Epidemiology Basics

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: What is epidemiology?; What is the basic premise of epidemiology?; What are the most common uses of epidemiology? and more...

What is epidemiology?
Epidemiology refers to applying the tools of public health to the population, rather than looking at specific individuals as clinical medicine does. The purpose of epidemiology is to look at the distribution and determinants of diseases and other health problems in the population. This is somewhat different from the focus of the clinician who's looking for signs and symptoms of disease or making diagnoses, but doing it in specific individuals rather than within the population.

What is the basic premise of epidemiology?

The basic premise of epidemiology is that health problems and health issues can be defined according to major characteristic variables, and these are known as person, time, and place variables. For example, many disease entities vary according to geographic location. There are some diseases that we have in some parts of the world, for example, the tropical areas of the world, that we don't have in the United States, that are located in temperate areas. Disease conditions and health problems tend to vary according to racial and ethnic breakdown as well. For example, non-Hispanic white people have certain characteristic forms of morbidity and mortality. And these may not be the same, or expressed to the same extent in other racial groups such as Hispanic whites, African Americans, Asians, or other groups. Another aspect we look at in epidemiology is the variable of time. Health conditions and diseases tend to vary over time. For example, there are seasonal variations in many infectious diseases, an example being influenza. There are long term time trends in diseases. Recently, coronary heart disease has tended to level off or decline. And then, that is being replaced by cancer, which is a fast growing cause of mortality in the United States.

What are the two branches of epidemiology?

One of them is called descriptive epidemiology, and then another one is known as analytic epidemiology. Descriptive epidemiology aims to describe a health condition within the population. For example, how does it vary according to age group, or by geographic location, or by other person variables. Also, place variables and time variables. The purpose of descriptive epidemiology is to try to devise hypotheses about the nature, or ideology, of a disease. For example, if we observe a problem that is relevant to many geographic areas. If we observe in Los Angeles that areas of Los Angeles that have high amounts of traffic have high rates of cancer, then we can already begin to think of some hypotheses about what may be going on, and then conduct further studies to investigate what is happening. In contrast with descriptive epidemiology is

analytic epidemiology, which tries to uncover the causes of diseases in populations. There are certain types of study designs that are used in analytic epidemiology. For example, case control studies, cohort studies, and experimental studies. The purpose of this is to take hypotheses that have been identified and then investigate them with respect to ideology, and then try to track down a cause of the disease, such as if it's a chronic disease or an infectious disease, or food borne illness, or whatever.

What are the most common uses of epidemiology?

There are seven identified uses of epidemiology. One of them is to study the history of the health of the population. For example, the types of problems that affect society and humanity have changed over periods of time. If you look at data for the 1900s, you would see that there were certain infectious diseases that predominated at that time. If you compare those with the patterns that we have at present, you would see that many of the infectious diseases have been replaced by chronic diseases of long duration, of long standing. Another use of epidemiology is for diagnosis of the health of the community. In this type of epidemiology, we try to make a picture of the characteristics of the community with respect to its demographic makeup, in terms of particular health problems that exist in the community. From that information we can propose specific plans and programs to intervene in order to optimize the health of the community. Another use is known as studying the working of health services, and this use is sometimes referred to as Operations Research. For example, we want to find out if there are areas of the community or our city or county, our state or whatever geographic subdivision we're looking at, that are lacking in health services or whether there are some that are overlapping. That is also known as Operations Research. Another use of epidemiology is called the study of individual risks. For example, one may have observed the prognosis of cancer patients who are diagnosed with a specific form of cancer, or cancer patients who undergo a certain type of treatment. What is their prognosis over time? How long are they likely to live? The use of epidemiology known as identifying syndromes has to do with identifying characteristic patterns of symptoms and other dimensions that are associated with a specific disease. As an example, the common cold has certain symptoms associated with it or the flu - runny nose, headaches, muscle aches, fever and so forth. This is another use of epidemiology. Completing the clinical picture is still another use of epidemiology, and that has to do with the full manifestations of a disease. Often, clinicians who come into first contact with the disease are only aware of the most acute or dramatic cases of the disease. In reality, there may be other types or other manifestations of the disease. Epidemiology enables us to find out what those are, and the final use of epidemiology is known as the search for causes. An example of this type of use of epidemiology would be to find out what causes chronic diseases such as cancer or heart disease. What causes common infectious diseases that we know about. Sometimes epidemiologists have very little knowledge about the disease when they begin, and as a result of their investigations they're able to more fully uncover the causes for the disease.

What are the main components of epidemiology?

The components of epidemiology include the following: disease determinants - which are the cause or factors, the distribution, and morbidity or mortality. Distribution refers to how the disease occurs in the population, morbidity refers to sickness, and mortality refers to death.

Why is epidemiology considered an interdisciplinary field?

Epidemiology is called an interdisciplinary field meaning that it draws on many different disciplines. An example being statistics and biostatistics, microbiology, toxicology, clinical medicine, even psychology and the behavioral sciences. Epidemiology aims to use the appropriate tools that may exist to investigate and study diseases and disease outbreaks.

What are the scientific foundations of epidemiology?

