1. Teacher Note: Module 1 Overview
Content Area: Descriptive epidemiology, Surveillance, and Hypothesis-Generation
Essential Questions: How is the health or disease outcome distributed in terms of person, place, and time? What are some possible explanations for this distribution?
Enduring Understanding: 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 possible causes.
Core Concepts:
CDC
Ethics
Hypothesis
Human subjects
Prevalence rate
Person, place, and time
Surveillance
Survey questions
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
Teacher Note: Each lesson in a Module begins with an overview slide that includes the Content Area, Essential Question(s) and the Enduring Understanding for that Module. The idea is that students’ abilities to answer the Essential Question(s) will lead to the development of the Enduring Epidemiological Understanding. The lessons in the Module are geared toward helping students uncover how to answer the Essential Question(s). In the lower part of the overview slide, you will find the Core Concepts for the Module and a listing of the lessons in the Module (with the current lesson highlighted).
New Lesson 1-8: Surveillance Studies – In School Revised Oct 22, 2011 1

2. Teacher Note: Enduring Epidemiological Understandings for the Epidemiology and the Energy Balance Equation Curriculum
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.
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.
Teacher Note: An enduring understanding is a big idea that resides at the heart of a discipline and has lasting value outside the classroom (Wiggins and McTighe, Understanding by Design). The Epidemiology and the Energy Balance Equation curriculum is based on two big ideas – enduring epidemiological understandings. (NOTE: There are other enduring understandings that have been identified as big ideas in epidemiology, but the ones primarily addressed in this curriculum are the two on this slide. . For examples of other listings of enduring epidemiological understandings, go to: and click on “Overview,” or go to and click on “Enduring Epidemiological Understandings.”
The purpose of the eight lessons in Module 1 is to develop students’ comprehension of the first enduring epidemiologic understanding - 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 possible causes.
In Lesson 1-8, Surveillance Studies – In-School, the experience is similar to Lesson 1-7 – Surveillance Questions – In-Class, except that in this lesson 1-8, the study teams carry out their simulated research with students from other classes. Under more pressure and with a wider scope, students will demonstrate their abilities to request informed consent, ask questions, count, calculate a prevalence rate of a health-related behavior, look for patterns, make accurate statements about the prevalence of the behavior, and formulate hypotheses based on their observations.
Teacher Note: To the extent you can, provide as little direction as possible. The epidemiologic knowledge and skills they have developed in the previous seven lessons should have prepared them to succeed at this assessment. A notable exception to this is that you, as the teacher, should pay careful attention to the informed consent script and process to be sure that all potential study participants are made to feel that participation is entirely voluntary and that there will be absolutely not adverse consequences if they choose not to participate. Care should also be taken to avoid having anyone stand out who is not participating.
New Lesson 1-8: Surveillance Studies – In School

3. Teacher Note: 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.
Teacher Note: The authentic assessment for Module 1 requires students, in study teams, to conduct surveillance studies among students in their class, and then among students in other classes. Lessons 1-1 through 1-6 provide learning experiences to prepare for the authentic assessment (in a sense, “teaching to the assessment”) and the studies are conducted as part of Lessons 1-7 and 1-8.
New Lesson 1-8: Surveillance Studies – In School 3

4. Teacher Note: Photos of Worksheets for Lesson 1-8
1-8b
1-8c
If desired, these photos of worksheets could be enlarged for viewing in Power Point.
New Lesson 1-8: Surveillance Studies – In School 4

5. (estimate 4 class periods)
Start of Lesson 1-8
(estimate 4 class periods)
New Lesson 1-8: Surveillance Studies – In School 5

6. Steps and materials should all be ready prior to starting.
Review
Big Ideas in Lesson 1-7
The in-class surveillance study is the final practice for conducting a survey of other students in the school
This is simulated research, not actual research, because the results are not generalizable
Steps and materials should all be ready prior to starting.
In all aspects of the survey, every effort should be made to protect the privacy of participants and their information
The survey yields counts, that can be turned into prevalence rates, that can be turned into statements, tables, and/or bar graphs
Survey results can help formulate hypotheses (educated guesses) to explain patterns of a health-related behavior
New Lesson 1-8: Surveillance Studies – In School

