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Product Specialist Carter McAlister Rights Media Specialist John Rusk. Production Manager Carolyn Rogers Pershouse Media Development Editor Shannon Sheehan. Associate Production Editor Navigate Jamie Reynolds Cover Image Title Page Chapter Opener. Senior Marketing Manager Sophie Fleck Teague Smartboy10 DigitalVision Vectors Getty Images. Manufacturing and Inventory Control Supervisor Amy Bacus Printing and Binding Bang Printing. Cover Printing Bang Printing, Library of Congress Cataloging in Publication Data. Names Aschengrau Ann author Seage George R author, Title Essentials of epidemiology in public health Ann Aschengrau ScD. Professor of Epidemiology Boston University School of Public Health. George R Seage III ScD Professor of Epidemiology Harvard T H Chan. School of Public Health, Description Fourth edition Burlington MA Jones Bartlett Learning. 2020 Includes bibliographical references and index. Identifiers LCCN 2018023772 ISBN 9781284128352 paperback. Subjects LCSH Epidemiology Public health Social medicine BISAC. EDUCATION General,Classification LCC RA651 A83 2020 DDC 614 4 dc23. LC record available at https lccn loc gov 2018023772. Printed in the United States of America,22 21 20 19 18 10 9 8 7 6 5 4 3 2 1. Smartboy10 DigitalVision Vectors Getty Images,Preface vii Chapter 3 Comparing Disease. Acknowledgments xi Frequencies 57,Introduction 57, Chapter 1 The Approach and Evolution Data Organization 58. of Epidemiology 1 Measures of Comparison 61,Introduction 1 Direct Standardization 69. Definition and Goals of Public Health 2 Summary 72. Sources of Scientific Knowledge in Public Health 3 References 73. Definition and Objectives of Epidemiology 5 Chapter Questions 73. Historical Development of Epidemiology 8, Modern Epidemiology 27 Chapter 4 Sources of Public. Summary 29 Health Data 77,References 30,Introduction 77. Chapter Questions 31,Census of the U S Population 78. Chapter 2 Measures of Disease Vital Statistics 79,Frequency 33 National Survey of Family Growth 84. National Health Interview Survey 84,Introduction 33. National Health and Nutrition, Definition of a Population 34 Examination Survey 85. Definitions of Health and Disease 36 Behavioral Risk Factor Surveillance System 85. Changes in Disease Definitions 37 National Health Care Surveys 86. Measuring Disease Occurrence 39 National Notifiable Diseases. Types of Calculations Ratios Surveillance System 87. Proportions and Rates 40 Surveillance of HIV Infection 87. Measures of Disease Frequency 41 Reproductive Health Statistics 88. Commonly Used Measures of Disease National Immunization Survey 89. Frequency in Public Health 51,Survey of Occupational Injuries. Summary 52 and Illnesses 89,References 53 National Survey on Drug Use. Chapter Questions 54 and Health 90,iv Contents, Air Quality System 90 Overview of Case Control Studies 163. Surveillance Epidemiology and When Is It Desirable to Use a. End Results Program 91 Particular Study Design 168. Birth Defects Surveillance Other Types of Studies 170. and Research Programs 91 Summary 177,Health United States 92 References 178. Demographic Yearbook 92 Chapter Questions 179,World Health Statistics 92. Cancer Incidence on Five Continents 93 Chapter 7 Experimental Studies 181. Other Resources 93 Introduction 181,Summary 94 Overview of Experimental Studies 182. References 96 Types of Experimental Studies 185,Chapter Questions 97 Study Population 190. Sample Size 191, Chapter 5 Descriptive Epidemiology 99 Consent Process 192. Introduction 99 Treatment Assignment 192,Person 100 Use of the Placebo and Masking 196. Place 102 Maintenance and Assessment,Time 104 of Compliance 197. Disease Clusters and Epidemics 105 Ascertaining the Outcomes 200. Ebola Outbreak and Its Investigation 110 Data Analysis 202. Uses of Descriptive Epidemiology 116 Generalizability 205. Generating Hypotheses About Special Issues in Experimental Studies 205. Causal Relationships 116 Summary 207,Public Health Planning and References 207. Evaluation 117 Chapter Questions 209,Example Patterns of Mortality. in the United States According to Age 118 Chapter 8 Cohort Studies 211. Overall Pattern of Mortality 121,Introduction 211,Examples Three Important Causes. Cohort Study Definitions and Overview 212,of Morbidity in the United States 129. Types of Populations Studied 213,Summary 144,Characterization of Exposure 215. References 145,Follow Up and Outcome,Chapter Questions 150. Assessment 215,Timing of Cohort Studies 216,Chapter 6 Overview of Epidemiological. Issues in the Selection of Cohort,Study Designs 153 Study Populations 218. Introduction 153 Sources