The specific foundations is discipline that draws on the best things from a lot of different fields. For example, my own background was in psychology. Epidemiology is interested in the psychosocial aspect of disease and process these relating to disease. Demography is certainly important in the description of the population. Microbiology is an aspect of epidemiology. Biostatistics is certainly at the core of epidemiology and is very much a central aspect of epidemiology. Molecular and genetic techniques are now becoming more prominent. In some, epidemiology varies from a large number of disciplines and uses the best tools that it can.

What are the most common methods epidemiologists use to study disease?
One of the common methods that epidemiology uses to study disease is called quantification. Quantification involves translating qualitative information or qualitative impressions into numbers that can be measured. And then, in addition, epidemiology uses a special vocabulary. Some examples of the special vocabulary are morbidity, mortality, incidence, prevalence, rate, risk, and so forth. All of these terms, and vocabulary terms, are characteristic to the discipline of epidemiology.

How does epidemiology approach the study of diseases within a population?

Epidemiology uses an interdisciplinary approach to study the occurrence of diseases in populations. For example, the work of biostatisticians is important in quantifying and measuring the occurrence of disease. The skills of microbiologists are helpful to identify and track down agents of disease. The contributions of demography are certainly important - sociology, psychology and many other disciplines.

What are the most common variables used to evaluate my community's health?

Examples of common demographic variables are the age distribution of the population, the racial and ethnic distribution, socioeconomic status, education, and lifestyle characteristics. Social characteristics relate to social instability, the social support level, affluence, availability of health care facilities and related variables.

Do clinical descriptions of disease differ from epidemiological descriptions of disease?

The clinical description of a disease is quite different from an epidemiologic description. A clinical description involves the use of specific signs and symptoms of a disease. For example, what you might see on your clinical record, such as what your temperature was, or what your height is, or your weight. Essentially, it looks at what your symptoms are. In an epidemiologic description of a disease, we're interested in describing the populations among which the disease is more common, the subsets of the population where it occurs, how it varies by age, gender and other demographic variables.

Which sources of data do epidemiologists draw upon?

Epidemiologists draw from a wide number of data sources, and I can name several examples. For example, one of the most important ones is vital statstics data. This includes data from birth records, death records, surveillance systems mantained by local government that are forwarded to the state level, to the Centers for Disease Control and Prevention. There are data registries that collect data on specific diseases such as cancer, and then there are national and local surveys that are conducted such as the Health Interview Survey and the Health Examination Survey. An example of a local survey conducted in California is the CHIS, or California Health Interview Survey.

Epidemiology Definitions
Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: What do epidemiologists mean by the term 'morbidity'?; What does 'etiology' mean? and more...

What is 'population medicine'?

The term population medicine is sometimes used as a synonym for the term epidemiology. It indicates that the techniques of epidemiology are applied to the entire population rather than specific individuals.

What do epidemiologists mean by the term 'determinants'?

The term determinants' refers in epidemiologic language to causes of disease. Examples of determinants are fairly clear when we're speaking about infectious diseases. The

common cold is caused by a virus. There are many bacterial agents that cause disease. The issue of determinants becomes clouded when we're speaking about many of the chronic diseases of long duration. For example, the determinants of many forms of cancer are unclear. In addition, some diseases have multiple determinants. For example, with coronary heart disease, heart disease mortality has more than a single determinant. The specific determinants that are involved and the way that they interact with one another clouds the picture of causality of disease.

What do epidemiologists mean by the term 'distribution'?

Well the term 'distribution' refers to the fact that diseases vary in populations according to the characteristics of the population. For example, the disease Tuberculosis is endemic in many parts of the world but not as frequent in the United States, although it is a significant problem. Many forms of chronic diseases, such as cancer or coronary heart disease, vary according to the distribution of the population in which they occur. Some groups---ethnic groups---may have reduced occurrence of some chronic diseases, such as cancer, because of lifestyle factors that prevent cancer from occurring.

What do epidemiologists mean by the term 'population'?

The population refers to entire group of people and it can have several definitions, depending on the frame of reference that one works with. For example we can speak of the population of the world; we can speak of the population of a specific country. Sometimes, we refer to the population of a state or a county. Or it can even be important sub-group, such as a University population of the students who are attending the University, or almost any group as defined by the epidemiologist.

What do epidemiologists mean by the term 'population at risk'?

The population at risk refers to those people who are specifically capable of coming down with the condition, or developing the condition, of interest. For example, we can give several good examples for many infectious diseases, if there is a specific immunization against that disease to protect the population, and then the individuals who have received the immunization generally will not be part of the population at risk. If we are talking about cervical cancer, women who have had a hysterectomy would not be a part of the population at risk for cervical cancer and so forth.

What do epidemiologists mean by the term 'morbidity'?

The term 'morbidity' refers to sickness in the population. For example, people who are afflicted with certain diseases and conditions. An example would be people who are afflicted with diabetes, Type I Diabetes, or people who are afflicted with the flu at any given time.

What do epidemiologists mean by the term 'mortality'?

Mortality refers to death and it is noteworthy for epidemiology, because it is an important outcome variable that is used in epidemiologic studies. Death is very clear cut, noted in important data sources such as death certificates and can be studied with some degree of clarity where as morbidity is often less clear.

What is 'biostatistics'?
The term biostatistics refers to the methods of statistics applied to biological problems. In many ways, biostatistics is similar or certainly a close relative of statistics that might be used in other disciplines. However, biostatistics has certain concerns in faux side that are applied specifically to health problems and public health problems. One example, is the calculation of survival peers would be an application of biostatistics, and how populations survive or some groups of a population, if they are given a specific treatment for a disease.

