PHC 6014: Behavioural Epidemiology
Course Syllabus
GENERAL INFORMATION
DESCRIPTION
This course examines human behaviours as determinants of health and disease, methods of exploring these
relationships, and ways of altering risk behaviours. The prevalence of salient human behaviours (eg drug
use, unprotected sex) will be explored along with the risk and protective processes associated with each of
these behaviour groups.
Behaviour has a marked impact on health. It can lead to positive and negative consequences in health
outcomes. Moreover, it can mediate and moderate other risk factors for disease. Designing effective
behavioural interventions can help to reduce morbidity and mortality, and is an important tool in public
health. However, one of the major challenges in the area of behavioural health is measurement. How do
we measure complex behaviours? Are we measuring what we think we are measuring? What are the most
important aspects of a given behaviour within the context of prevention or disease reduction? Another
challenge is assess the role of the behavior in health. Examining confounding, mediation, effect
modification, and interaction with other factors is essential. Behavioural epidemiology is at the forefront
in addressing these challenges.
This course, using problem based learning, will address these issues. By the end of this course, the student
will have an understanding of the prevalence, incidence, and secular trends for the major [current] risk
factors. Through critical thinking and inquiry the student will be able to address the questions of (i) what
is the public health importance of a given behavioural determinant in disease and health, (ii) what are the
measurement and analytic challenges, (iii) what is the evidence for causality, and (iv) what are the most
promising interventions. This course is designed to give the student the tools to examine the epidemiology
of behavioural determinants.
OBJECTIVES
A. Foundational knowledge
1. Understand and remember the major behavioural determinants of health (diet,
exercise, smoking, alcohol and drug use, and sexual behaviour)
2. Describe secular trends of behavioural determinants namely through prevalence
3. Understand the basics of instrument design, scoring, and analysis
B. Application
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
1. Critique a study with respect to its methodologic quality and public health
relevance
a. Design
b. Assessment of confounding and interactions
c. Measurement
2. Analysis of behavioural data
3. Make decisions about how to prioritize for focus on a given behavioural
determinant in a public health context
C. Integration
1. Identify and appreciate the interaction between societal and behavioural
determinants: Context: Behaviour does not happen in a vacuum
D. Human dimension and caring
1. Come to see yourself as part of the societal influence on behaviour
2. Understand and value others in terms of their situation and context
E. Learning how to learn
1. Be aware of behaviours that may have an impact in the future on health (eg
secular trend in obesity epidemic).
M
MPH CORE / CONCENTRATION-SPECIFIC COMPETENCIES
This course will assist students in developing the following MPH core competencies:
COMPETENCY
Identify key sources of data for use in epidemiologic
studies
COURSE OBJECTIVE
A2
Critically evaluate reports of epidemiologic studies
A1, B1
Given a health problem, choose and implement an
appropriate epidemiologic study design
B1
Appraise the direction and magnitude of bias on measures
of association and interpret them appropriately
B2
COURSE PREREQUISITES
PHC6000 Introduction to Public Health Epidemiology
REQUIRED TEXTBOOK
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.
There is no required textbook for this course. Readings will be assigned throughout the
semester, and will consist mainly of journal articles, and web-based readings.
Web Resources
BRFSS datasets, questionnaires, and methodology. http://www.cdc.gov/brfss/
OTHER RECOMMENDED SOURCES OF INFORMATION
Texts
Cody RP, Smith JK. Applied Statistics and the SAS Programming Language. New Jersey: Prentice Hall
(5th Edition), 2005. ISBN-13: 978-0131465329
Berkman LF, Kawachi I, Eds. Social Epidemiology. New York: Oxford University Press
Inc., 2000. ISBN-13 978-0-19-508331-6.
Glanz K, Rimer BK, Wiswanath K, Eds. Health Behavior and Health Education: Theory,
Research, and Practice. San Francisco, CA: Jossey-Bass (4th Edition), 2008. ISBN-13
978-0-7879-9614-7
DeVellis RF. Scale Development: Theory and Applications. Applied Social Research
Methods Series Volume 26. Thousand Oaks: Sage Publications (2 nd edition), 2003.
