Epidemiology

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Epidemiology in Action
An Integrated High School Curriculum for Math,
Science, Social Studies, Language Arts, and
Health
By Annette Holmstrom Curtis High School Tacoma,
Washington 98422
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CONTENTS Unit I What is Epidemiology? Unit
II Types of Epidemiology Studies Unit
III Measurement and Hypothesis Testing Unit
IV Understanding and Preventing Health and
Safety Problems
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• Unit I
• What is Epidemiology?
• Definition of Epidemiology
• Its Purpose
• How It Helps Us Answer Questions

• Activities
• A Plague Puzzle
• Design a Disease Museum
• Debate, Data, and Current Issues

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Definition of Epidemiology Epidemiology is
the science of discovering causes of illness and
injury in populations. Epidemiology studies
are used to control and prevent health problems.


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• Scenario
• Youve just arrived in Washington, D.C. for an
  International Conference on Epidemiology.
• Your puzzle cards tell us two things
• The city youve come from,
• Whether youve got symptoms of some strange
  DISEASE.

THE PLAGUE PUZZLE Youve just arrived from
Paris, France.
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THE PLAGUE PUZZLE Youve just arrived from
Paris, France.


If your card looks like this one, you are
displaying no symptoms.

• If your card looks like this one, you are
  displaying a variety of the following symptoms
• high fever
• fatigue
• severe back pain
• sometimes stomach pain/vomiting
• if your card also has an X on it, you have a
  rash on your face, hands, and forearms.

THE PLAGUE PUZZLE Youve just arrived from
Paris, France.
Healthy
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Epidemiology is the science of discovering the
causes of illness and injury in populations.
Epidemiology studies are used to control and
prevent health problems.

• This is a health problem. We need to think like
  epidemiologists. Imagine you are the
  epidemiology team thats been called in to study
  our group and brainstorm answers to the following
  questions.
• What would you do first?
• What information do you need to gather?
• What are your initial guesses about the cause
  of illness?
• How would you know who has this disease, for
  sure?
• What studies could you do to figure out what
  caused the outbreak?
• How would you know if your studies were right?
• If your studies were correct, what steps would
  you take to protect everybody else?

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• In the case of a real outbreak, the basic steps
  in an outbreak investigation are to
• Gather information and confirm existence of
  outbreak,
• Confirm diagnosis,
• 3) Establish a case definition a standard set
  of criteria for identifying who has the disease,
• 4) Perform descriptive studies,
• 5) Develop and test hypotheses,
• 6) Implement control and prevention, and
• 7) Report findings

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To learn how to investigate a disease outbreak
in greater detail, the following websites provide
excellent lesson plans and resources How to
Investigate an Outbreak National Institute of
Health Infectious Disease Curriculum Virus
Encounters Note to teachers These materials
are free - for classroom use only.
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In the case of our classroom disease, you may
have hypothesized that we are showing the
symptoms of a smallpox outbreak. In epidemiology,
our HYPOTHESES are based on research, and must be
able to be TESTED. You can research more detailed
information about smallpox signs/symptoms, and
the progression of the disease (what about those
card with red Xs?) at the websites below.

Source CDC/Fred Murphy, Sylvia Whitfield 1975
LINK Center for Disease Control Smallpox web page
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• SMALLPOX
• 12 14 day incubation period
• Early flu-like symptoms -- fever,
• fatigue, back pain, stomach pain--
• lasting two to three days.
• When fever drops, rash appears,
• spreads. Forms bumps/scabs.
• 25 30 of those infected
• die, survivors left scarred

Source CDC/James Hicks, Bangladesh 1973
Source CDC/Fred Murphy, Sylvia Whitfield 1975
LINK Center for Disease Control Smallpox web page
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In any study, the first thing epidemiologists do
is gather information. We want to know the
Disease Distribution, or how the cases are spread
across a population by gender, age, geography,
etc. (See Unit III, for a more detailed
explanation of a Chi Square.) In our class
population, how are cases spread across our
population by gender, age, geography?

Infected Not Infected Total
Male
Female
Age 13-15
Age 16-19
London
Paris
Seattle
New York
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• We also look for
• Disease Determinants - risk factors or prior
  events associated with the appearance of the
  disease/condition, and
• Disease Frequency - how many cases occur over
  a given time period (more detailed info on this
  in Unit III)

Collection of aids, left, used by polio victims,
including the iron lung
Link Polio Information Center Online (PICO)
SourceCDC/Meredith Hickson 1977
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The Aids virus under a microscope Link HIV
Infections
Source CDC/Dr. Edwin P. Ewing/1983 Aids
Kaposis sarcoma

• We also want to determine if the disease
  frequency is
• Endemic - low to moderate level of disease in
  given area
• Epidemic - level greater than what is expected
  in a given area
• Pandemic - level greater than what is expected
  in several
• countries and regions
  worldwide

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DESIGNING A DISEASE MUSEUM
To apply what weve learned so far, research and
investigate one of the following diseases, and
complete the activities on the assignment sheet.
DISEASES AIDS Influenza Anthrax
Bubonic Plague Tuberculosis Polio Ebola Meas
les West Nile Virus
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• ASSIGNMENT SHEET Designing a Room in a Disease
  Museum
• Research your assigned disease using the
  resources suggested. Present answers to the
  following questions visually in a museum room
  display (using butcher paper, display poster
  boards, or PowerPoint).
• How was the disease discovered, and what was/is
  the case definition?
• Give at least two real-life examples of
  researchers using the steps in an
• outbreak investigation.
• What were/are the disease distributions,
  determinants, and frequency?
• Was/is the disease outbreak endemic, epidemic,
  or pandemic, and why?
• What were some of the original hypotheses about
  the causes of this disease?
• What IMPACT did this disease have,
  historically, on the course of world events?
• Real-life account of someone who
  suffered/suffers from the disease
• One visual that summarizes data a bar graph,
  pie chart, etc. Cite your source.
• Pictures/artwork related to the disease
• Include correct documentation for all your
  sources.