What does 'etiology' mean?

That is a very important feature of epidemiology. What are the etiologic features of cancer? What causes cancer? What causes diabetes? What causes the major chronic diseases? Epidemiology can often identify risk factors, which indicate increased probability of developing the disease within the population, but is often less able to identify specific etiologic factors for diseases.

What's the difference between 'incidence' and 'prevalence'?

The incidence of disease refers to new cases of disease. Incidence information is used to study risk to the population, and also to study the ideology of diseases. Prevalence of disease refers to the total number of cases of disease that exist in the population, either during a period of time or at a specific point in time. Incidence and prevalence are related terms. As the duration of disease increases, for example, the prevalence of the disease must increase as well.

What's the difference between a 'disease rate' and 'disease proportion'?

There's a very important distinction between the two. A "proportion" refers to a numerator expressed as a fraction of the entire population. In contrast, a "rate" has similar information that refers to the number of new cases of disease that occur as the fraction of the population, but also involves a time period during which the events occurred.

Epidemiological Research Of Public Health

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: Which characteristics determine my susceptibility to a disease?; How important is my sex in determining my susceptibility to disease?; How important is my marital status in determining my susceptibility to disease? and more...

What is 'descriptive epidemiology'?

Descriptive epidemiology is the branch of epidemiology that aims to show how diseases are distributed in the population according to the variables of person, time and place.

What is a 'descriptive epidemiological study'?

A descriptive epidemiologic study refers to a type of study that is used to describe the occurrence of disease in a population. That is, it's distribution according to the descriptive variables of person, time and place.

What are the objectives of descriptive epidemiology?

The objectives of descriptive epidemiology are three-fold. One is to evaluate trends and the occurrence of disease, the second one is to provide a basis for planning and evaluation of health services and the third is to set the stage for further analytic studies.

What's the difference between descriptive and analytic epidemiology?

Descriptive epidemiology attempts to show how a problem or condition varies in the population, and to set hypotheses. Analytic epidemiology tries to follow up on the hypotheses developed in descriptive studies, and to investigate specific causes or etymology of diseases.

Which characteristics determine my susceptibility to a disease?

Some of these important characteristics include the demographic status of the person. For example, gender and age or race and socioeconomic status. Another important factor would be lifestyle characteristics. And then finally, the immune status of the individual or prior immunity and immunization status.

How important is my sex in determining my susceptibility to disease?

Gender is an important factor in occurrence of disease. For example, there are conditions that are predominant among women and others that are predominant among men. In general, women have higher rates of morbidity than men, but at the same time, tend to live longer than men.

How important is my marital status in determining my susceptibility to disease?

Marital status is an important factor in the occurrence of disease. In general, studies show that single people tend to live less long than married people. Apparently, marriage has either a protective, or selective effect in the occurrence of morbidity and mortality. Protective meaning social support that arises from marriage, and selective meaning that

healthier people may tend to select one another; and therefore, married people live longer than single people.

How important is my race in determining my susceptibility to disease?

Diseases show substantial variation according to race. Sometimes, race is a factor that defines health disparities in some racial groups. For example, in the United States, some African American groups and other minority groups may tend to have higher amounts of morbidity and higher rates of mortality than other groups.

Why is race a factor in susceptibility to disease?

The association between race and disease is related sometimes to cultural and socioeconomic factors. For example, some racial groups may have cultural values that protect against disease through lifestyle factors such as avoidance of smoking or dietary factors that are more healthy than those that are maintained by other groups.

Does my socioeconomic status determine my susceptibility to disease?

Socioeconomic status is a very important variable in the occurrence of disease. There is a clear inverse association between being lower on the socioeconomic status scale and the occurrence of many infectious and chronic diseases and mortality.

Does my religion determine my susceptibility to disease?

Diseases vary in populations according to religion. Some religions may prescribe lifestyles that are positive with respect to health status. Religions that espouse a vegetarian diet, avoidance of meats and saturated fats, avoidance of smoking, tobacco use and alcohol may have higher rates of life expectancy and lower rates of morbidity. In addition, religion is known to play a role among people who are so disposed in terms of coping with disease once one is afflicted with a chronic disease.

What are some good examples of descriptive epidemiology at work?

Epidemiologists have had many success stories, but I would like to just mention three that come to mind. For example, there is a known association between smoking and lung cancer, and the public policies that have come about as a result of this finding. Another one has to do with the identification of genetic factors that are related to breast cancer, and then finally the work surrounding the human papilloma virus and the development of a new vaccine to prevent human papilloma virus.

Disease Control

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: How do epidemiologists control disease?; To what extent is epidemiology focused on infectious disease? and more...

What's the best way to keep myself informed about the latest threats to my health?
Sometimes it's possible to answer a question like that by keeping up with the local media. There are very good reports in the media. For that reason, I ask my students to read the newspaper, keep track of media to find out what's happening. And then I would refer those people to the media to take a look and see what the latest reports are.

How do epidemiologists control disease?

