1. Why Evaluate? Did the prevention strategy work?
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Did the prevention strategy work?
In Module 5 investigations, students will learn how, when a disease prevention strategy is implemented, epidemiologists answer the question “Did the prevention strategy work?”
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

2. Where are we and where are we going?
1. How is this disease distributed and what hypotheses might explain that distribution?
2. Is there an association between the hypothesized cause and the disease?
3. Is the association causal?
4. What should individuals and society do when preventable causes of disease are found?
Remind students that they have learned how epidemiologists answer the first, second, third, and fourth Essential Questions:
■ How is this disease distributed and what hypotheses might explain that distribution?
■ Is there an association between the hypothesized cause and the disease?
■ Is the association causal?
■ What should individuals and society do when preventable causes of disease are found?
In the Module 5 investigations, they will now learn how epidemiologists answer the fifth Essential Question: Did the prevention strategy work?
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5. Did the prevention strategy work?
Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

3. Where are we and where are we going?1
How is this disease
distributed?
Hypotheses 2
Is there
an association? 3
Is the association
causal?
What’s my hypothesis?
Did the exposure and the disease turn up together?
Why did the exposure and the disease turn up together? 4
What should be done
to prevent the disease?
What should I do? What should society do? 5
Did the prevention
strategy work?
Was it worth the effort? Should we continue it?
Tell students that this Concept Map is another way to look at the Essential Questions.
In Module 1 investigations, students learned how epidemiologists answer the question “How is this disease distributed?” or “What’s my hypothesis?”
In Module 2 investigations, students learned how epidemiologists answer the question “Is there an association?” or “Did the exposure and the disease turn up together?”
In Module 3 investigations, students learned how epidemiologists answer the question “Is the association causal?” or “Why did the exposure and the disease turn up together?”
In Module 4 investigations, students learned, when an association is judged to be causal, how to answer the question “What should be done to prevent the disease?” or “What should I do?, What should society do?”
And now, in Module 5 investigations, students will learn how epidemiologists answer the question “Did the prevention strategy work?” or “Was it worth the effort?, Should we continue it?”
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

4. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
By completing Investigation 5-1: Why Evaluate?, students will uncover the reasons why a risk management strategy should be evaluated.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

5. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Review
Epi Speak
Ethical
In accordance with the accepted principles of right and wrong governing the conduct of a group.
Ask students to find “Ethical” in the Epi Speak list.
Review its definition.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

6. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Review
Epi Speak
Risk
A measure of how often an event occurs in a defined group of people in a defined period of time.
The likelihood of developing a disease.
Ask students to find “Risk” in the Epi Speak list.
Review its definition.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

7. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Review
Epi Speak
Risk Management
Steps taken to reduce the levels of risk to which an individual or a population is exposed.
Ask students to find “Risk management” in the Epi Speak list.
Review its definition.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

8. Review Actual Evidence of Risk Perception of Risk
Acceptability of Risk
Risk Management Strategy
Remind students that before developing a risk management strategy, the actual evidence of risk (science), as well as people’s perception of risk and the acceptability of risk, needs to be considered.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

9. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Epi Speak
Epi Speak
Strategy Evaluation
A scientific investigation of the effectiveness of a risk management strategy.
Give students the Epi Speak list for Module 5.
Ask students to find “Strategy evaluation” in the Epi Speak list.
Review its definition.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

10. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Reasons to Evaluate
Learn if the strategy is working
Stop wasting, time, energy, and money
Ensure public is not mislead
Learn if a new strategy is needed
Lead the class in discussion about why a risk management strategy should be evaluated.
As students suggest ideas, write each reason on the board.
Continue to probe until students’ suggestions include the following:
■ Learn if the strategy is working.
■ Stop wasting time, energy, and money.
■ Ensure the public is not misled.
■ Learn if a new strategy is needed.
☼ Teacher Alert: Do not limit students’ suggestions to the above.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

11. Why Evaluate? Why Evaluate? Reasons to Evaluate
Reasons Not to Evaluate
Learn if the strategy is working
Save time, energy, and money
Stop wasting, time, energy, and money
Avoid having to admit that you were wrong
Ensure public is not mislead
Avoid embarrassment
Learn if a new strategy is needed
Avoid having people mad at you
Ask students:
■ Can you identify reasons why someone may not want to evaluate a risk management strategy?
As students suggest ideas, write each reason on the board.
Continue to probe until students’ suggestions include the following:
■ Save time, energy, and money.
■ Avoid having to admit that you were wrong.
■ Avoid embarrassment.
■ Avoid having people angry with you.
☼ Teacher Alert: Do not limit students’ suggestions to the above.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