ISBN-10 0-7619-2604-6
Web Resources
1. The following document is downloadable at no charge: Centers for Disease Control & Prevention.
Principles of Epidemiology. 3rd Edition. Atlanta: U.S. Department of Health and Human Services.
http://www.cdc.gov/training/products/ss1000/ss1000-ol.pdf
2. http://www.who.int (World Health Organization Homepage)
3. http://www.cdc.gov (Centers for Disease Control and Prevention)
4. http://www.census.gov (US Census Bureau)
5. http://www.nlm.nih.gov (National Library of Medicine: Medline)
6. http://www.doh.state.fl.us (Florida Department of Health)
9. http://www.healthypeople.gov (U.S. Department of Health and Human Services)
10. http://www.census.gov (U.S. Census)
11.Population Reference Bureau. How to effectively present data. Tips on slide preparation available at
http://www.prb.org/pdf/ConnectingPeopleSect3.pdf
CLASS POLICIES AND PROCEDURES
This course will use active learning methods to achieve the above described learning goals in the areas of
foundational knowledge, application, integration, human dimension, and learning how to learn. Moreover,
the student will be assessed across these areas.
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
The class will meet once per week for two hours, 40 minutes with a 10-15 minute break in the middle of
the session. This course will involve reading, critical thinking, analysis, and discussion. Students will be
responsible for preparing adequately for each class. The class sessions may consist of the following
components:
1. Short lectures giving an overview of topics
2. Exemplars (indirect observation): Guests will present their research relevant to the topic
3. Problem based learning (research, discussions, and oral presentations)
4. Analyses of BRFSS data
5. Reflection
a. One minute papers
b. Reflection papers
Problem based learning (PBL). PBL is not a project where students merely apply what they learned from
instruction, rather it is the instruction itself, whereby one is presented with a problem, and students are
responsible for solving the problem. It is used to teach content, to promote critical thinking and problem
solving, and to develop collaborative working relationships. Students have control over content and
direction, within the parameters of the problem.
For each behavioural determinant, students will work in small groups, randomly selected for each
determinant. The problem presented is “What is the public health relevance of this determinant, and what
should be done”. Students will work together to determine the prevalence and incidence of the
determinant, with what diseases it is associated, what are the secular trends, what are relevant behavioural
interventions, what is the evidence for causality, and how much of a public health problem is it. Most
PBLs will cover two class sessions. The first week students will establish a work plan to address the
questions, and begin working on them. During the week, students will prepare for the next week. The
second week students will present their findings. Presentations may consist of presentations, discussions,
and critiquing of articles. (If articles are to be critiqued it is the team’s responsibility to make assign the
readings ahead of time. It is essential that other class members have an adequate amount of time to read).
Part of the PBL process requires feedback and revision. Students will communicate with the instructor
throughout the week for feedback.
Analysis of BRFSS data. Data from the CDC Behavioral Risk Factor Surveillance System 2010 Annual
Questionnaire will be analyzed. In-class time will be reserved for exploring behavioural determinents in
health. SAS will be the primary analytic package used; extensive knowledge of SAS programming is not
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.
required for this course; the instructor will facilitate programming. Each student will select a state to
analyze throughout the semester, culminating in a behavioural health assessment report for that state.
Reflection. In order to address the objectives in the areas of integration, human dimension, and learning,
students will write two reflection papers where they reflect on the what they are learning, the social context,
how they fit into it.
In addition, at the end of most class students will write a one-minute reflection narrative, based on a
question posed on that day. The intent is to help clarify to the student what he or she is getting out of the
class, as well as to provide perspective to the instructor.
Disability
The University provides reasonable accommodations and services to all students on a nondiscriminatory
basis consistent with legal requirements as outlined in the Americans with Disabilities Act as Amended
(ADAAA) of 2008 and the Rehabilitation Act as Amended. . If you have disability and/or need special
assistance during the course or exams, please make arrangements through the Office of Disability Services
(305-348-4131). More information about the accommodation process is available at
http://drc.fiu.edu/index.php
EVALUATION AND GRADING
Students will be evaluated on the following basis:
Problem based learning performance
State behavioural health assessment
Reflection papers
Final exam
45%
25%
10%
20%
Grading Scale
A
AB+
B
BC+
92.6 – 100
89.6 – 92.5
86.9 – 89.5
82.6 – 86.5
79.6 – 82.5
76.6 – 79.6
C
CD+
D
DF
72.6 – 76.5
69.6 – 72.5
66.9 – 69.5
62.6 – 66.5
59.6 – 62.5
< 59.5
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
Problem based learning: Assessment will be done both by the instructor (35%) and the students (10%),
for a total of 45% of the final grade.
Instructor Assessment. The instructor will assign a shared group grade using the following rubric:
Element
Background and overview (15%)
Prevalence and secular trends (15%)
A scale of 1-4 will be assigned with respect to
exceeds expectation, meets expectations,
partially meets expectations, does not meet
expectations.
Interventions and causal evidence (15%)
Public health relevance (15%)
In-depth inquiry (sophistication of work) (10%)
Communication and collaboration (process) (10%)
Quality of presentation or activities (10%)
Engagement (5%)
Overall (5%)
Student Assessment. Students will assess themselves and members of their group. They will complete a
grading sheet using the below rubric. Grades will be moderated by the instructor, and a summary will be
prepared for each student. Students will know the grades their peers gave them, but will not know who
gave what grade.