Well, the methods that epidemiologists use to control disease tend to vary with the type of disease that they are looking at. For example, if we're speaking about specific infectious diseases, then the epidemiologist will try to look for the components of the cause of the disease: where did it occur, and what factors were associated with the disease. Then they will introduce controls at the point where the source of infection occurred. If we're speaking about a chronic disease, then the methods are somewhat different. For example, if the person is affected with cancer, or looking at cancer within the population, the epidemiologist would be interested in finding out which groups are at risk for cancer. For a specific form of cancer they will be looking at; what are the factors associated with the cancer, the form of cancer, and they will then try to make interventions in the person's lifestyle or in the society in order to bring these risk factors under control.

What are the 'Centers For Disease Control' or the 'CDC'?

Well the Centres for Disease Control and Prevention, known as the CDC, is the government agency that is responsible for monitoring outbreaks of infectious disease and also the occurrence of other types of diseases, not only infectious diseases. They compile statistics related to the occurrence of disease, provide press releases about diseases that are happening in the world and our important repository for people that would like to learn more about specific diseases, infectious or otherwise.

What is the 'World Health Organization' or 'WHO'?

The World Health Organization plays a key role in terms of describing the occurrence of disease at the international level, and it is one of our key organizations in helping to monitor the occurrence of infectious diseases and other types of diseases from the worldwide perspective. It also cooperates with individual governments; for example, the Centers for Disease Control in increasing the value of the information that it provides to the world.

What is the 'Epidemiologic Intelligence Service' or 'EIS'?

The Epidemiologic Service is a branch of the Centers for Disease Control. Members of the Epidemiologic Intelligence Service (EIS) are often sent to local areas. It could be within the United States ,if there's an unusual occurrence of infectious diseases to try to track down and control the problem, or they could even be sent to other countries. An example being Africa where there was an outbreak of Ebola virus several years ago.

To what extent is epidemiology focused on infectious disease?

Infectious disease has remained an important aspect of epidemiology and of epidemiologic investigations and will continue to do so into the foreseeable future. In many respects, infectious disease epidemiology forms one of the underpinnings of the discipline. However, other types of diseases such as the chronic diseases of long duration are now becoming an important subfield or discipline within epidemiology and illustrate the growing applications of growing epidemiology to diseases such as diabetes, obesity, tobacco use, and diseases associated with lifestyle.

To what extent does epidemiology focus on non-infectious diseases?

Epidemiology has a great role to play in non-infectious conditions, in many ways. Some of the important work, or much of the important work, that has been done in epidemiology nowadays relates to non-infectious diseases. I'm thinking particularly of molecular and genetic epidemiology and some of the techniques that it is using, although these are applied to infectious diseases as well as non-infectious conditions. The progress that has been made in curtailing the mortality rates from coronary heart disease, changes in morbidity and mortality from cancer, are examples of this.

Has the HIPAA privacy law affected epidemiological research?

The HIPAA law passed by the legislator in 1996 is an important law for epidemiological research since it includes a privacy rule to protect personal health information, even though the law has restricted access to patients' records to a certain extent. On the other hand, it has introduced some important safeguards needed to protect the rights of the individual regarding the release of their medical information. In this case, any information concerning ones health is released only after you get approval from that specific person, which is not so difficult. Often, organizations compile information known as Archival Datasets in which the specific identifying features of the patients have been deleted so that you cannot trace or track the individual and can proceed with your research.

Stopping An Epidemic Before It Starts

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: What's an example of a recent significant outbreak of a disease?; Who has the authority to intervene in a dangerous disease outbreak? and more...

What is 'surveillance epidemiology'?

Surveillance in epidemiology refers to a process of continuing observation of the population. It's used by government agencies, for example the Centres for Disease Control and Prevention in Atlanta, to monitor the occurrence of infectious diseases and other diseases in the population and to try to be on the outlook for unusual occurrence diseases.

What is the goal of surveillance epidemiology?

The goal of surveillance in epidemiology is to try to monitor the occurrence of unusual outbreaks of disease. Currently government agencies are using surveillance techniques to monitor for outbreaks of disease that might be caused by bioterrorism events, but also surveillance is used in general to measure unusual occurrences of infectious diseases.

What's an example of a recent significant outbreak of a disease?

One example of a significant outbreak of disease was the outbreak of E-coli that was associated with spinach. It at first began to appear in one or more states and spread to several other states in the United States. It caused fairly widespread illness of about 200 people, several deaths and it was eventually tracked to the Salinas Valley in California, to a lettuce grower in Salinas Valley. But the ultimate cause of the outbreak and source of the E-coli was never established definitively.

What does the term 'epidemiologic triangle' mean?

The term epidemiologic triangle refers to a model for the causation of disease and it involves three elements: the agent, host and environment.

What is the epidemic threshold for a disease?

The epidemic threshold refers to a statistical statement and it refers to the minimum number of cases that need to be observed in order to assert that an epidemic is taking place.

Who has the authority to intervene in a dangerous disease outbreak?

Intervening in a dangerous disease outbreak can occur at several levels. It is, primarily, a responsibility of government, and the first line of defense against it would be the local health officer at the county level, then at the state level. The health officer has certain powers to declare an emergency. And finally, at the government level with the Centers For Disease Control and Prevention.

Epidemiology And Disease Prevention

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: Which kinds of diseases do epidemiologists study?; What is epidemiological 'primary prevention' of disease?; What is epidemiological 'secondary prevention' of disease? and more...

Which kinds of diseases do epidemiologists study?