12. Why Evaluate? Why Evaluate? Reasons to Evaluate
Reasons Not to Evaluate
Learn if the strategy is working
Save time, energy, and money
Stop wasting, time, energy, and money
Avoid having to admit that you were wrong
Ensure public is not mislead
Avoid embarrassment
Learn if a new strategy is needed
Avoid having people mad at you
Ask students:
■ Can you weigh the reasons to evaluate and the reasons not to evaluate?
■ Should risk management strategies be evaluated, given the reasons you have identified?
Students should uncover the importance of evaluating whether or not a risk management strategy is being successful.
Help them discover these major points:
■ Failing to evaluate a program is unscientific.
■ If the strategy does not help prevent the disease, it is unethical.
■ If the strategy does not help prevent the disease, it is a waste of scarce resources.
■ The strategy does not reduce the risk of getting the disease!
Later in the Module 5 investigations, students will learn that one way to determine if a risk management strategy is working is to evaluate the strategy with an epidemiologic study design. Although a well-conducted evaluation costs money and other resources, too, failure to do one may be even more costly to society.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

13. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
United States TX CA MT AZ ID NV NM OR CO UT IL WY KS IA NE SD MN ND OK FL WA WI MO AL GA AR MI LA IN NY PA NC MS TN KY VA OH ME SC WV VT NH MD NJ MA CT DE RI
Students should now take out their assigned homework reading, “Accessibility to Children of Video Games with Violent Content.”
Ask students to identify the state of Missouri.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

14. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Missouri
Now have students identify St. Louis County.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

15. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
St. Louis County
I-270
I-44
I-64
I-70
I-55
I-170
HWY 67
MANCHESTER RD.
OLIVE BLVD.
HWY 367
LINDBERGH BLVD.
PAGE AVE.
CLARKSON RD.
CITY of
ST LOUIS
ILLINOIS
MISSOURI
COUNTY
Explain that St. Louis County includes the large city of St. Louis and other smaller towns and rural areas. The ordinance that students read about in their homework reading applies to all communities in St. Louis County except cities that have 75,000 or more people and that have an organized health department.
Ask students:
■ Why do you think the larger cities are not included? (Large cities will determine their own risk management strategies.)
Ask the class to discuss the following questions about the St. Louis County Ordinance 20193:
■ Is this a risk management strategy?
■ What is the law trying to do?
■ What are the stated reasons for wanting this law?
■ Who is affected?
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

16. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Epi Teams
Divide the class into Epi Teams of four or five students per team.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

17. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Epi Log Worksheet
Give each student an Investigation 5-1: Epi Log Worksheet.
Working in their Epi Teams, students should answer Questions 1 to 8 on their Investigation 5-1: Epi Log Worksheet during the next 15 minutes.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

18. Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Good Idea?
Ordinance Number: 20193
■ Is the strategy aimed at a behavior that has potential to reduce the undesired outcome―violence?
■ Is the strategy aimed at the right people? Children under age 17?
■ Will the strategy achieve the shorter term goal of reducing access to violent video games?
■ Will this strategy be accepted and supported by the community?
■ Are there adequate resources to enforce the strategy?
Lead a class discussion on each question.
Question 1: Is this risk management strategy a good idea?
☼ Teacher Alert: Help students examine this strategy and decide what they think about it. Encourage them to ask and answer tough questions such as the following:
■ Is the strategy aimed at a behavior that has potential to reduce the undesired outcome―violence?
■ Is the strategy aimed at the right people? Children under age 17?
■ Will the strategy achieve the shorter term goal of reducing access to violent video games?
■ Will this strategy be accepted and supported by the community?
■ Are there adequate resources to enforce the strategy?
Encourage other questions from students.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

19. Will the strategy reduce violence?2
Will the strategy reduce violence?
Arguments For Success
Arguments Against Success
Question 2: Do you think this risk management strategy will reduce violence?
☼ Teacher Alert: Help students uncover the reasons why they think this strategy may or may not reduce violence.
■ Arguments for its success may include the following:
□ Playing violent video games really causes violent behavior, and increasing parental consciousness and control over the playing of these games might reduce their use and, therefore, reduce violent behavior.
■ Arguments against its success may include the following:
□ The effort to restrict access may not work. Children might find other ways to obtain the video games, such as from older siblings and friends.
□ Even if there were more restricted access, it would not reduce violence if violent video games do not cause violent behavior. It can be argued that a reversed time order is operating here; that is, people who are violent like to play violent video games. If this were true, taking away violent video games would not reduce violent behavior.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

20. Should the strategy be evaluated?3
Should the strategy be evaluated?
Video games in this establishment which are marked with a red dot may contain graphic violence not suitable for persons under age 17.
Question 3: Do you think the risk management strategy should be evaluated?
☼ Teacher Alert: Help students review the reasons why this risk management strategy needs to be evaluated:
■ An evaluation is the only way to know if all the effort is worth it.
■ It is not ethical to restrict behavior unless its usefulness can be shown.
■ It is not practical to make the effort if it is not accomplishing what is intended; resources could be allocated to more effective programs.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

