Discuss the four types of causal relationships and use an example not listed in the textbook to describe each relationship



Define endemic, epidemic, and pandemic, and provide an example of each. Describe a current epidemic. Describe one example of each of the prevention types (primary, secondary, and tertiary) that could be applied to control the epidemic.


Discuss the role the CDC’s Morbidity and Mortality Weekly Report (MMWR) plays in conveying public health information and recommendations. Describe the type of data and information provided by the MMWR. Choose a report posted within the last 2 years from the “Publications – Weekly Report” tab. Provide a brief summary of the disease report, including the natural history and mode of transmission, and whether the report is an example of descriptive epidemiology or analytical epidemiology.


Read Chapters 1, 2, and 6 in Gordis Epidemiology.

Read “Smoking and Carcinoma of the Lung,” by Doll and Hill, from British Medical Journal (1950). URL: https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC2038856/pdf/brmedj03566-0003.pdf

Read “The Training of Epidemiologists and Diversity in Epidemiology: Findings from the 2006 Congress of Epidemiology Survey,” by Carter-Pokras et al., from Annals of Epidemiology (2009). URL: http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S104727970900060X

Watch “Epidemiology the Backbone of Public Health,” by Greg Martin (2017), located on the YouTube website. URL: https://www.youtube.com/watch?v=S5XRh47T420

Read “The Framingham Study: ITS 50-Year Legacy and Future Promise,” by Kannel, from Journal of Atherosclerosis and Thrombosis (2000). URL: https://www.jstage.jst.go.jp/article/jat1994/6/2/6_2_60/_pdf

Read “Epidemiological Background and Design: The Framingham Study,” located on the Framingham Heart Study website. URL: https://www.framinghamheartstudy.org/fhs-about/history/epidemiological-background/

Read “Epidemiological Approaches to Heart Disease: The Framingham Study,” by Dawber, Meadors, and Moore, from American Journal of Public Health (1951). URL:http://scholar.google.com/scholar_url?url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525365/pdf/amjphnation00421-0020.pdf&hl=en&sa=X&scisig=AAGBfm10VqiSJ6tLAYY0TMfm15VR8M93MA&nossl=1&oi=scholarr

View “Global Disease Detectives,” by the Center for Global Health (2013), located on the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/cdctv/dataandstatistics/disease-detectives.html

Read “Section 2: Historical Evolution of Epidemiology,” from Lesson 1 of  the Centers for Disease Control and Prevention (CDC) self-study course, Principles of Epidemiology in Public Health Practice (2012), located on the CDC website. URL:https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section2.html

Explore the CDC Current Outbreak List page of the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/outbreaks/index.html

Explore the Epidemic Intelligence Service page of the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/eis/index.html

Explore the Morbidity and Mortality Weekly Report (MMWR), located on the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/mmwr/index.html



Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems?


Explain the importance of validity and reliability in diagnostic testing or research. Describe how validity relates to sensitivity and specificity in diagnostic testing. Identify a health screen specific to a diagnostic test that is currently being debated regarding its use, recommended ages, or frequency, and discuss how validity and reliability play into this debate. What other factors should you consider when you assess the recommendations for a diagnostic test or screen?


Read Chapters 3-5 and 18 in Gordis Epidemiology.

Read “Types of Surveillance,” located on the London School of Hygiene and Tropical Medicine website. URL:http://conflict.lshtm.ac.uk/page_75.htm

Read “WHO Report on Global Surveillance of Epidemic-Prone Infectious Diseases – Introduction,” located on the World Health Organization (WHO) website. URL: https://www.who.int/csr/resources/publications/introduction/en/

Read “CDC 24-7 Fact of the Week,” located on the Centers for Disease Control and Prevention (CDC) website. URL:https://www.cdc.gov/about/facts/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fabout%2Ffacts%2Fcdcfastfacts%2Fsurveillance.html

Read “Two by Two Tables,” by Sullivan, Dean, and Pezzullo, from OpenEpi: Open Source Epidemiologic Statistics for Public Health (2013), located on the OpenEpi website. URL: http://www.openepi.com/TwobyTwo/TwobyTwo.htm

Read “Goodness of Measurement: Reliability and Validity,” by Bajpai and Bajpai, from International Journal of Medical Science and Public Health (2014). URL: https://www.ejmanager.com/mnstemps/67/67-1380953319.pdf

