EPIB 301 Epidemiology for Public Health Practice · epidemiologic methods, and the application of epidemiologic research to public health practice. The subject matter is applicable

University of Maryland School of Public Health

EPIB 301 – Epidemiology for Public Health Practice

Semester: Spring 2020

Classroom and Time:

Tuesday/Thursday 2-3 PM, ESJ 0224

Course webpage:

ELMS

Instructor: Typhanye Dyer, PhD Office Hours by Appointment Only

Office: 2234 FF

Phone: 301-405-8547

Email: [email protected]

Discussion Sections:

Section TA E-mail Discussion

0101, 0102, 0103, 0104 Jonathan Aram [email protected] SPH 0116A

0105, 0106, 107, 0108 Amanda Ng [email protected] SPH 0116A

0201 Bani Saluja [email protected] SPH 0301

0202 Jennifer Robinson [email protected] SPH 0301

0203 Christopher Williams [email protected] SPH 0301

**TA Office Hours are by appointment only

Course Description: Epidemiology—the fundamental science underlying public health—is the study of the distribution and determinants of health and diseases at the population-level, including infectious and chronic diseases, mental disorders, community and environmental health hazards, and unintentional injuries. In contrast to medicine, which is the study of health at the individual level, epidemiology looks at the causes and outcomes of disease and health in groups of people. This course will introduce students to basic epidemiologic methods, and the application of epidemiologic research to public health practice. The subject matter is applicable to a variety of fields, such as health promotion, medicine and other health professions, communication, education, psychology, environmental health, sociology, and social work. The goal of the course is to enable students to become informed and intelligent consumers of epidemiologic literature and to provide a basis for further studies and careers in public health sciences and other related fields. Each course concept builds on the next and requires students to be actively engaged in readings, discussions, and lecture, as well as careful critical thinking, and participation in-class and on assignments. The weekly Sections portion of this course will focus on the practical applications of the course material, and opportunities for more in-depth discussion than possible during the large format lectures.

mailto:[email protected]






2 EPIB301, Spring/2020 Dyer

Course Learning Objectives: Upon completing this course, the student will be able to:

1. Discuss the epidemiologic or population perspective used in the study of health and disease; 2. Identify key sources of epidemiologic data; 3. Define measures of disease occurrence including incidence, prevalence, morbidity and

mortality; 4. Describe the distribution of disease in terms of person, place, and time; 5. Define measures of association including odds ratios and relative risk; 6. Discuss criteria for causality; 7. Discuss the feasibility, strengths, and limitations of different study designs; 8. Describe concepts such as effect modification and confounding; 9. Describe ethical issues regarding research and evaluation; 10. Critically review published epidemiologic studies and assess their validity and generalizability; 11. Understand the place of epidemiology in health policy and disease prevention and health

promotion, including infectious disease outbreak investigations. Program Competencies Addressed in this Course: The following competencies for the Public Health Science Program are addressed in this course:

1. Identify and describe core scientific concepts underlying disease prevention, environmental protection, and health promotion;

2. Identify and define public health problems from an ecological and interdisciplinary perspective; 3. Synthesize scientific knowledge to formulate solutions to public health problems.

Required Texts and Other Readings: Required: Friis R.H. (2010). Epidemiology 101: Essential Public Health Series, Second Edition. Sudbury, MA: Jones and Bartlett Publishers, Inc. ISBN: 9781284107852. This book is on reserve at McKeldin Library. Additional readings will be available on the class website. Students are expected to read the assigned readings and participate in class discussions. Required Technology and Other Materials: A calculator should be brought to each class—calculators on cell phones or laptops cannot be used for tests or exams. You will need a computer to access the course resources, submit coursework on our ELMs page (elms.umd.edu), and for the in-class exams. You can use campus computers for homework (lib.umd.edu/services/computing) and borrow a laptop for exams


(lib.umd.edu/tlc/equipment) if you do not own one. Elms quizzes will be used for in-class participation. These questions can be completed using a cell phone or computer. Course Communication: The instructor will communicate with students via course announcements (delivered via e-mail) regarding class cancellation, room change, or other timely announcements. Course Requirements and Expectations:

1. Reading. In order to be prepared to participate in class discussions, students are required to complete the reading assignments before attending class. Lectures will not necessarily cover all materials included in the reading assignments. You will however, be responsible for ALL content.

