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
Epidemiology in Action
CONTENTS:
Unit I
What is Epidemiology?
Unit II
Types of Epidemiology Studies
Unit III
Measurement and Hypothesis
Testing
Unit IV
Understanding and Preventing
Health and Safety Problems
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Epidemiology in Action
Unit I
What is Epidemiology?
•
Definition of Epidemiology
•
Its Purpose
•
How It Helps Us Answer Questions
Activities:
1.
A Plague Puzzle
2.
Design a Disease Museum
3.
Debate, Data, and Current Issues
3
Epidemiology in Action
4
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 in Action
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.
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Epidemiology in Action
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:
If your card looks like this one, you
are displaying no symptoms.
• high fever
• fatigue
• severe back pain
• sometimes stomach pain/vomiting
• if your card also has an X on it,
you have a rash on your face, hands,
and forearms.
THE PLAGUE PUZZLE
You’ve just arrived from Paris, France.
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Epidemiology in Action
“Epidemiology is the science of discovering the causes of illness
and injury in populations. Epidemiology studies are used to
control and prevent health problems.”
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 information do you need to gather?
• What are your initial guesses about the cause of illness?
• How would you know who has this disease, for sure?
• What studies could you do to figure out what caused the
outbreak?
• How would you know if your studies were right?
• If your studies were correct, what steps would you take to protect
everybody else?
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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
Epidemiology in Action
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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.
Epidemiology in Action
10
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
LINK: Center for Disease Control Smallpox web page
Epidemiology in Action
SMALLPOX
• 12 – 14 day incubation period
• Early flu-like symptoms -- fever,
fatigue, back pain, stomach pain-lasting two to three days.
• When fever drops, rash appears,
spreads. Forms bumps/scabs.
Source: CDC/James Hicks, Bangladesh 1973
Source: CDC/Fred Murphy, Sylvia Whitfield 1975
• 25 – 30% of those infected
die, survivors left scarred
or blinded.
LINK: Center for Disease Control Smallpox web page
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Epidemiology in Action
12
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?
Infected
Male
Female
Age 13-15
Age 16-19
London
Paris
Seattle
New York
Not
Infected
Total
Epidemiology in Action
We also look for
• 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)
Collection of aids,
left, used by polio
victims, including the
iron lung
Link: Polio Information Center
Online (PICO)
Source:CDC/Meredith Hickson 1977
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Epidemiology in Action
The Aids virus under a
microscope
Link: HIV Infections
Source: CDC/Dr. Edwin P. Ewing/1983 Aids Kaposi’s sarcoma
We also want to determine if the disease frequency is:
• Endemic - low to moderate level of disease in given area
• Epidemic - level greater than what is expected in a given area
• Pandemic - level greater than what is expected in several
countries and regions worldwide
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Epidemiology in Action
DESIGNING A
DISEASE MUSEUM
To apply what we’ve learned so far, research and
investigate one of the following diseases, and complete
the activities on the assignment sheet.
DISEASES
AIDS
Influenza
Anthrax
Bubonic Plague
Tuberculosis
Polio
Ebola
Measles
West Nile Virus
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Epidemiology in Action
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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).
• How was the disease discovered, and what was/is the case definition?
• Give at least two real-life examples of researchers using the “steps in an
outbreak investigation.”
• What were/are the disease distributions, determinants, and frequency?
• Was/is the disease outbreak endemic, epidemic, or pandemic, and why?
• What were some of the original hypotheses about the causes of this disease?
• 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.
Epidemiology in Action
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SUGGESTED ONLINE SOURCES: Designing a Disease Museum
CDC/Health Topics A to Z
World Health Organization: Infectious diseases
All the Virology on the WWW
NFID Web Sites & Virtual Library of Diseases
Johns Hopkins Infectious Diseases
HIV infections
PICO: Polio Information Center Online
WHO/OMS: Malaria
Tuberculosis: Ancient Enemy, Present Threat
CDC /Division of Vector-Borne Infectious Diseases (DVBID) Plague Home Page
The American Experience | Influenza 1918
The 1918 Influenza Pandemic
NOVA Online | Anthrax
New Hampshire Anthrax Outbreak of 1957
CDC/National Center for Infectious Diseases Viral hemorrhagic fever
CDC/Division of Vector-Borne Infectious Diseases (DVBID) West Nile Virus Home Page
Epidemiology in Action
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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:
• Evaluate risk factors for diseases/accidents.
(What’s your risk of getting cancer?)
• Conduct long-term population studies to understand
what causes diseases/accidents.
(If you start smoking as a teenager, what is your risk of developing
lung cancer by the time you are 50?)
• Design and conduct experiments to evaluate control
and prevention measures.
(Can stop-smoking education campaigns help prevent teen smoking?)
Epidemiology in Action
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?
Because of Epidemiology,
that’s why.
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Epidemiology in Action
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Website: http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/TSF2000/2000ydrive.pdf
Link to more studies: NHTSA 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
Epidemiology in Action
Website: http://www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/TSF2000/2000ydrive.pdf
Link to more studies: NHTSA 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
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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
Epidemiology in Action
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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
• Note what the data does NOT say (how might it be misleading?)
• Explain what change you’re proposing/not proposing
• Tell us why this change should/should not be made
Risk Factors:
Alcohol/Drug Use
Teen Violence
Diet
Accidents
LC/1973
AIDS/STD’s
Epidemiology in Action
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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 Charts
Epidemiology in Action
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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