Use the “Compendium of Acute Foodborne and Waterborne Diseases,” located on the Centers for Disease Control and Prevention (CDC) website, to assist in completing the Oswego Outbreak Case History assignment. URL: https://www.cdc.gov/eis/casestudies/xoswego.401.303.compendium.pdf

View “How to Create an Epidemic Curve,” by Martin (2016), located on the YouTube website. URL: https://www.youtube.com/watch?v=dn84ezAzV4k

View “Know How to Interpret an Epidemic Curve?” by Martin (2017), located on the YouTube website. URL: https://www.youtube.com/watch?v=7SM4PN7Yg1s

Explore the National Notifiable Diseases Surveillance System (NNDSS) page of the Centers for Disease Control and Prevention (CDC) website. URL: https://wwwn.cdc.gov/nndss/

Explore Public Health Surveillance and Data page of the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/surveillance/



Differentiate between bias and confounding. Discuss the criteria necessary to establish a factor as a confounder and provide an example applying these criteria. What is one way to adjust for a confounding relationship in the study design or the analysis?


Explain the two major types of bias. Identify a peer-reviewed epidemiology article that discusses potential issues with bias as a limitation and discuss what could have been done to minimize the bias (exclude articles that combine multiple studies such as meta-analysis and systemic review articles). What are the implications of making inferences based on data with bias? Include a link to the article in your reference.


Read Chapters 14 and 15 in Gordis Epidemiology.

Read “Association or Causation: Evaluating Links Between ‘Environment and Disease,'” by Lucas and McMichael (2005), located on the World Health Organization website. URL: https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC2626424/pdf/16283057.pdf

Read “Weak Associations in Epidemiology: Importance, Detection, and Interpretation,” by Doll, from Journal of Epidemiology (1996). URL: https://www.jstage.jst.go.jp/article/jea1991/6/4sup/6_4sup_11/_pdf

Read “Causal Inference Based on Counterfactuals,” by Hofler (2005), located on the BioMed Central website. URL: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-5-28

Read “Multicausality: Confounding,” by Schoenbach (2004), located on the Epidemilog.net website. URL: http://www.epidemiolog.net/evolving/Multicausality-Confounding.pdf

View “Sensitivity and Specificity – Explained in 3 Minutes,” by Martin (2014), located on the YouTube website. URL: https://www.youtube.com/watch?v=FnJ3L-63Cf8

View “The Relationship Between Incidence and Prevalence,” by Patwari (2013), located on the YouTube website. URL: https://www.youtube.com/watch?v=1jzZe3ORdd8

Use the “Creating a 2×2 Contingency Table” resource to assist with the completion of the Measuring Morbidity: Prevalence and Incidence assignment, as needed.



Based on the “Multicausality: Confounding – Assignment,” by Schoenbach, discuss two significant insights you learned about confounding. Use specific examples from the assignment to support your answer.


Describe the characteristics and design of a cohort study. Based on a disease or health condition identified from the “2020 LHI Topics” on the Healthy People 2020 website, or an article from the GCU library, discuss a real example of a cohort study (include the link to the article in your post to the forum). Include the participants, exposures or treatment groups, timeframe, and outcomes that were measured. Why is a cohort study described as an “observational” study rather than an “experimental” study design?


Read Chapters 7-9 in Gordis Epidemiology.

View “Randomized Control Trials and Confounding,” by Martin (2013), located on the YouTube website. URL: https://www.youtube.com/watch?v=7ybuE39BpQ8

Read “2020 LHI Topics,” located on the Healthy People 2020 website. URL: https://www.healthypeople.gov/2020/leading-health-indicators/2020-LHI-Topics

Complete the “Multicausality: Confounding – Assignment,” by Schoenbach (2001), located on the Epidemilog.netwebsite. URL: http://www.epidemiolog.net/evolving/ConfoundingAssgt.pdf

Refer to the “Multicausality: Confounding – Assignment Solutions,” by Schoenbach (2001), located on the Epidemilog.netwebsite, to check your answers to the assignment. URL: http://www.epidemiolog.net/evolving/ConfoundingSolns.pdf

Read “Understanding Controlled Trials: Why Are Randomized Controlled Trials Important?” by Sibbald and Roland, from British Medical Journal (1998). URL:http://search.proquest.com.lopes.idm.oclc.org/docview/1777585669/fulltextPDF/2BDCED02960C4E6APQ/1?accountid=7374



Describe the common characteristics and design of a case-control study. Discuss the three important features when it comes to selecting cases and controls, and identify a situation when one of these might be violated. Discuss the limitations of using questionnaires for determining exposure status and provide examples of alternative strategies for collecting this information in a case-control study.