of Information 224, Overview of Experimental Studies 156 Analysis of Cohort Studies 229. Overview of Cohort Studies 159 Special Types of Cohort Studies 231. Contents v, Strengths and Limitations of Controlling for Confounding. Cohort Studies 232 in the Analysis 305,Summary 233 Residual Confounding 309. References 234 Assessment of Mediation 310,Chapter Questions 235 Summary 311. References 312, Chapter 9 Case Control Studies 237 Chapter Questions 313. Introduction 237, The Changing View of Case Control Studies 238 Chapter 12 Random Error 315. When Is It Desirable to Use the Introduction 315,Case Control Method 242. History of Biostatistics in Public Health 316,Selection of Cases 244. Precision 317,Selection of Controls 247,Sampling 319. Sources of Exposure Information 252,Hypothesis Testing and P Values 320. Analysis of Case Control Studies 255,Confidence Interval Estimation 326. The Case Crossover Study, A New Type of Case Control Study 258 P Value Function 329. Applications of Case Control Studies 260 Probability Distributions 330. Strengths and Limitations Hypothesis Testing Statistics 336. of Case Control Studies 261 Confidence Intervals for Measures of. Summary 262 Disease Frequency and Association 339, References 263 Sample Size and Power Calculations 345. Chapter Questions 265 Summary 346,References 348,Chapter 10 Bias 267 Chapter Questions 349. Introduction 267,Overview of Bias 268 Chapter 13 Effect Measure. Selection Bias 270 Modification 351,Information Bias 278 Introduction 351. Summary 291 Definitions and Terms for Effect,References 292 Measure Modification 352. Chapter Questions 292 Effect Measure Modification,Versus Confounding 353. Chapter 11 Confounding 295 Evaluation of Effect Measure Modification 354. Introduction 295 Synergy and Antagonism 359, Definition and Examples of Confounding 295 Choice of Measure 360. Confounding by Indication and Severity 301 Evaluating Effect Measure Modification and. Confounding in Stratified Analyses 361,Controlling for Confounding. General Considerations 302 Summary 362,Controlling for Confounding References 363. in the Design 302 Chapter Questions 363,vi Contents. Chapter 14 Critical Review of Predictive Value A Measure of. Screening Program Feasibility 431,Epidemiological Studies 367. Evaluating a Screening Program 434,Introduction 367. Guide to Answering the Critique Questions 369,Selecting an Outcome 437. Sample Critiques of Epidemiological Studies 378,Study Designs to Evaluate. Summary 391 Screening Programs 438, References 391 Examples of the Effect of Screening on Public. Health 440,Chapter 15 The Epidemiological Summary 442. Approach to Causation 393 References 444,Introduction 393 Chapter Questions 445. Definitions of a Cause 395, Characteristics of a Cause 397 Chapter 17 Ethics in Research Involving. Risk Factors Versus Causes 398 Human Participants 449. Historical Development of Disease Causation Contributed by Molly Pretorius Holme. Theories 399,Introduction 449,Hill s Guidelines for Assessing Causation 402. Historical Perspective 450,Use of Hill s Guidelines by Epidemiologists 407. International Ethical and Research,Sufficient Component Cause Model 408. Practice Guidelines 457,Why Mainstream Scientists Believe That. The U S Regulatory Framework for Human,HIV Is the Cause of HIV AIDS 411. Subjects Research 458,Summary 414,Limitations Posed by Ethical Requirements 460. References 415,Contemporary Examples 460,Chapter Questions 416. The Informed Consent Process 461,Chapter 16 Screening in Public Summary 466. Health Practice 419 References 466,Chapter Questions 467. Introduction 419,Natural History of Disease 420,Chapter 18. Answers to Chapter,Definition of Primary Secondary and. Tertiary Prevention 421,Questions Chapters 1 17 469. Appropriate Diseases for Screening 423, Characteristics of a Screening Test 426 Glossary 493. Lead Time 430 Index 503,Smartboy10 DigitalVision Vectors Getty Images. What is epidemiology and how does it con University Not only have our students suc. tribute to the health of our society Most peo cessfully mastered the material but they. ple don t know the answer to this question have also found that the new ideas enhanced. This is somewhat paradoxical because epide their understanding of epidemiology and its. miology one of the basic sciences of public application. health affects nearly everyone It affects both In addition to providing an up to date. the personal decisions we make about our lives education we have taught our students the. and the ways in which governments public necessary skills to become knowledgeable con. health agencies and medical organizations sumers of epidemiological