Epidemiology has a fairly broad scope in the types of problems that it investigates. The one that comes to mind first of all is infectious disease epidemiology. And in a sense infectious disease epidemiology forms one of the underpinnings of the history of epidemiology. However, the scope of epidemiology has grown considerably to include other types of problems. For example, many chronic diseases, I mention the example of; coronary heart disease, cancer, diabetes, and obesity. Many types of disorders, and mental disorders are within the scope of epidemiology. There's a field of epidemiology known as Psychiatric epidemiology. Occupational epidemiology certainly is an important field. Neuro epidemiology, to study about neurologically related diseases. The field of accident and injury epidemiology. There are many, many branches and applications; it is a diverse field.

What is epidemiological 'primary prevention' of disease?

Primary prevention is one of the most important aspects of public health. Primary prevention refers to eliminating the occurrence of disease before it ever happens in the first place. As one could imagine, primary prevention is one of the most effective forms of prevention. After the disease occurs, then other types of prevention are relevant. But, often, those forms of prevention are much more expensive and much more costly than primary prevention. Public health and epidemiology has made great strides in terms of its contributions to primary prevention.

What is epidemiological 'secondary prevention' of disease?

Secondary prevention of disease occurs during the pathogenesis of disease, early in the pathogenesis of disease, and it is a type of prevention, an example being screening for diseases, that is directed towards limiting the disease before it becomes more serious or develops into a more serious form. Screening for breast cancer, screening for many diseases, is a form of secondary prevention. The goal of secondary prevention is to refer individuals for further diagnostic workups and to arrest the condition, or try to clear the condition, before it progresses into a more serious form.

What is epidemiological 'tertiary prevention' of disease?

Tertiary prevention refers to rehabilitation of disease and occurs in the later phases of pathogenesis of disease. For example, when a person who is afflicted with a stroke undergoes rehabilitation to reintegrate them with society and help them perform activities of daily living or to return to work. This would be an example of tertiary prevention.

Epidemiological Improvement Of Public Health

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: How do epidemiologists discover the causes of disease?; What is a 'public health officer'? and more...

What are the most common practical applications of epidemiology?

The common practical applications of epidemiology include investigation of infectious diseases. These are done on a routine basis and are conducted by health departments to investigate common infectious diseases, particularly food borne illness, and food borne disease. Epidemiology comes into practice in the health care system, and in hospitals where nurse epidemiologists and other epidemiologists explore the causes and outbreaks of hospital borne infections. Then a third kind of trend is to do with the use of epidemiology to evaluate policies that are adopted and that our government set up; policies that relate to health, curtailment of smoking, to changes in our diet, to elimination of trans-fats and fatty foods from our diet, and the elimination of sugary snacks from schools, and so forth.

How is epidemiology used to create or change public health laws?

There are several ways in which epidemiology is used to inform public policy and to assist legislators and other officials in developing new policies that affect the health of a population. One of these is in the area of basic research in which the findings are applied to reduce morbidity and mortality from diseases. In other cases epidemiologists may act as expert witnesses and testify before government groups in order to provide their expertise, sometimes they may sit on government panels as a partner in the development of specific policies. An example would be in the development of laws to prevent medication errors. Sometimes epidemiologists are involved with the development of laws of that type and they have a specific perspective in terms of evaluating the evidence and decides which types of study might have been more relevant to the situation and bringing new factual information to verify the problem.

How do epidemiologists discover the causes of disease?

There are generally five criteria's accepted for the causality of any disease, and these five criteria were articulated in a famous surgeon general's report regarding whether or not smoking is a cause of lung cancer. For example, the five criteria include the strength of association, and let's look specifically at the association between smoking and lung cancer. The data suggested that the more people that smoked or the greater the number of cigarette smoke, then the greater the likelihood of developing lung cancer. This was an example of strength of association. Another criterion was time sequence: whether or not the occurrence of the exposure factor occurs before the development of the outcome, and in the case of smoking and lung cancer, this was demonstrated in the surgeon general's report. Consistency and repetition is a third criterion and this refers to the ability to

demonstrate the association in a number of different settings and in a number of different ways. Specificity, perhaps, is one of the weakest criteria. Of course, smoking and lung cancer, means that smoking causes lung cancer and only lung cancer. However, when we examine the evidence, we find that smoking is associated with other forms of cancer and other diseases as well as lung cancer, so the association tends to be less specific than would be ideal. And then, finally, the fifth criterion of association is called coherence of explanation, and really, this criterion means: does the association observed make scientific sense? I believe that the surgeon general's report argued that it did make sense; that if one is exposed to irritating substances found in cigarette smoking, that it is plausible that lung disease and other health effects could occur as a result of cigarette smoking.

What are the most common professions for epidemiologists?

There are many professions in which epidemiologists have an involvement. Of course, university professors are one of the most well known professions and in the job of a professor one does teaching, and is involved with basic research, and applied research. However, epidemiologists are employed in a broad cross section of organizations, for example, government organizations, research organizations that are devoted to research on public health problems. They work in what I would call the voluntary sector, such as voluntary health organizations. So they have many, many different occupational opportunities, and play a central role whenever we're talking about the health of the population.

What is a 'public health officer'?

A public health officer is usually a physician who is designated by the government authority to intervene and control the public health in a jurisdiction. In California, we have a county level public health officer. In some cities in California we also have a health officer. At the state level, there is also a public health officer, and then at the federal government level, there is the Surgeon General who is like a public health officer.