Discuss the strengths and weaknesses of cross-sectional studies and examples of how they can be “descriptive” or “analytic” study designs. Discuss an example of a disease where survival could influence the association between a possible exposure and the disease when measured with a cross-sectional study. Do not discuss examples used in the textbook.


Read Chapter 10 in Gordis Epidemiology.

View “Cohort and Case Control Studies,” by Martin (2013), located on the YouTube website. URL: https://www.youtube.com/watch?v=J3GHTYa-gZg

Read “Introduction to Study Designs – Cross-Sectional Studies,” located on the Health Knowledge website. URL: https://www.healthknowledge.org.uk/e-learning/epidemiology/practitioners/introduction-study-design-css

Read “Cross-Sectional Studies,” from ERIC Notebook (2012), located on the Gillings School of Global Public Health -University of North Carolina website. URL: https://sph.unc.edu/files/2015/07/nciph_ERIC8.pdf

Read “Section 7: Analytic Epidemiology,” from Lesson 1 of the Centers for Disease Control and Prevention (CDC) self-study course, Principles of Epidemiology in Public Health Practice: An Introduction to Applied Epidemiology and Biostatistics (2012), located on the CDC website. URL: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section7.html



Differentiate between association and causation using the causal guidelines. Discuss which of the guidelines you think is the most difficult to establish. Discuss the four types of causal relationships and use an example not listed in the textbook to describe each relationship.


Explain the difference between relative risk, attributable risk, and population attributable risk. Provide an example (not from the textbook) of how each type of risk is used in epidemiology. How would you propose using population attributable risk to advocate for a health policy or intervention relative to your health interest?


Review Chapter 14, and read Chapters 11-13 in Gordis Epidemiology.

Read “Causation in Epidemiology: Association and Causation,” located on the Health Knowledge website. URL: https://www.healthknowledge.org.uk/e-learning/epidemiology/practitioners/causation-epidemiology-association-causation

Read “Section 5: Measures of Association,” from Lesson 3 of the Centers for Disease Control and Prevention (CDC) self-study course, Principles of Epidemiology in Public Health Practice: An Introduction to Applied Epidemiology and Biostatistics (2012), located on the CDC website. URL: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section5.html

Use the “BRFSS Web Enabled Analysis Tool,” located on the Centers for Disease Control and Prevention (CDC) website, to complete the topic assignment. URL: https://nccd.cdc.gov/weat/#/

Review “Multicausality: Confounding,” by Schoenbach (2004), located on the Epidemilog.net website. URL: http://www.epidemiolog.net/evolving/Multicausality-Confounding.pdf

View “How to Calculate Relative Risk,” by Shaneyfelt (2012), located on the YouTube website. URL: https://www.youtube.com/watch?v=xk2uK14eHNs

View “How to Calculate an Odds Ratio,” by Shaneyfelt (2012), located on the YouTube website. URL: https://www.youtube.com/watch?v=ITi0SxmQTO8



Epidemiological methods are used in a variety of public health areas (including infectious disease, chronic disease, and social health) and settings (including the community, schools, and the workplace). Epidemiological methods are used to assess, describe, analyze, and make comparisons of populations to inform evidence-based practices, policies, and interventions. Propose a study based on the methods you have learned thus far designed to investigate an association within one of the public health areas listed (infectious disease, chronic disease, or social health) and the methods you would apply. Discuss and define the risk factor or exposure that is being assessed, the method of comparison that is used, and the setting or situation (community, school, workplace, etc.) your study would look to address. Consider the concepts of causal inference, measures of association, and study design.


Race is often used as a descriptor of disease burden and helps us to determine where health disparities exist in order to address them, which is important. It is helpful to differentiate between race as a descriptor and race as a risk factor. Think about institutional racism and its influence on health. Consider the factors related to race and ethnicity that might be influencing disease status more than the genetics of race when answering this discussion question.

Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.” Discuss the ethical and public health implications of this statement. When might collecting data on race perpetuate institutional racism leading to health disparities and when is it necessary to improve public health? Provide support and examples for your answer. Consider ethical issues related to respect for persons, beneficence, and justice as described in “The Belmont Report.”


Read Chapters 17, 19, and 20 in Gordis Epidemiology.