literature Gaining. make policy decisions that affect how we live competence in the critical evaluation of this. In recent years the field of epidemiology literature is particularly important for public. has expanded tremendously in size scope and health practitioners because they often need to. influence The number of epidemiologists has reconcile confusing and contradictory results. grown rapidly along with the number of epide This textbook reflects our educational. miology training programs in schools of pub philosophy of combining theory and prac. lic health and medicine Many subspecialties tice in our teaching It is intended for pub. have arisen to study public health questions lic health students who will be consumers of. from the molecular to the societal level epidemiological literature and those who will. Recent years have also witnessed an be practicing epidemiologists The first five. important evolution in the theory and meth chapters cover basic epidemiological con. ods of epidemiological research and analy cepts and data sources Chapter 1 describes. sis causal inference and the role of statistics the approach and evolution of epidemiology. especially P values in research including the definition goals and histori. Unfortunately few of these changes have cal development of epidemiology and public. been taught in introductory epidemiology health Chapters 2 and 3 describe how epi. courses particularly those for master s level demiologists measure and compare disease. students We believe this has occurred mainly occurrence in populations Chapter 4 charac. because instructors have mistakenly assumed terizes the major sources of health data on the. the new concepts were too difficult or arcane U S population and describes how to interpret. for beginning students As a consequence these data appropriately Chapter 5 describes. many generations of public health students how epidemiologists analyze disease patterns. have received a dated education to understand the health status of a popula. Our desire to change this practice was the tion formulate and test hypotheses of disease. main impetus for writing this book For nearly causation and carry out and evaluate health. three decades we have successfully taught both programs. traditional and new concepts to our graduate The next four chapters of the textbook. students at Boston University and Harvard focus on epidemiological study design. viii Preface, Chapter 6 provides an overview of study and application of guidelines to ensure the. designs including experimental cohort ethical conduct of studies involving humans. case control cross sectional and ecological Up to date examples and data from the epi. studies and describes the factors that deter demiological literature on diseases of public. mine when a particular design is indicated health importance are used throughout the. Each of the three following chapters provides book In addition nearly 50 new study ques. a detailed description of the three main ana tions were added to the fourth edition. lytic designs experimental cohort and case Our educational background and research. control studies interests are also reflected in the textbook s. The next five chapters cover the tools outlook and examples Ann Aschengrau. students need to interpret the results of epide received her doctorate in epidemiology from. miological studies Chapter 10 describes bias the Harvard School of Public Health in 1987. including how it influences study results and and joined the Department of Epidemiology at. the ways in which it can be avoided Chapter the Boston University School of Public Health. 11 explains the concept of confounding meth shortly thereafter She is currently Professor. ods for assessing its presence and methods Associate Chair for Education and Co Director. for controlling its effects Chapter 12 covers of the Master of Science Degree Program in. random error including hypothesis testing Epidemiology For the past 30 years she has. P value and confidence interval estimation taught introductory epidemiology to mas. and interpretation and sample size and power ter s level students Her research has focused. calculations We believe this chapter provides on the environmental determinants of disease. a balanced view of the appropriate role of sta including cancer disorders of reproduction and. tistics in epidemiology Chapter 13 covers the child development and substance use. concept of effect measure modification an George R Seage III received his doctor. often neglected topic in introductory texts It ate in epidemiology from the Boston Univer. explains the difference between confounding