2. Attendance and Participation. Attending lectures and sections is necessary in order to do well. Exams are based on class material as well as assigned readings. I expect every student to attend all sessions. If you must miss more than 2 lectures or sections in a row, please let your TA know in advance. Participation is important to learning, and I encourage active participation; if you have a question, it’s likely that other students do as well. Please attend office hours or schedule an appointment with the instructor or Teaching Assistant if you are having trouble with the concepts and/or assignments.

3. Course Website. The syllabus, PowerPoint slides and other course materials will be posted on the EPIB301 Canvas website: http://elms.umd.edu/. I’ll place each session’s PowerPoint presentation on the Elms website the day it will be used. You will upload your assignments to the Elms site, and complete the homework questions via Elms as well.

Major Graded Assignments:

Students’ mastery of the course content will be assessed via homework, tests, assignments, and a final comprehensive exam.

1. Online Homework Questions – 20%. Three sets of homework questions (5% each) will be assigned (e.g., multiple choice, matching, fill in the blank, short answer, or reflective responses). Homework questions will be posted at least one week before the due date and should be submitted via Elms before midnight on the specified due date. Late homework submissions will not be graded unless there is a note stating a university-approved exception.

Homework 1: Due February 13th Homework 2: Due March 12th Homework 3: Due March 26th

Homework 4: Due April 28th

2. Tests and Exam – 55%. Two in-class tests and one final examination will be given, worth a total of 55 % of the final grade. The tests and exam will cover material from class and the assigned readings. The final exam will be cumulative. All tests will be closed-book, though you may bring a calculator [not your phone]. You will be provided with a page of formulas to use during the test or exam (you will receive an example at least one week in advance). If you arrive late, you must complete the test or exam during the time allotted.

Test 1: Thursday, February 27th (15%) Test 2: Thursday, April 2nd (15%) Comprehensive Final Exam**: Monday, May 18th 10:30 AM – 12:30 PM (25%)

http://elms.umd.edu/


**Final examinations are scheduled by the campus in the first weeks of the semester and often do not occur during typical class days/times. That schedule is provided to students as soon as possible. Students are expected to attend the final exam as scheduled and should plan accordingly.

3. Article Critique Assignment –15%. Due April 14th; 15%, instructions provided, week of March 2nd.

4. Lecture Participation – 5%. Over the course of the semester, there will be numerous opportunities for lecture participation mainly in the form of short-answer response to a topic in class, an in-class activity, or other forms of participation. You will complete the participation activity either via paper handed out in class, or via the Elms site, which can be accessed via smartphone or computer (I will have some paper copies at each session). There will not be “make-up” opportunities for lecture participation, with the exception of medically-excused absences or emergencies. At the end of the semester, I will adjust the denominator of all participation points, so that students can miss up to two of the 8 to 10 participation activities (unexcused) without penalty.

5. Discussion Participation – 5% Section participation will be based on contributions to group discussions and in-class exercises. The Discussion sessions are a required component of the course. In addition to regular participation in classroom activities, you will also be required to prepare a 2 to 4 minute presentation to summarize a recent Morbidity and Mortality Weekly Report (MMWR)—no slides, just a verbal summary that you will share with your peers. You will sign up for a date during your first Discussion session. You should subscribe to the MMWR list-serve in order to receive the weekly report: https://www.cdc.gov/mmwr/mmwrsubscribe.html

