: Performance on UICCP Fitness Test 1 min

7. STEPUICCP PE Example Dallas Fire Study Example 1. Choose a health related outcome Performance on UICCP Fitness Test Injuries from fires Step 1: Choose a health-related outcome 1

8. Step 2: Clearly define the outcome (a “case”) 1)How would you define: “fire-related injuries”? 2)Is your neighbor’s definition the same? 3)Why is it a problem if we have ambiguous definitions of our outcome? Think of it this way: - If Ms. Torres, Mr. Cartwright or Msgt. Pyles never explained what “passing” the UICCP fitness test means, what problems would that create for you? - If a doctor didn’t know what how to diagnose a “case” of H1N1, what might have happened? 4 min

9. Step 2: Clearly define the outcome (a “case”) STEPUICCP PE Example Dallas Fire Study Example 1. Choose a health related outcome Performance on UICCP Fitness Test Injuries from fires 2. Define a “case” Failure (for girls): ½ mi time > 6 min Sit-ups < 25 in 1 min Push-ups < 6 in 1min “Any person who was transported by emergency services or admitted to the hospital for a burn or smoke inhalation or died of fire- related injuries” 2

10. Step 3: Choose a population What are the characteristics of a population that you should consider? Ex: Size/Location (geographic) - School - Community -Chicago -IL -USA Other characteristics to consider: Age, gender, racial/ethnic group, income, housing, organizational membership, time period, etc. 3

11. Step 3: Choose a Population STEPUICCP PE Example Dallas Fire Study Example 1. Choose a health related outcome Performance on UICCP Fitness Test Injuries from fires 2. Define a “case” Failure (for girls): ½ mi time > 6 min Sit-ups < 25 in 1 min Push-ups < 6 in 1min “Any person who was transported by emergency services or admitted to the hospital for a burn or smoke inhalation or died of fire-related injuries” 3. Choose a population Juniors (females) at UICCP - Residents of Dallas, TX - 1991 - 1997 2

12. Step 4: Describe the Problem (descriptive study) Yesterday, I asked Mr. Cartwright, “How did the Jrs do on the PE fitness test?” He replied: “Not good at all.” -What’s the problem here? So I went to Ms. Torres and said: “Ms. Torres, I am an epidemiologist. Please DESCRIBE clearly HOW the Jrs did on the PE fitness test. ” She replied: “Don’t be trippin, Ms. Meixner, lots of people passed. If it was really that bad, I’d make them come to mandatory office hours!” -Is this better? 3

13. Step 4: Describe the Problem (descriptive study) -What do we NEED from Mr. Cartwright and Ms. Torres? A better answer: “17/168 did not pass one or more of the three parts of the fitness test. Therefore, 10% of Juniors did not pass the fitness test.” -Why is this better than saying 17 did not pass? 3 We need RATES!

14. Step 4: Describe the Problem (descriptive study) -2 of the rates epidemiologists use to describe a health outcome are: -Prevalence -Incidence WHAT!?!? <1

15. Step 4: Describe the Problem (descriptive study) Use prevalent and incidents in the following sentence: The five new _____________ of house fires in Pilsen showed that the problem of fire-related injuries was becoming a ____________________ concern. Prevalent: widespreadIncident: an eventPrevalent: widespreadIncident: an event prevalent incidents 2

16. Step 4: Describe the Problem (descriptive study) Rate PurposeFormula Prevalence To find out how widespread cases are (a “snapshot”) # Cases/ Total pop Incidence To find out the risk of new events (cases) occurring in a set time period (useful for less common problems) ( # new cases / Total pop)/Time) 4

17. Step 4: Describe the Problem STEPUICCP PE Example Dallas Fire Study Example 1. Choose a health related outcome Performance on UICCP Fitness Test Injuries from fires 2. Define a “case” Failure (for girls): ½ mi time > 6 min Sit-ups < 25 in 1 min Push-ups < 6 in 1min “Any person who was transported by emergency services or admitted to the hospital for a burn or smoke inhalation or died of fire-related injuries” 3. Choose a population Juniors (females) at UICCP - Residents of Dallas, TX - 1991 - 1997 Step 4: Describe the Problem Prevalence: 10% of Juniors failed the fitness test on 9/8/10 Incidence: 25% Jrs failed the fitness test at least once over 10 th gr yr Prevalence: not relevant here (fires aren’t frequent enough for this to be useful) Incidence: 5.2 injured people per 100,000 per year 2