Epidemiological Study Of Disease

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: Why do epidemiologists use case-controlled studies?; What is an 'ecologic study'?; Why do epidemiologists use ecological studies? and more...

What is an 'observational study'?

Observational studies are the method of choice of epidemiology and, in many respects, one of the features that characterizes epidemiology. As one could imagine, it's not possible to cause specific diseases in the population, so the epidemiologist instead takes advantage of naturally occurring situations or observational situations in which to

observe the occurrence of disease. An example of that might be things that are done, such as public health methods, or interventions that are taken to control diseases in the population. For example, when fluoridation of water was applied to communities to evaluate the effects of water fluoridation. In a sense, this was kind of a naturally occurring situation that could be observed by epidemiologists. Another example has to do with the many public health interventions that we have to protect the safety of the public, such as the use of lap belts to prevent injury during automobile accidents, and lowering the speed limit, and so forth. These are all naturally occurring situations, or situations that were introduced by statute, and they have great implications for health of the population and could be studied from the epidemiologic point of view.

What do epidemiologists mean by the term 'natural experiments'?

Well, a natural experiment is one that takes advantage of a naturally occurring situation. One of the best examples of that is the work, or was the work, of John Snow during the 1800's. Snow was interested in trying to determine the cause of a major outbreak of cholera that was occurring in the Soho district in London during that time. And what he found out was that this particular region of Soho was served by two different water companies, and then he could try to show the correlation between the source of the water and contamination from the river Thames that supplied the water companies. It turned out the reason why it was a natural experiment, was that one of the companies changed the source of the water to a purer source from the Thames river, and then he was able to show that the people who had the purer source of water had lower amounts of cholera than those who had the existing source, or who maintained the same water source.

What is a 'cohort study'?

A cohort study is a specific study used in epidemiology that first identifies individuals on the basis of their exposure to a disease causing factor, such as exposure to a toxic chemical or other factor that may be implicated in a disease. It begins by taking a group of people who are free from the disease of interest. For example, the epidemiologist may hypothesize that exposure to a specific chemical may be related to a certain form of lung disease. It's important to then rule out or to eliminate all individuals who have any evidence that is being studied. The epidemiologist then follows the individuals over a period of time and observes new occurrences of the disease. It is called a cohort because a cohort of individuals refers to a group of individuals who are similar with respect to exposure to a certain disease causing factor.

Why do epidemiologists use cohort studies?

Some of the advantages of a cohort study, perhaps the most important one, is the fact that the cohort studies make it possible to directly assess risk of coming down with the condition or developing the condition if one is exposed to the factor. So they are among the most powerful studies designed with respect to studying the ideology of the disease. In addition cohort studies solve the problem of temporality. In other words we want to see the cart follow the horse rather than the reverse of that, the cart after the horse. So in a

cohort study we first have the appearance of exposure and then the development of the disease. Finally, cohort studies make it possible to study exposure that are rare to the population such as those that can occur on occupational groups, those who work with toxic chemicals or industrial groups and so forth.

What are the drawbacks of cohort studies?

Well, the drawbacks of cohort studies is that they often require large numbers of subjects in order to observe the outcome, and the occurrence of the outcome. They require long periods of time because of the latency period required for certain types of disease. And, by their very nature, because they take a long period of time, and require a large number of subjects; they are expensive to operate.

What is a 'case-control' study?

A case control study is a type of etiologic study that is epidemiology study, that involves the comparison of two groups. The first group is called the cases and the cases are a group of individuals who have a specific disease that we are interested in studying. The controls refer to a group of people who do not have the condition that we are investigating, but in many ways are similar to the case group. In a 'case-control' study, we use what is known as a retrospective approach. The retrospective approach means that we investigate the history of the individuals to find out whether or not they have had an exposure to a specific etiologic agent or factor that we would like to try to relate to the disease or outcome of interest.

Why do epidemiologists use case-controlled studies?

The reasons why epidemiologists use case-controlled studies is that they often provide a rapid answer to pressing problems. For example, when there is an outbreak of food-borne illness, it is not unusual to conduct a case-controlled study to quickly identify the agents, or suspected agents, that were involved in the outbreak. Case-controlled studies enable us to get a quick answer to pressing and mysterious problems that are occurring. Another advantage of case-controlled studies is that they are rapid. They are less expensive, and they also permit the study of diseases that are uncommon in the population, so we can identify people who have a rather unusual disease, include them in the case group, and then select controls that we will use in the case-control group for the case-controlled study.

What are the drawbacks of case-control studies?

There are some drawbacks to the case-control study. One of those stems from the use of the retrospective approach to analyze exposures or to try to identify exposures to a factor. We are never really certain at what time the exposure occurred. We are looking retrospectively into the exposure to the disease, but our information about exposure is more fallible, depending on the source of the information that we use to gather the

exposure. For example, if we ask the individuals in the study, the participants about their exposure some of them might have forgotten or been unaware of their past exposure.

What is an 'ecologic study'?