7. Rubric for Evaluating Report Out and Poster
Criteria
Got It
Getting It
Will Get It Soon
Participation
All study team members participate
Most study team members participate
Some study team members participate
Use of epidemiology terminology such as prevalence and surveillance
All are appropriate and accurate
Most are appropriate and accurate
Some are appropriate and accurate
Accurate calculation of prevalence (either fraction or percentage)
All prevalence measures correctly calculated
Most prevalence measures correctly calculated
Few to no prevalence measures correctly calculated
Understanding of analysis by gender
Explanation of gender analysis is clear and accurate
Explanation of gender analysis is either unclear or inaccurate
Explanation of gender analysis is not clear or accurate
Generation of reasonable and/or interesting hypotheses
1 or more hypotheses make sense in light of survey results
1 or more hypotheses make limited sense in light of survey results
1 or more hypotheses make little or no sense in light of survey results
Understanding of limitations of their survey
Identified at least 2 reasonable and logical limitations
Identified 1 reasonable and logical limitation
Did not identify any reasonable or logical limitations
Remind students of your previous discussion (end of Lesson 1-7) as a basis for evaluating their in-school studies. This rubric will be used by the teacher, and also as a self-assessment tool by study teams.
Remind students that each team will prepare a poster of their findings to communicate their results to the students from the class(es) in which they carried out their simulated research, and perhaps to others.
Tell students that the class will review this rubric once more after their studies are completed and before they make their posters.
As needed, address any questions or concerns about the rubric before continuing with this Lesson 1-8.
Teacher Note: This rubric is displayed in Worksheet 1-8c, which will be passed out after students have completed their in-class studies. If you think it will be helpful, you could post a copy of this slide in the classroom or pass out copies of the slide to each team now.
New Lesson 1-8: Surveillance Studies – In School

8. Putting It All Together Under Pressure
Asking for informed consent
Asking questions
Counting
Calculating prevalence
Writing statements
Formulating hypotheses
Summarizing results in a table and a bar graph
Reporting out
Tell students that in this lesson, Lesson 1-8: Surveillance Studies – In School, each study team will “put it all together under pressure,” carrying out simulated research among students in other classes, not their classmates. They will be asking for their informed consent, asking students to answer their health-related behavior and gender questions, counting the frequency with which it occurred, calculating overall prevalence and prevalence of the behavior in terms of gender (this is new), writing accurate statements about the prevalence of those behaviors among their classmates, formulating hypotheses, and summarizing their results in a table and bar graph before reporting out.
Tell students that this lesson is an authentic assessment. It has been designed to be realistic so that they will experience some of the challenges that epidemiologists face when looking for patterns of health-related events in the real world. It will require them to use judgment and innovation, rather than simply following a routine. It will require them to "do" epidemiology rather than simply define vocabulary words and recall facts. It will require them to have developed and to be able to use a variety of epidemiological knowledge and skills efficiently and effectively.
Teacher Note: To repeat, to the extent you can, provide as little direction as possible to the study teams. The epidemiological knowledge and skills they have developed in the previous nine lessons should have prepared them to succeed at this assessment. A notable exception to this is that you, as the teacher, should pay careful attention to the informed consent script and process to be sure that all potential study participants are made to feel that participation is entirely voluntary and that there will be absolutely no adverse consequences if they choose not to participate. Care should also be taken to avoid having anyone stand out who is not participating.
New Lesson 1-8: Surveillance Studies – In School

9. Steps and Expectations for Putting It All Together
Is our team prepared for all the steps for putting it all together?
Give each team a copy of worksheet 1-8a, Steps and Expectations for Putting It All Together.
Remind students that they had the same sheet for their in-class surveillance studies.
Tell students that they should use 1-8 a in a similar way as they used 1-7a in the last lesson.
Remind students that 1-8a should be a guide to their conduct of their simulated research and will serve as a self-assessment when they are finished (using the “Met,” “Somewhat Met,” and “Not Met” boxes to evaluate their work).
Teacher Note: These rubrics can also be the basis for teacher assessment of student performance.
Remind students of the “tips” they came up with for having a successful interaction with the class as they administer the survey:
Assign tasks among team members.
One person should read the informed consent. Before starting, have some kind of “hello” message to participants.
Speak loudly and SLOWLY while reading the informed consent.
Do not have other team members pass out the survey form until the informed consent reading is completed.
While passing out the form, team members can reinforce instructions verbally, such as reminding participants to NOT put their name on the form.
Upon completion of collecting the folded forms, be sure to thank the class for their participation.
Teacher Note: Suggest to students that as they go out in the school to administer their surveys in other classes, they should keep these tips in mind.
New Lesson 1-8: Surveillance Studies – In School