sity School of Public Health in 1992 For more. and effect measure modification and describes than a decade he served as the AIDS epide. the methods for evaluating effect measure miologist for the city of Boston and as a fac. modification Chapter 14 pulls together the ulty member at the Boston University School. information from Chapters 10 through 13 by of Public Health He is currently Professor. providing a framework for evaluating the liter of Epidemiology at the Harvard T H Chan. ature as well as three examples of epidemiolog School of Public Health and Director of the. ical study critiques Harvard Chan Program in the Epidemiology. Chapter 15 covers the epidemiological of Infectious Diseases For over 30 years he. approach to causation including the historical has taught courses in HIV epidemiology to. development of causation theories Hill s guide master s and doctoral students His research. lines for assessing causation and the sufficient focuses on the biological and behavioral deter. component cause model of causation Chapter minants of adult and pediatric HIV transmis. 16 explains screening in public health practice sion natural history and treatment. including the natural history of disease char Drs Aschengrau and Seage are happy. acteristics of diseases appropriate for screen to connect with instructors and students via. ing important features of a screening test and email aaschen bu edu and gseage hsph. methods for evaluating a screening program harvard edu Also check out Dr Aschengrau s. Finally Chapter 17 describes the development Twitter feed AnnfromBoston. Preface ix, New to This Edition Introduction of the latest epidemiological. terms and methods, Completely updated with new examples New figures depicting epidemiological. and the latest references and public health concepts. statistics Expanded ancillary materials including, New section on process of investigating improved PowerPoint slides an enlarged. infectious disease outbreaks glossary and new in class exercises and. New section on the Ebola outbreaks and test questions. their investigation in Africa Over 50 new review questions. Smartboy10 DigitalVision Vectors Getty Images,Acknowledgments. Our ideas about the principles and practice Fleming Megan Murray Marc Lipsitch Sam. of epidemiology have been greatly influenced Bozeman Anne Coletti Michael Gross Sarah. by teachers colleagues and students We feel Putney Sarah Rogers Kimberly Shea Kunjal. privileged to have been inspired and nurtured Patel and Kelly Diringer Getz We are partic. by many outstanding teachers and mentors ularly grateful to Krystal Cantos for her many. including Richard Monson George Sandy contributions to this edition particularly the. Lamb Steve Schoenbaum Arnold Epstein new sections on disease outbreaks and Molly. Ken Rothman the late Brian MacMahon Julie Pretorius Holme for contributing the chapter. Buring Fran Cook Ted Colton Bob Glynn on ethics in human research Ted Colton also. Adrienne Cupples George Hutchison and deserves a special acknowledgment for origi. the late Alan Morrison We are pleased to help nally recommending us to the publisher. spread the knowledge they have given us to the We thank our students for graciously. next generation of epidemiologists reading drafts and earlier editions of this text. We are also indebted to the many col in their epidemiology courses and for contrib. leagues who contributed to the numerous edi uting many valuable suggestions for improve. tions of this book in various ways including ment We hope that this book will serve as a. clarifying our thinking about epidemiology useful reference as they embark on productive. and biostatistics providing ideas about how to careers in public health We also recognize Abt. teach epidemiology reviewing and comment Associates Inc for providing George Seage. ing on drafts and revisions of the text pilot with a development and dissemination grant. testing drafts in their classes and dispensing to write the chapter on screening in public. many doses of encouragement during the time health practice We are very grateful to the. it took to write all four editions of this book staff of Jones Bartlett Learning for guiding. Among these individuals are Bob Horsburgh the publication process so competently and. Herb Kayne Dan Brooks Wayne LaMorte quickly Finally we thank our son Gregory an. Michael Shwartz Dave Ozonoff Tricia Coo actor for his patience and for providing many. gan Meir Stampfer Lorelei Mucci Murray interesting and fun diversions along the way. Mittleman Fran Cook Charlie Poole Tom Break a leg,.
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