Student Feedback for Improving the Course: We are interested in your feedback as we proceed through the semester! You can communicate feedback regarding the course in person or over email to the instructor and/or TA. Thank you in advance for sharing your thoughts and ideas! Use of Course Assistance Websites and Online Group Forums: Course assistance websites, such as CourseHero and others, are not permitted resources for SPH courses, unless the professor explicitly gives permission for you to use one of these sites. Material pulled from these sites can be deemed unauthorized material and a violation of academic integrity. These sites offer information that might not be accurate and more generally stifle the learning process. In addition, it is understandable that students may use one of a variety of online or virtual forums for course-wide discussion (e.g., GroupME, WeChat, etc.). Collaboration in this way regarding concepts discussed in this course is permissible. However, collaboration on graded assignments is strictly prohibited. Examples include: asking classmates for answers on quizzes or exams, asking for access codes to clicker polls, etc. Additional information on academic integrity is found in University Course Related Policies, below. University Course Related Policies:

All University of Maryland-approved course policies are provided at the following website:

http://www.ugst.umd.edu/courserelatedpolicies.html Policy descriptions, resources, and links to official policy documents are provided for:

https://www.cdc.gov/mmwr/mmwrsubscribe.html

http://www.ugst.umd.edu/courserelatedpolicies.html


Academic Integrity: What is cheating? What is plagiarism? What is the Honor Pledge? Code of Student Conduct: What behavior is prohibited? Sexual Misconduct: What to do in case of sexual harassment or sexual assault. Non-Discrimination: Procedures to prohibit discrimination, complaints about discrimination,

harassment, and retaliation. Accessibility: Information about disability support services (DSS) and accommodations. Attendance, Absences, or Missed Assignments: The student must notify the instructor in a timely

manner (typically first week of class). Read this prior to Schedule Adjustment date. Student Rights Regarding Undergraduate Courses: What should I find in the course syllabus? Am I

allowed to see my exams after they are graded? Official UMD Communication: Use of email, communication with faculty, communication about

cancelled class meetings, and weather-related or other urgent notifications. Mid-Term Grades: Provided for 100 and 200 level courses, and all student athletes. Complaints About Course Final Grades: Questions about course grades should first be addressed to the

course instructor. Copyright and Intellectual Property: Who owns the work that I produce in class? Final Exams: Final exams are scheduled by the University. Course Evaluations: The School of Public Health is committed to the use of student course evaluations

for improving the student experience, course and curriculum delivery, and faculty instruction. Campus Resources: ELMS, counseling, learning workshops, tutoring, writing help, questions about

graduation, adding or dropping classes, withdrawing from the semester, etc. Inclement Weather / University Closings / Emergency Procedures: In the event that the University has a delayed opening or is closed for an emergency or extended period of time, the instructor will communicate to students regarding schedule adjustments, including rescheduling of examinations and assignments due to inclement weather and campus emergencies. Evaluation Summary

Online Homework Questions #1 – #4 (@5% each) 20%

Tests #1 and #2 (@15% each) 30%

Cumulative final exam 25%

Article Critique Assignment 15%

Lecture Participation (5%) 5%

Discussion Section Participation (5%) 5%

TOTAL 100%

Course grade will be assigned as follows: A+ 100 – 97 % A 96.9 – 93 % A- 92.9 – 90 % B+ 89.9 – 87 % B 86.9 – 83 % B- 82.9 – 80 % C+ 79.9 – 77 % C 76.9 – 73 % C- 72.9 – 70 % D+ 69.9 – 67 % D 66.9 – 63 % D- 62.9 – 60 % F < 60 %


Available Support Services

Basic Needs Security If you have difficulty affording groceries or accessing sufficient food to eat every day, or lack a safe and stable place to live and believe this may affect your performance in this course, please visit http://go.umd.edu/basic-needs for information about resources the campus offers you and let me know if I can help in some way.