10. Finalizing the In-School Survey Form
As in Lesson 1-7, students should finalize their survey questions and type any corrections to the previous one using the Word file: “Template for Typing Survey Form and IC (informed consent)” available in the Lesson 1-8 section of the website.
If the informed consent has changed, it should also be re-typed on the second page of the Word file: “Template for typing survey form and IC.”
Teacher Note: Check the questions for each study team to be sure they are appropriate and will not cause study participants to be uncomfortable or upset.
Teacher Note: Have students work together to “fix” any questions their classmates may have struggled with during the in-class survey. This is their opportunity to do any final “tweaking” before conducting their surveys outside their class.
Teacher Note: Also, make sure informed consent scripts do not make any promises of compensation or offer contact information that is invalid. This script should be as truthful and honest as possible.
Let’s make sure our surveillance questions are just right and re-type the survey form if necessary
New Lesson 1-8: Surveillance Studies – In School

11. Preparation
Enough copies of our Surveillance Form sheets for each participant
Practice
Informed Consent Script
I am about to give you a Question / Answer Form on which a question is written. Do not write your name on the form. I am going to ask you to answer the question by circling your answer with a No. 2 pencil and then immediately folding the form in half so that no one else can see your answer. You do not need to answer the question. If you do not wish to participate, simply fold the form in half. Your participation is voluntary, anonymous, and confidential. Let me repeat – You are not required to participate and nothing will happen to you if you do not. I will pass several large envelops around the class into which you can place your folded form regardless of whether or not you answered the question.
To make final preparations for their simulated research, have each study team:
Practice reading their Informed Consent script
Make enough hard copies of the Surveillance Form sheets for each of their classmates (the actual survey sheet from the Word template should be used).
Sharpen enough #2 pencils for each of their classmates
Get a large envelope in which to collect the completed, folded question sheets
Supplies
New Lesson 1-8: Surveillance Studies – In School

12. Conducting In-School Surveys
Next Class
Conducting In-School Surveys
New Lesson 1-8: Surveillance Studies – In School 12

13. Preparation and Conduct of In-School Survey
Tell students to prepare to carry out their simulated research about their health-related behavior among the students in their assigned other classroom(s).
Teacher Note: Assist study teams in locating one or more other classes for their survey and arrange with teachers a time for administration of the survey. Based on experience, we strongly advise that you discuss this activity with all teachers whose students will be participants, emphasizing the importance of the experience to your students and the necessity to maintain class order and cooperation during the few minutes that the study teams will be visiting their classes.
Give students as little further guidance as possible (with the exception of any needed advice about the informed consent form and process). At this point, they should know how to prepare to carry out their simulated research.
New Lesson 1-8: Surveillance Studies – In School

14. Putting It All Together
Students are now prepared to administer their surveys. Have each study team visit pre-selected classes to administer their surveys, reminding them to follow the steps needed to “Put it All Together.”
This slide should remind them to: read the informed consent loudly and clearly, pass out survey questions, and remind students to fold their surveys prior to the surveys being collected, whether they answered the survey questions or not.
Teacher Note: Observe as you deem appropriate.
New Lesson 1-8: Surveillance Studies – In School

15. Next Class Data Analysis 15
New Lesson 1-8: Surveillance Studies – In School 15

16. Discussion About How it Went
Teacher Note: Before beginning data analysis, discuss with students how the administration of their surveys went. Ask students to share their “war stories” (positive and negative).
New Lesson 1-8: Surveillance Studies – In School 16

17. Completeness and Accuracy
Ask students to consider how the expanded simulated research outside their own class might affect their results (more accurate because of larger numbers versus less accurate because of study limitations and errors they might now be aware of). Probe.
Ask students to consider how the expanded simulated research outside their own class affected confidence in their ability to conduct research (more confident through experience or less confident because of more unknowns). Probe.
Ask students what they would do differently the next time in order to get a more complete and accurate accounting of the prevalence and distributions of their health-related behavior (larger sample, later capture of absent students, more precise wording of questions).
New Lesson 1-8: Surveillance Studies – In School

18. In-School Survey Results Summary
1-8b
In-School Survey Results Summary
Data Management and Calculations for the In-Class Surveillance Studies
Following discussion about how the survey administration went, pass out 1-8b In-School Survey Results Summary.
Explain that, as was done in Lesson 1-7, the blank forms will be used to manage and analyze their data for the in-school surveillance study.
Then tell the students to open their envelopes and remove the folded survey forms. Tell students to unfold all the sheets and put them in a neat pile.
Explain to students that instead of you (the teacher) leading the class through all the steps in worksheet 1-8b, you want them to do the first page on their own, filling in all the blanks and the table, calculating the prevalence rate of the health behavior, and writing an accurate statement.
Teacher Note: Lead the discussion of report out of each team’s overall prevalence rate and statement. Address misconceptions and errors in calculations.
Analysis of Overall Prevalence
New Lesson 1-8: Surveillance Studies – In School

