1. 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

2. Epidemiology in Action 2 CONTENTS: Unit IWhat is Epidemiology? Unit IITypes of Epidemiology Studies Unit IIIMeasurement and Hypothesis Testing Unit IVUnderstanding and Preventing Health and Safety Problems

3. Epidemiology in Action 3 Unit I What is Epidemiology? What is Epidemiology? Definition of EpidemiologyDefinition of Epidemiology Its PurposeIts Purpose How It Helps Us Answer QuestionsHow It Helps Us Answer Questions Activities: 1.A Plague Puzzle 2.Design a Disease Museum 3.Debate, Data, and Current Issues

4. Epidemiology in Action 4 Definition of Epidemiology: 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. Epidemiology studies are used to control and prevent health problems.

5. Epidemiology in Action 5 Scenario: You’ve just arrived in Washington, D.C. for an International Conference on Epidemiology. Your puzzle cards tell us two things: 1. The city you’ve come from, 2. Whether you’ve got symptoms of some strange DISEASE. THE PLAGUE PUZZLE You’ve just arrived from Paris, France.

6. Epidemiology in Action 6 THE PLAGUE PUZZLE You’ve just arrived from Paris, France. THE PLAGUE PUZZLE You’ve just arrived from Paris, France. 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 X if your card also has an X on it, you have a rash on your face, hands, and forearms. If your card looks like this one, you are displaying no symptoms.

7. Epidemiology in Action 7 health problem This is a health problem. We need to think like epidemiologists. Imagine you are the epidemiology team that’s been called in to study our group and brainstorm answers to the following questions. What would you do first? What would you do first? What information do you need to gather? What information do you need to gather? What are your initial guesses about the cause of illness? What are your initial guesses about the cause of illness? How would you know who has this disease, for sure? How would you know who has this disease, for sure? What studies could you do to figure out what caused the outbreak? What studies could you do to figure out what caused the outbreak? How would you know if your studies were right? How would you know if your studies were right? If your studies were correct, what steps would you take to protect everybody else? If your studies were correct, what steps would you take to protect everybody else? Epidemiology is the science of discovering the causes of illness and injury in populations. Epidemiology studies are used to control and prevent health problems.” “Epidemiology is the science of discovering the causes of illness and injury in populations. Epidemiology studies are used to control and prevent health problems.”

8. Epidemiology in Action 8 In the case of a real outbreak, the basic steps in an outbreak investigation are to: 1)Gather information and confirm existence of outbreak, 2)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

9. Epidemiology in Action 9 To learn how to investigate a disease outbreak in greater detail, the following websites provide excellent lesson plans and resources: 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.

10. Epidemiology in Action 10 LINK: Center for Disease Control Smallpox web page 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 X’s?) at the websites below. Source: CDC/Fred Murphy, Sylvia Whitfield 1975

11. Epidemiology in Action 11 LINK : LINK : Center for Disease Control Smallpox web pageSMALLPOX 12 – 14 day incubation period 12 – 14 day incubation period Early flu-like symptoms -- fever, Early flu-like symptoms -- fever, fatigue, back pain, stomach pain-- fatigue, back pain, stomach pain-- lasting two to three days. lasting two to three days. When fever drops, rash appears, When fever drops, rash appears, spreads. Forms bumps/scabs. spreads. Forms bumps/scabs. 25 – 30% of those infected 25 – 30% of those infected die, survivors left scarred die, survivors left scarred or blinded. or blinded. Source: CDC/Fred Murphy, Sylvia Whitfield 1975 Source: CDC/James Hicks, Bangladesh 1973

12. Epidemiology in Action 12 Disease Distribution Chi Square. 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? InfectedNot Infected Total Male Female Age 13-15 Age 16-19 London Paris Seattle New York

13. Epidemiology in Action 13 We also look for Disease Determinants - risk factors or prior events associated with the appearance of the disease/condition, and 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) Disease Frequency - how many cases occur over a given time period (more detailed info on this in Unit III) Source:CDC/Meredith Hickson 1977 Link: Polio Information Center Online (PICO) Polio Information Center OnlinePolio Information Center Online Collection of aids, left, used by polio victims, including the iron lung

14. Epidemiology in Action 14 disease frequency We also want to determine if the disease frequency is: Endemic Endemic - low to moderate level of disease in given area Epidemic Epidemic - level greater than what is expected in a given area Pandemic Pandemic - level greater than what is expected in several countries and regions worldwide Source: CDC/Dr. Edwin P. Ewing/1983 Aids Kaposi’s sarcoma The Aids virus under a microscope Link: HIV Infections HIV InfectionsHIV Infections

15. Epidemiology in Action 15 To apply what we’ve learned so far, research and investigate one of the following diseases, and complete the activities on the assignment sheet. DESIGNING A DISEASE MUSEUM DISEASES DISEASES AIDSInfluenza Anthrax Bubonic Plague TuberculosisPolio EbolaMeasles West Nile Virus West Nile Virus

16. Epidemiology in Action 16 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). case definition How was the disease discovered, and what was/is the case definition? “steps in an Give at least two real-life examples of researchers using the “steps in an outbreak investigation.” outbreak investigation.” disease distributions, determinants, and frequency? What were/are the disease distributions, determinants, and frequency? endemic, epidemic, or pandemic Was/is the disease outbreak endemic, epidemic, or pandemic, and why? hypotheses What were some of the original hypotheses about the causes of this disease? IMPACT 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.