Course Schedule Summary

Week Session Date Topic Assignments

1 Section *No Sections This Week; sections begin Week 2

Class #1 1/28 Course Overview, Introductions, History

Class #2 1/30 Uses Of Epidemiology

2 Section Epidemiological Measures & Contingency Tables Part 1

Class #3 2/4 Epidemiological Sampling and Data Presentation

Class #4 2/6 Epidemiologic Measurements

3 Section Epidemiological Measures & Contingency Tables Part 2 Class #5 2/11 Data Sources & Descriptive Epidemiology

Class #6 2/13 Comparing Measures of Disease Frequency: Differences Homework #1

4 Section Review For Test #1

Class #7 2/18 Comparing Measures of Disease Frequency: Ratios

Class #8 2/20 Causality In Epidemiology

5 Section Causality Case Study

Class #9 2/25 Case Study: Smoking and Lung Cancer

Class #10 2/27 Test #1 Test #1

6 Section Intro to Article Critique Assignment; Review of Test #1

Class #11 3/3 Overview of Epidemiological Study Designs

Class #12 3/5 Ecological and Cohort Studies

7 Section Case Study

Class #13 3/10 Case Control Studies

Class #14 3/12 Experimental Studies Homework #2

3/16 **Spring Break: No Discussion or Class**

8 Section Design a Study!

Class #15 3/24 Bias and Random Error

Class #16 3/26 Confounding and Effect Modification Homework #3

9 Section Review For Test #2 Class #17 3/31 Case Study: Oral Contraceptives and Ovarian Cancer

Class #18 4/2 Test #2

10 Section Article Critique Part II; Review of Test #2

Class #19 4/7 Public Health Research Day: BINGO

Class #19 4/9 Ethics in Epidemiology

11 Section Screening Metrics

Class #21 4/14 Epidemiology & Policy, Part I Assignment due

Writing Center https://ter.ps/writing

Counseling https://counseling.umd.edu

IT Helpdesk https://helpdesk.umd.edu

301.405.1500

http://go.umd.edu/basic-needs

https://ter.ps/writing

https://counseling.umd.edu/

https://helpdesk.umd.edu/


Class #22 4/16 Screening in Public Health Practice

12 Section Outbreak Investigation Case Study

Class #23 4/21 Infectious Disease Epidemiology

Class #24 4/23 Infectious Disease Outbreak Investigation

13 Section Final Exam Review

Class #25 4/28 Case Study: Ebola Virus Disease Homework #4

Class #26 4/30 Career Panel

14 Section *No Sections This Week

Class #27 5/5 Life Course Epidemiology

Class #28 5/7 The Future of Epidemiology & Course Summary 15 Section *No Sections This Week; Last day of class is 5/12

Class #29 5/12 Final review

DETAILED COURSE SCHEDULE

Week 1

Section No section this week

1/28 Course Overview, Introductions, History Readings: Friis Chapter 1, p 1-19. Learning Objectives:

• The definition of epidemiology • Key characteristics of the discipline • Important figures in the history of epidemiology

Program Competencies: 1, 2 Course objectives addressed: 1,11

1/30 Uses of Epidemiology Reading:

Friis Chapter 1, p 20-22

Samet JM, Woodward A. On Being an Epidemiologist. Am J Epidemiol. 2019;188(5):818-824.

Glymour, 2018. Why I love epidemiology. LinkedIn Blog. Learning Objectives:

• The contemporary era of epidemiology • Uses of epidemiology (historical, community health, health services, risk

assessment, disease causality) • Describe the difference between descriptive and scientific/analytic

epidemiologic studies, and identify whether a particular study is descriptive or scientific/analytic

• Explain the role of descriptive studies for identifying problems and establishing hypotheses, including their use during disease outbreaks

Program Competencies: 1, 2 Course objectives addressed: 1,11

Week 2

Section Epidemiologic Measures & Contingency Tables Part 1

2/4 Epidemiological Sampling and Data Presentation Reading: Friis Chapter 2 Learning Objectives:


• Epidemiologic sampling methods • Graphic presentation of epidemiologic data • Rate, incidence, prevalence • Fixed vs. dynamic populations