19. In-School Survey Results Summary
1-8b
In-School Survey Results Summary
Data Management and Calculations for the In-Class Surveillance Studies
Tell students that before they go ahead with the rest of the analysis, you are going to first explain how to do it, because it is new to them.
Explain that the next step in the analysis is analysis by gender. They did not analyze by gender in the in-class surveys, but now have larger numbers of participants which makes an analysis by gender more meaningful.
Tell students that first, you are going to show them how to do it with an example.
Analysis of Prevalence by Gender
New Lesson 1-8: Surveillance Studies – In School

20. Total 3/5 30 20 50 60% Total 1/5 10 40 50 20% Prevalence in FEMALES
All FEMALES
Met Cut Point of
Total
Did Not Meet Cut Point
Prevalence in FEMALES
Fraction = ___________
Percent = ____________
3/5 30 20 50
60%
All MALES
Met Cut Point of
Total
Did Not Meet Cut Point
Prevalence in MALES
Fraction = ___________
Percent = ____________
Explain to students that this is an example of an analysis by gender. This analysis provides additional information about the health behavior, in terms of what the prevalence of the behavior is for females versus males
Tell students that such an analysis is called a stratified analysis, because the data are divided into two strata. Strata is the plural for stratum, which means one or more portions or divisions. Two divisions (or strata) of gender are male and female.
Tell students that analysis by gender requires students to re-sort all forms into two new piles. One pile is for FEMALES and the other pile is for MALES. Then, for EACH of the two piles, there is a separate calculation of prevalence of the health behavior.
Show students the progression of numbers via the animated slide.
When finished, ask students what it might mean if the two prevalence rates are different, as they are here. (It might give rise to some hypotheses to explain the difference).
Teacher Note: For ease of calculations, this example shows a population that is half female (50) and half male (50).
1/5 10 40 50
20% 20
New Lesson 1-8: Surveillance Studies – In School

21. In-School Survey Results Summary
1-8b
In-School Survey Results Summary
Data Management and Calculations for the In-School Surveillance Studies
Tell students that now you will lead the class in filling out the next two pages of Worksheet 1-8b; this is the analysis by gender.
Teacher Note: Conduct a read-through of these next two pages of the worksheet and address any misconceptions. Then, walk through all the steps (items 3-9, keeping the class with you for all steps). Make sure misconceptions are addressed as you go, and wait for all teams to complete a step before going on to the next step.
Teacher Note: Analysis by gender requires students to re-sort all forms into two new piles. One pile is for FEMALES and the other pile is for MALES. Then, for EACH of the two piles , calculate a separate prevalence of the health behavior (in other words, sort each pile into two piles according to the cut point established for the overall prevalence analysis).
Analysis of Prevalence by Gender
New Lesson 1-8: Surveillance Studies – In School

22. In-School Survey Results Summary
1-8b
In-School Survey Results Summary
Numerator
Denominator
Prevalence
Overall Study Group – watch TV 3 or more hours per day 30
100
30.0%
Boys 10 50
20.0%
Girls 20
40.0%
Live in apartment 24 60
Do not live in an apartment 6 40
12.5%
Data Management and Calculations for the In-School Surveillance Studies
Tell students to turn to the last page of 1-8b and fill in the table with their data and also draw a graph of the results.
Teacher Note: Visit the study teams as they work and offer guidance as you deem necessary.
Table and Graph
New Lesson 1-8: Surveillance Studies – In School

23. Next Class Reporting Out 23
New Lesson 1-8: Surveillance Studies – In School 23

24. Initial Report-Out To Classmates
Numerator
Denominator
Prevalence
Overall Study Group – watch TV 3 or more hours per day 30
100
30.0%
Boys 10 50
20.0%
Girls 20
40.0%
Live in apartment 24 60
Do not live in an apartment 6 40
12.5%
Overall Prevalence
Results by Gender
Hypotheses?
Explain to students how results will be presented and discussed with their class.
Tell students that each team will have a chance to show what they found and discuss any possible hypotheses with the rest of the class, according to the following order.
Overall Prevalence (Items 1 and 2 on 1-8b, the In–School Survey Results Summary)
Results by gender (Items 3-9 on the In–School Survey Results Summary)
Results displayed in additional ways besides statements. (Items 10 (Table) and 11 (graph) on the In–School Survey Results Summary
Discussion of how the survey would be done differently if repeated (Item 12)
Teacher Note: Decide the extent to which you want this report-out to be conducted. It can be done in a similar way as was done in Lesson 1-7, or in an abbreviated way according to class needs and teacher preference.
Teacher Note: In any case, students should report and discuss their findings in an orderly and consistent manner. Students should have ample opportunity to share and discuss their results and any questions regarding further report-out to others outside the class (to whom, when, and how).
New Lesson 1-8: Surveillance Studies – In School