An ecologic study requires somewhat of a change of perspective to think about it. It is a study that analyzes the occurrence of disease or investigates the occurrence of disease among groups; where the groups are the unit of observation. In most of the studies that we consider, the individual is the unit of observation. In an ecologic study, the group may be the unit of of observation. For example, if we study the occurrence of help problems related to air pollution, our group might be the county. We could look at the occurrence at the county level of specific lung diseases, and then identify pollution levels at the county level, and try to show, demonstrate or assess the association between exposure and the outcome. Another example of a ecologic study would be if we compare different countries with respect to their dietary practices. For example, the amount of fat that they consume in their diets and the occurrence of breast cancer mortality. In this example, the unit of analysis would be the country.

Why do epidemiologists use ecological studies?

Ecological studies are also a way to gather information quickly in order to achieve answers rapidly. They are inexpensive to conduct, however the results that they give us are often unsatisfactory because we do not have precise information about exposure and disease outcome. Another difficulty with ecology studies is that they are prone to what is known as the ecologic fallacy. That is the inability to generalize information that we gathered at the group level to specific individuals.

What is a 'cross-sectional' study?

A cross-sectional study is a type of study that is referenced about a single point in time. In other words, information about the exposure factor, and the outcome variable, are collected at the same point in time. Now, this may seem as a somewhat puzzling statement, but it's used very commonly, and will become clear when I give an example. An example would be a survey that is conducted of the population. It is possible to conduct a survey in which information about exposure is collected, and information about disease outcomes are collected at the same time. This is an example of the cross-sectional approach.

Why do epidemiologists use cross-sectional studies?

Cross-sectional studies are used in epidemiology primarily for the purpose of developing interesting hypotheses and showing trends in the distribution of diseases in the population that can be followed up in other types of studies. A cross-sectional study is a type of descriptive epidemiologic study that can lead the way to additional analytic studies such as a case controlled study or a cohort study.

What is an 'occupational epidemiological study'?

An occupational epidemiologic study is one that applies the methods of epidemiology to specific occupational health problems. The world of work and occupations are filled with many questions of interest to epidemiology, particularly in the aetiology of chronic diseases such as cancer, and heart disease. Occupational epidemiology simply uses the full range of techniques that are available within epidemiology to study these types of problems

Why do epidemiologists use occupational studies?

Occupational health problems are a significant aspect of environmental health, and many occupations carry risks of specific diseases. For example, the construction industry has very high rates of mortality. Other types of industrial processes carry risks of morbidity and mortality. It is very important for our society to try to reduce morbidity and mortality from these occupational causes, and for this reason, epidemiologists are interested in focusing on these problems.

Epidemiology And Today's Deadliest Diseases

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: What is a 'pandemic'?; What are the top three causes of death in the US?; What's the most common form of cancer in the US? and more...

What is an 'epidemic'?
An "epidemic" refers to an unusual occurrence of disease in the population. In common thinking, we might consider an epidemic to be a dramatic occurrence of disease, with numerous cases that occur worldwide or in a population. However, this is not necessarily true. It depends specifically on the type of disease that we are talking about. In some cases, an epidemic can be represented by a single case of a disease that has been long absent from the population, an example being small pox, which has been eradicated from the world. Or an epidemic can be one or two cases of a disease that is uncommon, such as the plague. These diseases are potentially a great concern to public health authorities because they could spread rapidly in the population. In other cases, we are simply talking about an unusual or greater occurrence of a disease that exists normally. For example if we speak about an epidemic of influenza, then the centres for disease control maintains statistics that shows seasonal transitional distribution of influenza, and when we observe a major departure from what the normal expectancy is, then it can be said that an epidemic is occurring.

What is a 'pandemic'?

A pandemic refers to an epidemic that occurs on a worldwide scale. So there is concern, for example, about Avian Influenza as a condition that could produce a pandemic. Or, many forms of Influenza that could be occurring on a pandemic scale. It means that the disease has jumped its national boundaries wherever it occurs, and then has spread to many other countries and is affecting many countries at the same time. A really good example of this is the 1918 Influenza pandemic that affected not only the United States but the entire world, and was an important cause of mortality worldwide.

What are the top three causes of death in the US?

In the United States, the top three causes of death are coronary heart diseases, diseases of the heart, cancer and then cerebrovascular disease.

What's the most common form of cancer in the US?

In the United States, the most common form of cancer for both men and women is lung cancer. Among women, breast cancer was formerly a more common form of cancer, but apparently as women are smoking with greater frequency the rates of lung cancer are increasing among women.

Are the causes of death in the US different from the rest of the world?
In the United States, coronary heart disease is the leading cause of mortality. If we look at less developed areas of the world, infectious diseases are often the leading cause of mortality, although in some developing areas, coronary heart disease, cancer and other chronic diseases of this type are coming to the forefront. In many other developed parts of the world, cancer is the leading cause of mortality and not coronary heart disease.

Which country in the world has the highest life expectancy?

The country in the world that has the highest life expectancy is Andorra, which is a small country located near Spain. Another country that has a high life expectancy is Japan.

Where does the US rank in the world in terms of life expectancy?

In comparison to other developed countries the United States falls behind in terms of life expectancy. It is not among the top ten in the world and in fact is among the lower countries in the world. The life expectancy levels is close to that of Cuba; which is our neighbor nearby.

Which diseases are of the highest concern to epidemiologists today?