Element
Understands material at end of project (25%)
Responsibility to oneself (25%)
A scale of 1-4 will be assigned with respect to
above standard, at standard, approaching
standard, below standard. (See handout for
guidelines in assigning grade).
Helping the team (25%)
Respect for others (25%)
State behavioural health assessment: Students will produce a report, presenting tables and graphs that
summarize each of the main behavioural determinants as well as related self-reported outcomes (if
available). Descriptive univariate and bivariate analyses are to be presented. Analyses may include
examining determinants by age, gender, race and ethnicity, and education. A narrative should be
incorporated onto the report and should provide an introduction, summary, and clarify tables and graphs.
The narrative will supplement the representation of the data, and need be only several paragraphs.
Presents overall prevalence (20%)
Presents stratified tables of prevalence (20%)
Bivariate analyses with at least two outcomes (15%)
A scale of 1-4 will be assigned with respect to
exceeds expectation, meets expectations, partially
meets expectations, does not meet expectations.
Appropriate use of date (collapsing variables) (10%)
Effective presentation of tables (10%)
Effective presentation of graphs (10%)
Narrative clear and concise (10%)
Overall (5%)
Extra Credit: Multivariate modelling (+10%)
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.
Reflection papers: Reflection papers and one-minute papers will be graded as expectation met or
expectation not met. In order to receive credit for a reflection paper, it must be completed and turned into
the instructor, and there must be some degree of self-reflection and thoughtfulness in the paper, particularly
in terms of social context.
Final exam: The exam will test students’ knowledge of behavioural determinants of health. The questions
will be written centered on the objectives of the course. The format will be primarily essay and short
answer, and in a forward assessment style (applying what was learned).
Evaluation of course and instructor: The instructor will ask for feedback frequently throughout the
course. Mid-way through the course, a representative from the Center for the Advancement of Teaching
will meet with the class, without the instructor, to get feedback from students on what works, what does
not, and any other concerns relevant to the course the students may have. Students may give feedback to
the instructor directly throughout the course, or anonymously, by submitting to Caridad Galvez (AHC2595-1). Standard FIU end-of-the-course evaluations will also be distributed.
FIU HONOR CODE
Florida International University is a community dedicated to generating and imparting knowledge through
excellent teaching and research, the rigorous and respectful exchange of ideas and community service. All
students should respect the right of others to have an equitable opportunity to learn and honestly to
demonstrate the quality of their learning. Therefore, all students are expected to adhere to a standard of
academic conduct, which demonstrates respect for themselves, their fellow students, and the educational
mission of the University. All students are deemed by the University to understand that if they are found
responsible for academic misconduct, they will be subject to the Academic Misconduct procedures and
sanctions, as outlined in the Student Handbook.
Misconduct includes: Cheating – The unauthorized use of books, notes, aids, electronic sources; or
assistance from another person with respect to examinations, course assignments, field service reports,
class recitations; or the unauthorized possession of examination papers or course materials, whether
originally authorized or not. Plagiarism – The use and appropriation of another’s work without any
indication of the source and the representation of such work as the student’s own. Any student who fails to
give credit for ideas, expressions or materials taken from another source, including internet sources, is
responsible for plagiarism. All students are expected to abide by the Florida International University
Honor Code. Any violation will be reported.
In addition, for this course, students are required to sign an honour code at the end of all assignments and
exams. The honour code should state “I have neither given nor received any unauthorized aid on this
[assignment, exam]”. Please sign after the statement.
Student conduct
Students are responsible for knowing and complying with all FIU Policies and Regulations which are
listed in the Student Handbook and also at the following link: http://policies.fiu.edu/files/740.pdf.
The following are excerpts:
Reason for the policy:
“Graduate students at Florida International University are expected to adhere to the highest standards of
integrity in every aspect of their lives. Honesty in academic matters is part of this obligation. Academic
integrity is the adherence to those special values regarding life and work in an academic community. Any
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
act or omission by a graduate student which violates this concept of academic integrity and undermines the
academic mission of the University shall be defined as academic misconduct and shall be subject to the
procedures and penalties that follow.”