Program Competencies: 1,2 Course objectives addressed: 1,2,3,4

2/6 Epidemiologic Measures Reading: Friis Chapter 3 Learning Objectives:

• Explain what is meant by the term “at risk” • Define and calculate prevalence • Define and calculate incidence rate • Explain relationship between prevalence and incidence rate


Week 3

Section Epidemiologic Measures & Contingency Tables Part 2

2/11 Data Sources & Descriptive Epidemiology Reading: Friis, Chapters 4 & 5 Learning Objectives:

• Sources of epidemiologic data • Distinguishing features of descriptive studies, including case reports and

case series, cross-sectional studies, and ecologic studies • Types of epidemiologic questions that can be addressed by descriptive

studies • Life expectancy, death, and birth rates • Define crude, specific, and adjusted “rates” • Examples of person, place, and time variables


2/13 Homework #1 Due

Comparing measures of disease frequency: Difference Comparisons Reading: Friis Chapter 6 p. 129-136 and Aschengrau & Seage, Chapter 3 (see course page) Learning Objectives

• Compare disease prevalence or incidence in two or more groups • Understand the importance of using explicit definitions of exposed and

unexposed groups • Construct a 2x2 table for summarizing epidemiologic data • Define, calculate, and interpret absolute measures of association

Program Competencies: 1,2 Course objectives addressed: 1,5

Week 4

Section Review for Test 1

2/18 Comparing measures of disease frequency: Ratio Comparisons Reading: Friis Chapter 6 p. 129-136 and Aschengrau & Seage, Chapter 3 (see course page) Learning Objectives:

• Define, calculate, and interpret the relative measures of association • Discuss the differences between absolute and relative measures and when

they are most appropriate



2/20 Causality in Epidemiology Reading:

Friis Chapter 6, p 137—143 Learning Objectives:

• Define and generate a testable hypothesis • Describe Hill’s criteria of causality • Understand the concept of “counterfactuals”

Program Competencies: 1,2 Course objectives addressed: 1,6,10

Week 5

Section Causality Case Study

2/25 Case Study: Smoking and Lung Cancer

Application and extension of learning objectives on 9/19 Reading: case description, see course page Program Competencies: 1,2,3

2/27 Test #1

Week 6

Section Introduction to Article Critique Assignment; Review of Test #1

3/3 Overview of analytic epidemiologic study designs Reading: Aschengrau & Seage, Chapter 6 (see course page) Learning Objectives:

• Strengths and limitations of case reports and series, cross-sectional studies, and ecologic studies

• Introduction to key components of all analytic studies, the main types, key features of experimental, cohort, and case-control studies, and the strengths and limitations of each.


3/5 Ecological and cohort studies Reading: Friis Chapter 7, p 147-152, 155-157 Learning Objectives:

• Ecologic studies and the “ecologic fallacy” • Distinguishing features of retrospective and prospective cohort studies • Types of epidemiologic questions that can be addressed by cohort studies • Estimate and interpret measures of association from cohort studies • Identify potential strengths and limitations of cohort studies • Calculating relative risk and attributable risk within cohort studies


Week 7

Section Case Study


3/10 Case Control Studies Reading: Friis Chapter 7, p 153—155 Learning Objectives:

• Describe types of epidemiologic questions that can be addressed by case-control studies

• Describe the purpose of controls in a case-control study and the principles of valid control selection

• Estimate and interpret odds ratios from a case-control study • Identify the potential strengths and limitations of case-control studies



Intervention Studies Reading: Friis Chapter 7, p 158—160 Learning Objectives:

• Appropriate uses of randomized controlled trials and quasi-experimental designs

• Describe types of questions that can be addressed by experimental studies • Explain distinguishing features of an experimental study • Differentiate preventive, therapeutic, individual, and community trials • Explain why randomization is used and how to determine whether it has

been successful • Define “blinding” and “placebo” and explain their purpose • Discuss potential strengths and limitations of experimental studies


3/16 **Spring Break** No class or discussion this week

Week 8

Section Design a Study!