One of the conditions of concern to epidemiologists is the avian influenza. The concern is that the avian influenza could invade the human population and mutate into a form that can be spread from one person to another, and then be spread across the world as a pandemic. Fortunately, that hasn't happened yet, but it is something that epidemiologists

are concerned about. Another major condition of concern to epidemiologists is HIV AIDS. In the United States there has been control over HIV AIDS or a degree of control; however, it is becoming a major problem in some sub-groups of the United States population. And also, worldwide it is a problem of great significance. For example, in some of the countries of Africa, there is a very high morality rate due to HIV and AIDS, and epidemiologists are concerned about the impact that this will have on the population.

What is the 'influenza virus' or 'the flu'?

The term flu refers to influenza, and influenza is caused by a specific type of virus. The virus mutates every year so that's why it's necessary to have a new flu shot every year. The flu produces different symptoms, in many cases it depends on the type of variety that we're talking about, in most people it would produce fairly mild, self-limiting illness. However, in people who are vulnerable, who have reduced immune status, influenza can be a significant cause of mortality.

How do epidemiologists keep track of the flu?

Epidemiologists keep track of the flu through the national surveillance system that is used by the Centers for Disease Control and Prevention. They have collected over the years detailed information about seasonal trends. Flu is grouped with pneumonia and influenza mortality. They collect continuing statistics and then note whether or not the occurrence of mortality exceeds the expected levels during a particular time or season of the year.

Epidemiological Heroes And Landmark Studies

Robert Friis (Chair, Health Sciences Department, California State University, Long Beach ) gives expert video advice on: How did John Snow impact epidemiology?; How did John Graunt change epidemiology? and more...

What are the origins of epidemiology?

Well, the history of epidemiology is fairly venerable. For example, consider the writings of Hippocrates, and Hippocrates is interesting because he is one of the, among the first to try to show an association between an environmental factor and disease. For example, he pointed out that when people lived in certain areas near contaminated water or near lowlying areas, they're more likely to come down with health problems. The term "malaria" kind of harkens of the idea of "mal area", bad air. Later on in the history of epidemiology, there was important work done to look at vital statistics records. The investigator or the important historical figure John Graunt is called the Columbus of biostatistics and his important contributions were that he observed features of mortality that we observe today and also of births, for example, that more births are among males than among females. Later on then we have the work of John Snow who conducted his famous natural experiment on the association between water quality in London and Soho and the development of cholera. And then moving on from that, perhaps one of the more recent

historical breakthroughs was the work of Koch and Koch's postulates, whose work led to the identification of the micro bacterium tuberculosis and to the demonstration that a specific microbiologic agent was associated with the aetiology of tuberculosis. And then more recently, in the more recent history of epidemiology, we have of course the work that was done on showing an association between smoking and lung cancer. And then in addition, the famous Framingham study that developed some of the basic information that we have about coronary risk factors and coronary heart disease.

Who is John Snow?

John Snow is very significant to the history of epidemiology because of his work on the investigation of a cholera outbreak that occurred in Soho in London during the mid 1800's. Snow was an anaesthesiologist who took an interest in epidemiology and used what is known as the 'natural experiment methodology'. He was able to show that there was an association between the impure water and cholera. This finding, although it doesn't surprise us at present, was remarkable for his time.

How did John Snow impact epidemiology?

John Snow impacted epidemiology by devising the method that is known as a natural experiment. This method is used today in current epidemiologic research. For example, John Snow used a spot map to show the occurrence of disease and that technique is used in contemporary epidemiology. And he had many other innovations that he developed in his study of the London and Soho outbreak that are used today.

Who was John Graunt?

John Graunt is important to epidemiology because he is known as the father, the Columbus, of biostatistics. What he did was to examine vital statistics, date, births and deaths in London. And he was able to show certain regularities in the data, for example the excess of male births over female births that can be observed today in modern vital statistics records. He was among the first to do this and to make this particular contribution.

How did John Graunt change epidemiology?

John Grant impacted epidemiology by developing methods that are used in biostatistics today. He pioneered some of the methods for looking at the occurrence of disease in populations by examining vital statistics records. Many of the same methodologies that he devised during his time are relevant and in use today.

What is the 'British Doctors Study'?

The 'British Doctors Study' was a milestone in epidemiology, because it identified the association between cigarette smoking and lung cancer. It is always surprising when we hear about doctors who smoke, because they are supposed to safeguard our health. What

the investigators did, was to try to examine the occurrence of mortality from one cancer among physicians, and try to show linked association between the number of cigarettes smoked and mortality rates. In fact they were able to do this in the 'British Doctors Study'.

What is the 'Surveillance, Epidemiology, and End Results Program' or 'SEER Program'?
The SEER Program refers to a program of cancer registries within United States. SEER Program collects information for cancer registries which are databases for collecting information about the occurrence of cancer in local regions. The SEER Program then aggregates this information and develops reports on the overall incidence of various forms of cancer in United States.

What is the 'Health and Nutrition Examination Survey' or 'HANES'?

The "HANES" survey which stands for the Health and Nutrition Examination Survey, is a national survey mandated by the federal government to study the health characteristics of the population of the United States.

What is the 'Framingham Heart Study'?

The Framingham Heart Study is a community total community study, and it was begun in 1948. The purpose of the study was to examine the occurrence of diseases in a population, focusing on risk factors for coronary heart disease. The Framingham Heart Study produced many of the basic findings that are important today with respect to risks of coronary heart disease.