Definition of academic misconduct:
Academic misconduct is defined as the following intentional acts or omissions committed by any FIU
graduate student:
“Cheating: The unauthorized use of books, notes, aids, electronic sources; or unauthorized use of on-line
exams, library materials or assistance from another person with respect to examinations, course
assignments, field service reports, class recitations; or the unauthorized possession of examination papers
(or on-line examinations) or course materials, whether originally authorized or not. Any student helping
another cheat may be found guilty of academic misconduct”
Plagiarism: The deliberate use and appropriation of another's work without any indication of the source
and the representation of such work as the student's own. Any student, who fails to give credit for ideas,
expressions or materials taken from another source, including internet sources, is guilty of plagiarism. Any
student helping another to plagiarize may be found guilty of academic misconduct.
Misrepresentation: Intentionally lying to a member of the faculty, staff, administration, or an outside
agency to gain academic advantage for oneself or another, or to misrepresent or in other ways interfere with
the investigation of a charge of academic misconduct.
Misuse of Computer Services: The unauthorized use of any computer, computer resource or computer
project number, or the alteration or destruction of computerized information or files or unauthorized
appropriation of another's program(s).
Bribery: The offering of money or any item or service to a member of the faculty, staff, administration or
any other person in order to commit academic misconduct.
Conspiracy and Collusion: The planning or acting with one or more fellow students, any member of the
faculty, staff or administration, or any other person to commit any form of academic misconduct together.
Falsification of Records: The tampering with or altering in any way of any academic record used or
maintained by the University.
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.
COURSE SCHEDULE AND ASSIGNMENT
Note this is a tentative schedule and is subject to change
DATE
TOPIC
ASSIGNMENT
INTRODUCTION
Readings: Redding et al. 2000. Health
Objectives: The student will be able to
Behavior Models. International Electronic
 Describe instructor’s expectations of Journal of Health Education (3) 180-193.
students during course
 Understand the basis of problembased learning
 Understand the main theoretical
models of behavioural health
Readings: Bova et al. 2006. The health
care relationship (HCR) trust scale:
Objectives: The student will be able to
development and psychometric evaluation.
 Assess if one is measuring what one Research Nursing Health 29(5): 477-488
wishes to measure
Ajja et al. 2012. The healthy afterschool
 Identify key steps in developing
activity and nutrition documentation
behavioural measures
instrument. Am J Prev Med 43(3): 263 Understand the basic function of
271
factor analysis in instrument
development
Asante, et al. 2010. Cultural adaptation of
the condom use self-efficacy scale
(CUSES) in Ghana. BMC Public Health
10: 227
MEASUREMENT
Sternfeld B, Goldman-Rosas L. 2012. A
systematic approach to selecting an
appropriate measure of self-reported
physical activity or sedentary behavior. J
Phys Act Health Suppl 1:S19-28.
DeVillis. 2003. Scale Development.
Chapter 5.
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
SMOKING (I)
TBD
Exemplar: Hookah Use
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of smoking
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
SMOKING (II)
Presentation
Alcohol (I)
TBD
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of alcohol
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
EtOH (II)
Presentation
ILLICIT DRUG USE (I)
TBD
Exemplar: Substance use in adolescents.
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of illicit drug use
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.
9-Oct
ILLICIT DRUG USE (II)
Presentation
SEXUAL BEHAVIOUR (I)
TBD
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of risky sex
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
MID-COURSE ASSESSMENT
Center for the Advancement of Teaching
SEXUAL BEHAVIOUR (II)
Exemplar: HIV risk and women.
NUTRITION (I)
TBD
Exemplar: Obesity and cardiovascular
disease.
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of illicit drug use
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
NUTRITION (II)
Presentations
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PHC 6016 – Social Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers may be replaced with others.
PHYSICAL ACTIVITY (I)
TBD
Objectives: The student will be able to
 Discuss prevalence, incidence, and
secular trends of illicit drug use
 Analyze and critique evidence for
causality
 Analyze and critique current
behavioural interventions
 Integrate this knowledge into a public
health context
Lab: BRFSS data
PHYSICAL ACTIVITY (II)
Presentations
SELF-EFFICACY, STIGMA AND
DEPRESSION
TBD
Objectives: The student will be able to
 Understand the role of self-efficacy
and depression on behavioural
determinants
 Identify the interaction among these
constructs with behavioural
determinants and health outcomes
FINAL
NOTE
The schedule and topics are subject to change, as the course evolves. An effort will be made to provide
you with changes as soon as they are made.
Suggestions for students to be successful in course:
1) Be prepared by actively engaging in the course through reading, critical inquiry, and working with
each other.
2) Organize study time around objectives listed in syllabus as well as those presented for each class
session.
3) Meet with the instructor if having difficulties understanding the material, or meeting the demands
of the course.
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PHC 6014 – Behavioural Epidemiology
Changes or Modifications: The Instructor reserves the right to change, alter, add, or delete from the
content of this course as deemed appropriate by the Instructor based upon students’ needs. With advanced
notice some papers or assignments may be replaced with others.