3/24 Bias and Random Error Reading: Friis Chapter 6, p 160—162 Learning Objectives:

• Define bias (systematic error), and differentiate between the three different types of errors (selection and information bias, and confounding)

• Define and identify different types of selection biases: control selection bias; self-selection bias; healthy worker effect; loss to follow-up

• Define and identify different types of information biases: recall bias; interviewer bias; misclassification bias

• Identify which study features are prone to the various types of bias • Explain the effect of sample size on the precision of an estimate



Confounding and Effect Modification Reading: Friis & Sellers, Chapter 10, p 435-449

• Define and identify confounding • Describe ways to control for confounding in the design phase of a study


• Describe ways to control for confounding in the analysis phase of a study o Compare crude and stratum-specific measures of association to

identify whether confounding is present • Describe effect modification and how to identify whether it is present


Week 9

Section Review for Test #2

3/31 Case Study: Oral Contraceptives and Ovarian Cancer

Application and extension of learning objectives from 10/8 to 10/17 Reading: case description, see course page Program Competencies: 1,2,3

4/2 Test #2

Week 10

Section Article Critique Assignment, Part II; Review of Test #2

4/7 Public Health Research Day Learning Objectives:

Identify the study designs used in real-world public health research

Describe reasons why a given study design was selected

List strengths and limitations of given study designs, in the context of each study’s research question

Program Competencies: 3 Course objectives addressed: 7

4/9 Ethics in Epidemiologic Research Reading: Coughlin SS. Ethical issues in epidemiologic research and public health practice. Emerg Themes Epidemiol. 2006;3:16. Published 2006 Oct 3.

• Key principals of human subjects research and ethical dilemmas • Define equipoise and discuss its relevance to decisions about whether

experimental studies are ethical • Explain what is meant by “informed consent”

Program Competencies: 1,2,3 Course objectives addressed: 9,11

Week 11

Section Screening Metrics

4/14 Epidemiology & Policy Learning Objectives:

• Health and social policies and the role of epidemiologists Program Competencies: 1,2,3 Course objectives addressed: 1,11

4/16 Screening in Public Health Practice Reading: Friis Chapter 9, page 189-202 Learning Objectives:

Concepts of reliability and validity as they relate to disease screening

Define and calculate sensitivity, specificity, predictive value positive, and predictive value negative


Policy implications of disease screening

Program Competencies: 1, 2,3 Course objectives addressed: 1, 4,11

Week 12

Section Outbreak Investigation Case Study

4/21 Infectious Disease Epidemiology Reading: Friis Chapter 10, p 207-227 Learning Objectives:

• The “epidemiologic triangle” (agent, host, environment) • Modes of transmission of communicable diseases • Examples of significant infectious diseases

Program Competencies: 1,2,3 Course objectives addressed: 1,2,4,11

4/23 Infectious Disease Outbreak Investigation Reading: Friis Chapter 10, p. 228-230 Learning Objectives:

• Procedures for investigating infectious disease outbreaks Program Competencies: 1,2,3 Course objectives addressed: 1,11

Week 13

Section Final exam review


Case Study

Ebola Virus Disease

4/30 Career Panel Learning Objective: Provide students with the opportunity to speak with epidemiologists working a variety of contexts to learn more about career opportunities in epidemiology

Week 14


5/5 Life Course Epidemiology Reading:

• Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J., & Power, C. (2003). Life course epidemiology. Journal of Epidemiology and Community Health, 57(10), 778-783. doi: 10.1136/jech.57.10.778

Learning Objectives: • Definition of “life course epidemiology” • Life course models and empirical evidence • Implications of a life course perspective for public health programs and

policies Program Competencies: 1,2,3 Course objectives addressed: 1,10,11

5/7 The Future of Epidemiology & Course Summary

TBA Week 15


5/12 Final review

Documents

EPIB 301 Epidemiology for Public Health Practice · epidemiologic methods, and the application of epidemiologic research to public health practice. The subject matter is applicable