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  1. An introduction Epidemiology matters: a new introduction to methodological foundations Chapter 1

  2. Epidemiology is the science of understanding the causes and distribution of population health so that we may intervene to prevent disease and promote health. Epidemiology Matters – Chapter 1

  3. Examples of questions epidemiologists ask • What is the incidence of myocardial infarctions between 2010-2020 among women born in 1950 in the United States? • What are the causes of myocardial infarctions in this population? • If we were to change population dietary habits, what improvement in myocardial infarction incidence could we affect? Epidemiology Matters – Chapter 1

  4. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  5. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  6. Evolution of epidemiology • Epidemiology is a relatively new as a formal scientific discipline • Practice of conducting epidemiologic studies is not new; ‘counting’ health and disease goes back centuries • Many of design and analytic techniques that we use today arose in response to health concerns during 19th and 20thcentury Epidemiology Matters – Chapter 1

  7. Epidemiology, a beginning • John Graunt– 17thcentury - pioneered approaches to tabulating population health and mortality in rates, ratios, and proportions • William Farr – 18thand 19th century - developed more sophisticated life table approaches to understanding the force and burden of mortality • John Snow – 19th century - used epidemiologic approaches to understand London cholera epidemic; developed and applied basic measures of disease frequency and occurrence Epidemiology Matters – Chapter 1

  8. Epidemiology history, continued • 19th century – focus on infectious disease • 20th century – high-income countries shifted toward non-communicable diseases • Mid 20th century – methods formalized (1970s) • Late 20th century – Miettinen, Rothman, and Greenland - modern epidemiology (1980s) formalized central disciplinary principles Epidemiology Matters – Chapter 1

  9. Current conceptual movements • Ecosocialperspective on population health – suggests policies, institutions, and characteristics of context contribute to the shaping of health • Life course perspective – determinants of health are distributed across the life course and even before conception   Therefore, epidemiology understands causes of population health across levels of influence - from cells to society - and across life course. Epidemiology Matters – Chapter 1

  10. Individual/Population Health An ecosocial framework Social and Economic Policies Institutions Neighborhoods and Communities Living Conditions `` Social Relationships `` Individual Risk Factors Lifecourse Genetic/Constitutional Factors Pathophysiologic pathways Environment Kaplan, G. What’s wrong with social epidemiology, and how can we make it better? Epid Rev 2004; 26: 124-135

  11. A lifecourse approach to health production Uauy, R. et al. Diet, nutrition, and the life-course approach to cancer prevention. J Nutr 2005; 135: 2934S-2945S

  12. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  13. Our approach to teaching epidemiology • We are interested in an epidemiology of consequence, an epidemiology that can guide the improvement of the health of population • Therefore, we focus here on teaching underlying concepts that start from understanding populations, and lead the learner through the key steps to designing an epidemiologic study • We will mention and adopt the labels that are used in many other epidemiology textbooks (e.g., confounding) but only after we have introduced the reader to the underlying concepts Epidemiology Matters – Chapter 1

  14. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  15. Epidemiology of consequence,seven steps • Define the population of interest • Conceptualize and create measures of exposures and health indicators • Take a sample of the population • Estimate measures of association between exposures and health indicators of interest • Rigorously evaluate whether the association observed suggests a causal association • Assess the evidence for causes working together • Assess the extent to which the result matters, is externally valid, to other populations Epidemiology Matters – Chapter 1

  16. Epidemiology of consequence, seven steps Descriptive epidemiology • Step 1. Define the population of interest • Step 2. Conceptualize and create measures of exposures and health indicators • Step 3. Take a sample of the population • Step 4. Estimate measures of association between exposures and health indicators of interest Assessing for causal effect • Step 5. Rigorously evaluate whether the association observed suggests a causal association Conceptualizing and testing for interactions • Step 6. Assess the evidence for causes working together • Step 7. Assess the extent to which the result matters(is externally valid) to other populations Epidemiology Matters – Chapter 1

  17. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  18. Farrlandia • Examples often based on hypothetical geographic area, Farrlandia • Inspired by William Farr, pioneering epidemiologist and statistician • Through use of Farrlandia examples, students will focus on applying foundational concepts to populations Epidemiology Matters – Chapter 1

  19. Evolution of epidemiology • Our approach to teaching epidemiology • Seven steps to conduct an epidemiologic study • Farrlandia • Summary Epidemiology Matters – Chapter 1

  20. Summary • This book aims to provide learners with a systematic grounding in the theoretical underpinnings of epidemiology with an awareness of the practical considerations that are essential for public health professionals • This text establishes a foundation by building on methodological innovation and teaching of the previous century, while adopting a novel approach to teaching epidemiologic foundations Epidemiology Matters – Chapter 1

  21. epidemiologymatters.org Epidemiology Matters – Chapter 1