25. Completeness and Accuracy “… XX.X% had __________”
Emphasize to students that the “truth” is what really exists, not necessarily the prevalence they found for the health-related behavior among their classmates.
Ask students how close to the “truth” they think the prevalence they calculated and the patterns they observed (or did not observe) might be. Discuss and probe.
Another way to approach these issues is to ask what students think are the strengths of their simulated research in other classes, compared to their in-class studies. (larger sample, possibly more representative)
Then ask students to describe the limitations of their simulated research. (still relatively small sample, not representative of students in all middle schools, limits in quality of their question and/or answer choices, possibility of errors in answers due to mistakes or poor attitude/fooling around)
New Lesson 1-8: Surveillance Studies – In School

26. Putting It All Together
As was done in Lesson 1-7, give study teams an opportunity to revise their 1-8b -In-School Survey Results Summary and their abilities to carry out simulated research by placing checks in the appropriate “Met,” “Somewhat Met,” or “Not Met” boxes according to 1-8a - Steps for Putting It All Together.
Let’s revise our In-School Survey Results Summary (1-8b) based on what we discussed in the class about our results and about the other teams’ results.
Let’s assess how we did with our survey in light of Steps and Expectations for Putting It All Together (1-8a).
New Lesson 1-8: Surveillance Studies – In School

27. Rubric for Evaluating Report Out and Poster
Criteria
Got It
Getting It
Will Get It Soon
Participation
All study team members participate
Most study team members participate
Some study team members participate
Use of epidemiology terminology such as prevalence and surveillance
All are appropriate and accurate
Most are appropriate and accurate
Some are appropriate and accurate
Accurate calculation of prevalence (either fraction or percentage)
All prevalence measures correctly calculated
Most prevalence measures correctly calculated
Few to no prevalence measures correctly calculated
Understanding of analysis by gender
Explanation of gender analysis is clear and accurate
Explanation of gender analysis is either unclear or inaccurate
Explanation of gender analysis is not clear or accurate
Generation of reasonable and/or interesting hypotheses
1 or more hypotheses make sense in light of survey results
1 or more hypotheses make limited sense in light of survey results
1 or more hypotheses make little or no sense in light of survey results
Understanding of limitations of their survey
Identified at least 2 reasonable and logical limitations
Identified 1 reasonable and logical limitation
Did not identify any reasonable or logical limitations
Remind students that each team will prepare a poster of their findings to communicate their results to the students from the class(es) in which they carried out their simulated research, and perhaps to others.
Pass out 1-8c – Rubric for Evaluating Report Out and Poster of In-School Study Results in their Study Notebooks
Teacher Note: Go over the instructions in 1-8c with the study teams, emphasizing the expectations for a poster. Go over the specific instructions (text) and the criteria in the rubric. Address any questions and misconceptions.
Teacher Note: We recommend making posters as a generally good communication vehicle for middle school students. We also recommend that the posters be displayed in the school hallway so that participating students from other classes can view the results.
Remind students that you will evaluate their simulated research based on your observations of their data collection and calculations in section 1-8b, In-School Survey Results Summary and on your observations of their poster/report/presentation using the rubric on this slide.
Tell students that they have been thinking like epidemiologists and experiencing what epidemiologists do.
Encourage discussion about what this experience has meant to the students.
New Lesson 1-8: Surveillance Studies – In School

28. Making a Poster to Display Survey Results
After students have reported out in class, have each team make a poster to display their survey findings.
Tell the study teams that the informed consent process should be included in their poster.
Teacher Note: Check the posters to be sure the material presented is appropriate for display in a school hallway or bulletin board.
Teacher Note: Talk with students, other teachers, and school administrators about other possible places for displaying the posters.
Teacher Note: Assess students’ overall abilities to carry out simulated epidemiological research in light of your observations of their data collection methods, the accuracy of their work, the accuracy of their self-evaluations, and the quality of their posters. This should be assessed by team, and by individuals to the extent possible.
Teacher Note: The wrap-up discussion as shown in slide 22 of Lesson 1-7 could be conducted at the end of this Lesson 1-8 if desired.
New Lesson 1-8: Surveillance Studies – In School

29. Big Ideas in this Lesson (1-8) Same big ideas as in Lesson 1-7
Re-Cap
Big Ideas in this Lesson (1-8)
Same big ideas as in Lesson 1-7
The independent (to the extent possible) conduct of an in-school survey by the study team constitutes an authentic assessment of their knowledge and skills related to the first enduring understanding
New Lesson 1-8: Surveillance Studies – In School 29