Epidemiology

Week 6: Epidemiological Applications, Part 2 and Data Interpretation

Can a person’s experience with racial discrimination impact aging and his or her physical health? The answer may be yes, according to a preliminary epidemiologic research study sponsored by the National Institute on Aging (NIA) and the National Institute of Health (Szanton et al., 2011; NIH, 2011). The NIA looks at factors such as race and socioeconomic status in relation to health disparities and outcomes. The Szanton et al. study identified a sample population of African Americans living in the Baltimore area who reported experiencing racial discrimination in their lifetime. This sample population showed higher levels of red blood cell oxidative stress, a potential risk factor in cardiovascular and other age-related diseases. Although this study presents only preliminary findings, it is interesting to consider the role that stress and other psychosocial factors play in the overall health of individuals and populations.

This week, you will examine psychosocial factors that influence health and disease. By understanding the role of these factors in health, along with environmental and genetic factors, you will have additional tools to improve health outcomes for individuals and populations.

Finally, in order to develop evidence-based interventions, DNP-prepared nurses need to be able to critically appraise the research literature, including the conclusions drawn from the data analysis. To practice this skill, you will appraise two articles and consider potential sources of confounding and bias.

Learning Objectives

Students will:

• Evaluate the influence of psychosocial factors in health and disease
• Critically appraise epidemiologic literature
• Analyze the potential influence of confounding variables in a research study
• Analyze potential sources of bias in epidemiologic research

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.

• Chapter 10, “Data Interpretation Issues”
• Chapter 15, “Social, Behavioral, and Psychosocial Epidemiology”
• Appendix A – Guide to the Critical Appraisal of an Epidemiologic/Public Health Research Article

In Chapter 10, the authors describe issues related to data interpretation and address the main types of research errors that need to be considered when conducting epidemiologic research, as well as when analyzing published results. It also presents techniques for reducing bias. Chapter 15 features psychosocial, behavioral, and social epidemiology. Appendix A includes criteria to consider when reading an empirical journal article.

Elliott, A. M., Smith, B. H., Penny, K., Smith, W. C., & Chambers, W. A. (1999). The epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248–1252.

This article describes an early epidemiologic study on chronic pain. Carefully review this article noting the structure of the research design, assessment and data collection, and analysis strategies. You will refer to this article for Discussion 2.

Oppenheimer, G. M. (2010). Framingham Heart Study: The first 20 years. Progress in Cardiovascular Diseases, 53(1), 55–61.

The Framingham Heart Study is a landmark epidemiologic study that began in the 1940s. The author of this article reviews the history of the Framingham Heart Study and its contribution to population health. As you read this article, consider any sources of bias or potential conflict of interest. You will refer to this article for Discussion 2.

Phillips, C. V., & Goodman, K. J. (2004). The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives & Innovations, 1(3). Retrieved from http://www.biomedcentral.com/1742-5573/1/3

In 1965, Austin Bradford Hill worked on a paper that has become a standard in public health and epidemiologic study about how to make decisions based on epidemiologic evidence. Hill put forth strategies for inferring causation and stressed the need for considering costs and benefits when planning health-promoting interventions. Review this article, which examines how Hill’s strategies are often misused or misinterpreted.

Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, Supplement, (60), 1–114. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6001.pdf. [Read pages 11–32]

This report consolidates national data on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators. The required section of reading introduces the social determinants of health and environmental hazards.

World Health Organization. (2011). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/

According to the World Health Organization, “The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.” This article presents an introduction to social determinants of health.

World Health Organization. (2011). Social determinants of health: Key concepts. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html

This article outlines key concepts related to the social determinants of health.

Healthy People 2020. (2011). Social determinants of health. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39

This website presents an overview of the social determinants of health and addresses how the information relates to Healthy People 2020.

UCL Institute of Health Equity. (2018). ‘Fair society healthy lives’ (The Marmot Review). Retrieved from http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review

Optional Resources

Genaidy, A. M., Lemasters, G. K., Lockey, J., Succop, P., Deddens, J., Sobeih, & Dunning, K. (2007). An epidemiological appraisal instrumental – a tool for evaluation of epidemiological studies. Ergonomics, 50(6), 920–960.

Centers for Disease Control and Prevention. (2011). Social determinants of health. Retrieved from http://www.cdc.gov/socialdeterminants/

Discussion 1: Psychosocial Factors in Health

Although the United States spends more money per capita on health care delivery, statistics indicate it is not a particularly healthy country. Over 50% of all preventable deaths in the United States are a result of unhealthy lifestyle behaviors (AACN, 2006). As epidemiologists explore essential questions such as how stressful life events and behavioral choices may influence an individual’s health, society wrestles with the distinction of what is actually within the control of an individual, and therefore relates to a personal responsibility for promoting well being, versus how larger-scale efforts can modulate psychosocial risk factors that result in population health problems.

In this Discussion, you will consider the connection between psychosocial risk factors and health outcomes. As you review the research literature, consider how you have come across this issue in your professional practice. As a nurse leader, what opportunities do you have to apply the information presented this week to promote improvements in population health status?

To prepare:

• Review the Learning Resources, focusing on the influence of psychosocial factors on health and disease.
• Locate at least two examples from the research literature of how these factors influence health. If necessary, conduct additional research using the Walden Library and credible websites.
• Examine strategies currently being employed to address these factors, including health promotion and disease prevention efforts.
• Ask yourself: How are these strategies designed to improve population health status?

By Day 3

Post a cohesive scholarly response that addresses the following:

• Provide a brief summary of each example, including the influence of psychosocial factors on health and disease as discussed in the research literature. Cite your sources.
• What strategies are currently being used to address these factors? Support your response with examples from the literature.
• Knowing that there are psychosocial factors that influence acute and chronic diseases, what is the role of the nurse in probing for that information or in larger initiatives?

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least one of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 6 Discussion 1 Rubric

Post by Day 3 and Respond by Day 5

To participate in this Discussion:

Week 6 Discussion 1

Discussion 2: Appraising the Literature

For the DNP-prepared nurse, it is important to hone skills related to reviewing and evaluating research literature to implement evidence-based practices. As you examine epidemiological research, in particular, it is essential to ask, “What are the strengths and weakness of the research method(s)? Are the data analysis and interpretation sound? Is there any evidence of bias?” This Discussion provides you and your colleagues valuable practice in critically analyzing research literature.

To prepare:

• With this week’s Learning Resources in mind, reflect on the importance of analyzing epidemiological research studies.
• Critically appraise the Oppenheimer (2010) and Elliott, Smith, Penny, Smith and Chambers (1999) articles presented in the Learning Resources using Appendix A in Epidemiology for Public Health Practice as a guide.
• Determine the strengths and weaknesses of the research methods and data analysis of each study.
• Ask yourself, “Is any bias evident in either study? What did the researchers do to control for potential bias?”
• Finally, consider the importance of data interpretation in epidemiologic literature and the issues that may arise if potential confounding factors are not considered.

By Day 5

Post a cohesive scholarly response that addresses the following:

• Appraise the Oppenheimer (2010) and Elliott et al. (1999) articles, summarizing the strengths and weaknesses of each study.
• Analyze potential sources of bias in each study, and suggest strategies for minimizing bias.
• Suggest possible confounding variables that may have influenced the results of each study.

Read a selection of your colleagues’ responses.

By Day 7

Respond to at least one of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 6 Discussion 2 Rubric

Post by Day 5 and Respond by Day 7

To participate in this Discussion:

Week 6 Discussion 2