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SUGGESTED ONLINE SOURCES Designing a Disease
Museum
CDC/Health Topics A to Z World Health
Organization Infectious diseases All the
Virology on the WWW NFID Web Sites Virtual
Library of Diseases Johns Hopkins Infectious
Diseases HIV infections
PICO Polio Information Center Online
WHO/OMS Malaria Tuberculosis
Ancient Enemy, Present Threat CDC
/Division of Vector-Borne Infectious Diseases
(DVBID) Plague Home Page The
American Experience Influenza 1918
The 1918 Influenza Pandemic NOVA
Online Anthrax New Hampshire
Anthrax Outbreak of 1957
CDC/National Center for Infectious Diseases Viral
hemorrhagic fever CDC/Division of
Vector-Borne Infectious Diseases (DVBID) West
Nile Virus Home Page
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• So what do epidemiologists do, and how do they
  help us solve problems?
• Early epidemiologists studied outbreak of
  diseases, such as plague. They still do that
  today for example, theyd be on the front lines
  if a terrorist-caused outbreak of smallpox
  occurred and they also
• Evaluate risk factors for diseases/accidents.
• (Whats your risk of getting cancer?)
• Conduct long-term population studies to
  understand
• what causes diseases/accidents.
• (If you start smoking as a teenager, what is
  your risk of developing
• lung cancer by the time you are 50?)
• Design and conduct experiments to evaluate
  control
• and prevention measures.
• (Can stop-smoking education campaigns help
  prevent teen smoking?)

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To give you an idea of how important epidemiology
studies are to todays world, consider an
important item to most teens today Their
Drivers License Most states have instituted a
Restricted or Graduated Drivers License for
teens. When you have a Restricted/Graduated
Drivers License, you are not allowed to carry
more than a certain number of passengers until
youve been driving for a specified time period
(varies by state). So why are they doing
that? Because of Epidemiology, thats why.


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Website http//www-nrd.nhtsa.dot.gov/pdf/nrd-30/
NCSA/TSF2000/2000ydrive.pdf Link to more studies
NHTSA Research and Development site Source
Traffic Safety Facts 2000 DOT HS 809 336 National
Center for Statistics Analysis, Research and
Development, 400 Seventh Street S.W.,
Washington, D.C. 20590
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Website http//www-nrd.nhtsa.dot.gov/pdf/nrd-30/
NCSA/TSF2000/2000ydrive.pdf Link to more studies
NHTSA Research and Development site Source
Traffic Safety Facts 2000 DOT HS 809 336 National
Center for Statistics Analysis, Research and
Development, 400 Seventh Street S.W.,
Washington, D.C. 20590
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Other studies have shown a link between young
age, distractions (such as cell phones and
passengers) and a higher accident rate hence
the changes in the driver licensing laws. While
it may look like the epidemiologists are out to
make teenagers lives miserable, theyre working
for our HEALTH and SAFETY.

Source CDC/unknown
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• Assignment Sheet Debate, Data, and Current
  Issues
• To explore how epidemiology studies influence
  decision-making, take your assigned Risk Factor
  for health and safety, and examine
  epidemiological data that sheds light on the
  current situation. Use recommended bookmarks, or
  check other useful data bases to find your own
  information.
• Then, decide on a change you think needs to
  be made, based on this data, OR a possible change
  that should NOT be made. This change can be by
  the government, the schools, families,
  communities, etc. Prepare a class presentation
  in which you
• State the problem
• Share the data
• Note what the data does NOT say (how might it
  be misleading?)
• Explain what change youre proposing/not
  proposing
• Tell us why this change should/should not be
  made
• Risk Factors
• Alcohol/Drug Use
• Teen Violence
• Diet
• Accidents
• AIDS/STDs

LC/1973
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Debate, Data, and Current Issues - Example

• State the problem Overweight children, at
  risk for disease
• Share the data Explain chart/results you
  found
• Note what data does NOT say Could this
  vary by region? What about socio-economic class?
  
• Explain what change youre School
  cafeterias should only sell healthy food
• proposing/not proposing
• Tell us why this change should/ Will lead to
  diabetes, heart disease, etc.
• should not be made
• Link CDC/NCHS - United States Growth Charts

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Debate, Data, and Current Issues/Recommended
Resources
General N H A N E S - National Health and
Examination Survey - Homepage NIH Health
Information National Center for Health
Statistics The National Longitudinal Study of
Adolescent Health Alcohol/Drug Use National
Household Survey on Drug Abuse Statistics, SAMHSA
Office of Applied Studies Teen Violence Office of
Juvenile Justice and Delinquency
Prevention CANCER Cancer.gov Cancer Mortality
Maps Graphs Accidents Fatality Analysis
Reporting System (FARS) Sexual Risk Behaviors
(STDs, AIDS, Teen Pregnancy) Trends in Sexual
Risk Behaviors Among High School Students ---
United States, 19912001