1. Field Epidemiology Fall 2000 Patty Kissinger, PhD John L. Clayton, MPH Megan O’Brien, MPH

2. Field Epidemiology To provide students with data collection, data management, analytic, writing, and presentation skills Each student conducts an epidemiologic study using either existing data sources or they collect their own data The course has an in-class data management and analysis component in addition to field work A culminating capstone experience

3. Field Epidemiology (3 credits) First and Second Semester, Periods I and II Pre-requisites: EPID 601 or 603, BIOS 603, BIOS 620, and BIOS 623, 624, or 625 Recommended EPID 712, EPID 624, BIOS 706, BIOS 715 Recommented Text: Methods in Observational Epidemiology Kelsey JL, Thompson WD, Evans AS.

4. Field Epidemiology Discuss the role of an epidemiologist Discuss criteria for causality Describe the basic study designs Review possible projects Assign preceptors Discuss class logistics

5. Role of an Epidemiologist Surveillance Outbreak investigation Hypothesis testing or strength of association Evaluation Prediction of disease occurrence Communication

6. A Team Approach to Research and Evaluation Research team Epidemiologist Behavioralist Biostatistician Program manager Clinicians Consumers

7. Criteria for Causality (Hill, 1971) Strength of association Dose-response relationship Lack of temporal ambiguity Consistency of findings Biological plausibility Coherence of evidence Specificity of the association

8. Study Designs Descriptive Analytic Experimental Correlation Case report/case series Cross-sectional Cohort/Case-Control Community trial

9. Study Designs Descriptive Analytic Experimental correlational case report/ case series cross-sectional case control cohort clinical trial community trial

10. Cross-sectional Classification of exposure and disease at the same time –Descriptive in nature –Hypothesis generation –Cannot determine causality –Fast and generally inexpensive

11. Analytic Studies Case-Control Cohort (follow-up) Quasi-experimental

12. Case-Control Subjects are chosen on the basis of whether they do (case) or do not (control) have the disease of interest Particularly useful for diseases with low prevalence, or long latency Efficient in time and cost Can evaluate a wide range of etiologic factors Susceptible to selection bias, recall bias

13. Case-Control cont’d Definition and selection of cases Selection of controls

14. Case Control Classify by disease status Exposed Unexposed Disease No Disease Unexposed Exposed

15. Cohort Classify by exposure status Exposed Unexposed Disease No Disease Disease No Disease

16. Experimental Studies (clinical trials) Investigator allocates the exposure Exposed Unexposed Disease No Disease Disease No Disease Potential Subjects Randomization

17. Confounding Exposure / Disease relationship Confounder – related to both the exposure and the disease

18. Validity and Generalizability Total population Study sample

19. Field Epidemiology Home Page http://www.tulane.edu/~hivstd/epi714/john’s/Master/epi714.htm Exercises Assignments Field Work

20. Late Policy Assignments that are received late will lose points. Assignments are due by midnight on the designated due date. Each week the assignment is late, the student will lose one letter grade (e.g. 10 points on a 100 point scale). For example, if the assignment is 1-7 days late, one letter grade will be lost, if the assignment is 8-14 days late, two letter grades will be lost, etc. After 4 weeks, no credit will be given for the assignment. In order to not lose points for late assignments, students must contact Dr. Kissinger prior to the due date, and the she will use her discretion in grading that assignment.

21. HOP Clinic Requirements Wear your student ID Dress appropriately (no hats, jeans, shorts) Be on time Respect the clinic staff Respect patients Maintain confidentiality / sign form All analyses must occur at HOP