Read “Health Inequalities Among British Civil Servants: The Whitehall II Study,” by Marmot and Smith, from The Lancet (1991). URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=9107080526&site=ehost-live&scope=site

Read “The Role of Epidemiology in Disaster Response Policy Development,” by Thorpe et al., from Science Direct (2015). URL:http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S1047279714003184?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb

Read “Prescription Drug Abuse: From Epidemiology to Public Policy,” by McHugh, Nielsen, and Weiss, from Journal of Substance Abuse Treatment (2015). URL:http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S0740547214001871?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y

Read “The Role Epidemiology in Evidence-Based Policy Making: A Case Study of Tobacco Use in Youth,” by Aldrich et al., from Annals of Epidemiology (2015). URL:http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S1047279714001495?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb

Read “Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities,” by Carter-Pokras et al., from Annals of Epidemiology (2012). URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724931/

Read “Epidemiology and Public Policies,” by Barata, from Revista Brasileira de Epidemiologia (2013). URL: http://www.scielo.br/scielo.php?pid=S1415-790X2013000100003&script=sci_arttext&tlng=en

Read “Ethical Issues in Epidemiologic Research and Public Health Practice,” by Coughlin, from Emerging Themes Epidemiology (2006). URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594564/

Explore the “Viral Hepatitis Epidemiologic Profiles” map, located on the Association of State and Territorial Health Officials (ASTHO) website, to assist with topic assignment.URL: https://www.astho.org/Viral-Hepatitis-Epi-Profiles/Map/

Use the “BRFSS Web Enabled Analysis Tool,” located on the Centers for Disease Control and Prevention (CDC) website, to complete the topic assignment. URL: https://nccd.cdc.gov/weat/#/

Review the “Belmont Report,” by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1979), located on the U.S. Department of Health and Human Services – Office for Human Research Protections website. URL: https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Explore the resources on “Health Data Tools and Statistics,” located on the PHPartners website. URL: https://phpartners.org/health_stats.html

Explore “Surveillance, Epidemiology and the End Results Program,” from the National Cancer Institute.URL: https://seer.cancer.gov/

Explore the STEPwise Approach to Surveillance (STEPS) page of the World Health Organization (WHO) website. URL: http://www.who.int/chp/steps/en/



One method to investigate gene-environment interactions is to study monozygotic twins. Identify an example of a twin study not listed in the textbook used to examine the gene-environment interaction of a specific disease or condition. Briefly summarize the gene-environment interaction investigated, the methods, and the results. What are other possible methods for studying gene-environment interactions as they relate to improving population health?


Using the CDC Wonder website, set the query criteria for pancreatic cancer for the United States as illustrated below. Compare the rates by race for Wisconsin and Colorado. Discuss possible biological, genetic, and environmental reasons for differences. What are potential social determinants that contribute to the disparity presented between the two states?

Use this query upon entering the CDC Wonder website:

Select “Cancer Statistics” under the Wonder Systems tab

Select “Cancer Incidence 1999 – 2013” and click “Data Request”

Organize table layout:

  1. Group      results by 1. States and 2. Race (leave the rest of the group options as      “None”)
  2. Measures      – click “Count” (default) and “Age Adjusted Rates”

Select location – select “States” and “The United States”

Select year and demographics

  1. Year      – 2014
  2. Sex      – All genders
  3. Age      groups – All ages
  4. Ethnicity      – All ethnicities
  5. Race      – All races

Select cancers of interest – select “Pancreas”

Other options – keep default settings


Read Chapter 16 in Gordis Epidemiology.

Read “Gene-Environment Interaction,” located on the National Institute of Environmental Health Sciences website. URL: https://www.niehs.nih.gov/health/topics/science/gene-env/index.cfm

Read “Defeating the ZIP Code Health Paradigm: Data, Technology, and Collaboration Are Key,” by Graham, Ostrowski, and Sabina, from the Health Affairs Blog (2015), located on the Health Affairs website. URL: http://healthaffairs.org/blog/2015/08/06/defeating-the-zip-code-health-paradigm-data-technology-and-collaboration-are-key/

Explore the CDC Wonder page of the Centers for Disease Control and Prevention (CDC) website.URL: https://wonder.cdc.gov/

Review the Mapping Life Expectancy page of the Robert Wood Johnson Foundation website. URL: http://www.rwjf.org/en/library/articles-and-news/2015/09/city-maps.html

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