21. What might happen if it is not evaluated?4
What might happen if it is not evaluated?
Why Evaluate?
Learn if the strategy is working
Stop wasting, time, energy, and money
Learn if a new strategy is needed
Ensure public is not mislead
Reasons to Evaluate
Save time, energy, and money
Avoid having to admit that you were wrong
Avoid embarrassment
Avoid having people mad at you
Reasons Not to Evaluate
Question 4: What might happen if the strategy was not evaluated?
☼ Teacher Alert: Encourage students to uncover possible consequences of not evaluating this strategy. Help them by asking the following:
■ What would happen if violence did not decrease? (Eventually, others would question the value of the strategy and blame those who should have evaluated it. Another scenario would be that Ordinance would reduce access to violent video games but would also create a black market in violent video games that would increase violent behavior. For example, children would have to go to a violent neighborhood to get the games and would be exposed to circumstances that increase violent behavior. )
■ What would happen if violence did decrease? (You might get [unproven] credit for helping decrease violence. However, no one would know if the reason violence decreased was because of the risk reduction strategy, and yet you would have to keep enforcing the law without knowing if it was really successful.)
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

22. How should the strategy be evaluated?5
How should the strategy be evaluated? -
Question 5: How do you think the strategy should be evaluated?
☼ Teacher Alert: When suggesting ways of evaluating the strategy, review with students their knowledge about epidemiologic study designs.
Emphasize that when evaluating a risk management strategy, the “exposure” is the risk management strategy (Ordinance 20193) and the “outcome” is, in this case, violent behavior.
Ask students:
■ How would you use a cohort design to evaluate Ordinance 20193? (Start with two towns, one that is exposed to Ordinance and one that is not. Using some measure of violence, such as police or school records, compare the change in violence in the two towns during a certain period.)
■ How would you use a case-control design to evaluate Ordinance 20193? (Define cases as children who have exhibited violent behavior and controls as children who have not. Determine who was exposed by identifying who lived in the town with Ordinance and who did not. Compare the likelihood of having been exposed among the cases and the controls.)
Make it clear to students that if such evaluations were carried out, researchers would have to make sure to measure and take into consideration other factors that could influence violent behavior (confounders) besides Ordinance 20193, such as a new antiviolence program in school or increased police presence.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

23. Intro to Epidemiology – Investigation 5-1: Why Evaluate?6
Found Ineffective?
Question 6: What might happen if the risk management strategy was evaluated and found to be ineffective?
☼ Teacher Alert: Help students uncover a range of expectations.
■ It would be embarrassing to those who advocated the risk management strategy to find that it was ineffective.
■ The strategy may be discontinued.
■ Some people would not believe the evaluation and would be opposed to discontinuing the strategy. This would present political challenges.
■ When it comes to controversial issues, people may have strong beliefs on both sides and would not necessarily accept what the science showed.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

24. Intro to Epidemiology – Investigation 5-1: Why Evaluate?7
Ethical? -
Ordinance 20193
First
Question 7: Is it ethical to implement a risk management strategy without evaluating it first?
☼ Teacher Alert: Help students realize that the answer has to be “yes.” Something has to be implemented before it can be evaluated. Thus, it is ethical to implement an untried risk management strategy, provided it has a chance of success and there are plans to evaluate its effectiveness. Sometimes a strategy is pilot-tested with a small number of people first.
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Time
Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

25. Intro to Epidemiology – Investigation 5-1: Why Evaluate?8
Ethical? -
Ordinance 20193
After
Question 8: Is it ethical to implement a risk management strategy without evaluating it after implementation?
☼ Teacher Alert: This brings the discussion back again to the question of whether risk management strategies should be evaluated. At this point, students should know why evaluation is vital. Ethical considerations are one such reason.
The other important reason is that it is wasteful to invest resources in a risk management strategy that does not reduce risk. Those resources could be allocated for effective strategies.
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Time
Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

26. Essential Question 5 Did the prevention strategy work?
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Did the prevention strategy work?
Mention again that Essential Question 5 is “Did the prevention strategy work?”
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

27. Did the prevention strategy work?
Save time, energy, and money
Avoid having to admit you were wrong
Avoid embarrassment
Avoid having people mad at you
Remind students that to answer Essential Question 5―“Did the prevention strategy work?”―they must evaluate the strategy.
Remind them, too, that there are reasons for not evaluating.
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Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

28. Did the prevention strategy work?
Save time, energy, and money
Learn if the strategy is working
Avoid having to admit you were wrong
Stop wasting, time, energy, and money
Avoid embarrassment
Ensure public is not mislead
Avoid having people mad at you
Learn if a new strategy is needed
However, the reasons for evaluating the risk management strategy outweigh the reasons for not evaluating.
Next Slide
Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1

29. Investigation 5-1 has ended.
Why Evaluate?
Investigation has ended.
CDC
This concludes Investigation 5-1: Why Evaluate? and students can now put away their Epi Logs.
Intro to Epidemiology – Investigation 5-1: Why Evaluate?
Investigation 5-1