17. Epidemiology in Action 17 CDC/Health Topics A to Z CDC/Health Topics A to ZCDC/Health Topics A to ZCDC/Health Topics A to Z World Health Organization: Infectious diseases World Health Organization: Infectious diseasesWorld Health Organization: Infectious diseasesWorld Health Organization: Infectious diseases All the Virology on the WWW All the Virology on the WWW NFID Web Sites & Virtual Library of Diseases NFID Web Sites & Virtual Library of Diseases Johns Hopkins Infectious Diseases Johns Hopkins Infectious Diseases HIV infections HIV infectionsHIV infectionsHIV infections PICO: Polio Information Center Online PICO: Polio Information Center OnlinePICO: Polio Information Center OnlinePICO: Polio Information Center Online WHO/OMS: Malaria WHO/OMS: MalariaWHO/OMS: MalariaWHO/OMS: Malaria Tuberculosis: Ancient Enemy, Present Threat Tuberculosis: Ancient Enemy, Present ThreatTuberculosis: Ancient Enemy, Present ThreatTuberculosis: Ancient Enemy, Present Threat CDC /Division of Vector-Borne Infectious Diseases (DVBID) Plague Home Page CDC /Division of Vector-Borne Infectious Diseases (DVBID) Plague Home PageCDC /Division of Vector-Borne Infectious Diseases (DVBID) Plague Home PageCDC /Division of Vector-Borne Infectious Diseases (DVBID) Plague Home Page The American Experience | Influenza 1918 The American Experience | Influenza 1918The American Experience | Influenza 1918The American Experience | Influenza 1918 The 1918 Influenza Pandemic The 1918 Influenza PandemicThe 1918 Influenza PandemicThe 1918 Influenza Pandemic NOVA Online | Anthrax NOVA Online | AnthraxNOVA Online | AnthraxNOVA Online | Anthrax New Hampshire Anthrax Outbreak of 1957 New Hampshire Anthrax Outbreak of 1957New Hampshire Anthrax Outbreak of 1957New Hampshire Anthrax Outbreak of 1957 CDC/National Center for Infectious Diseases Viral hemorrhagic fever CDC/National Center for Infectious Diseases Viral hemorrhagic feverCDC/National Center for Infectious Diseases Viral hemorrhagic feverCDC/National Center for Infectious Diseases Viral hemorrhagic fever CDC/Division of Vector-Borne Infectious Diseases (DVBID) West Nile Virus Home Page CDC/Division of Vector-Borne Infectious Diseases (DVBID) West Nile Virus Home PageCDC/Division of Vector-Borne Infectious Diseases (DVBID) West Nile Virus Home PageCDC/Division of Vector-Borne Infectious Diseases (DVBID) West Nile Virus Home Page SUGGESTED ONLINE SOURCES: Designing a Disease Museum

18. Epidemiology in Action 18 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, they’d be on the front lines if a terrorist-caused outbreak of smallpox occurred –and they also: Early epidemiologists studied outbreak of diseases, such as plague. They still do that today – for example, they’d be on the front lines if a terrorist-caused outbreak of smallpox occurred – and they also: Evaluate risk factors for diseases/accidents. Evaluate risk factors for diseases/accidents. (What’s your risk of getting cancer?) (What’s your risk of getting cancer?) Conduct long-term population studies to understand Conduct long-term population studies to understand what causes diseases/accidents. what causes diseases/accidents. (If you start smoking as a teenager, what is your risk of developing (If you start smoking as a teenager, what is your risk of developing lung cancer by the time you are 50?) lung cancer by the time you are 50?) Design and conduct experiments to evaluate control Design and conduct experiments to evaluate control and prevention measures. and prevention measures. (Can stop-smoking education campaigns help prevent teen smoking?) (Can stop-smoking education campaigns help prevent teen smoking?)

19. Epidemiology in Action 19 To give you an idea of how important epidemiology studies are to today’s world, consider an important item to most teens today: Their Driver’s License Most states have instituted a Restricted or Graduated Driver’s License for teens. When you have a Restricted/Graduated Driver’s License, you are not allowed to carry more than a certain number of passengers until you’ve been driving for a specified time period (varies by state). So why are they doing that? Epidemiology Because of Epidemiology, that’s why.

20. Epidemiology in Action 20 Website: http://www-nrd.nhtsa.dot.gov/pdf/nrd- 30/NCSA/TSF2000/2000ydrive.pdfhttp://www-nrd.nhtsa.dot.gov/pdf/nrd- 30/NCSA/TSF2000/2000ydrive.pdf Link to more studies: NHTSA Research and Development siteNHTSA 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

21. Epidemiology in Action 21 Website: http://www-nrd.nhtsa.dot.gov/pdf/nrd- 30/NCSA/TSF2000/2000ydrive.pdfhttp://www-nrd.nhtsa.dot.gov/pdf/nrd- 30/NCSA/TSF2000/2000ydrive.pdf Link to more studies: NHTSA Research and Development siteNHTSA 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

22. Epidemiology in Action 22 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, they’re working for our HEALTH and SAFETY. Source: CDC/unknown

23. Epidemiology in Action 23 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 Share the data Note what the data does NOT say (how might it be misleading?) Note what the data does NOT say (how might it be misleading?) Explain what change you’re proposing/not proposing Explain what change you’re proposing/not proposing Tell us why this change should/should not be made Tell us why this change should/should not be made Risk Factors: Alcohol/Drug Use Teen Violence Diet Accidents AIDS/STD’s LC/1973

24. Epidemiology in Action 24 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 you’re 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 ChartsCDC/NCHS - United States Growth Charts

25. Epidemiology in Action 25 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 (STD’s, AIDS, Teen Pregnancy) Trends in Sexual Risk Behaviors Among High School Students --- United States, 1991—2001