Principles of epidemiology

Principles of epidemiology
Topic 1: Overview of Epidemiology
Objectives:

Discuss historically significant epidemiological advances.
Evaluate the three types of prevention used in public health interventions.
Explore sources of epidemiologic information.
Select quantitative and qualitative data collection methods appropriate for a given public health context.

Study Materials

Gordis Epidemiology

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Smoking and Carcinoma of the Lung

The Training of Epidemiologists and Diversity in Epidemiology: Findings from the 2006 Congress of Epidemiology Survey Principles of epidemiology

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Principles of epidemiology

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Epidemiology the Backbone of Public Health

The Framingham Study: ITS 50-Year Legacy and Future Promise

Epidemiological Background and Design: The Framingham Study

Epidemiological Approaches to Heart Disease: The Framingham Study

Global Disease Detectives

Section 2: Historical Evolution of Epidemiology

CDC Current Outbreak List

Epidemic Intelligence Service

Morbidity and Mortality Weekly Report

Historical Review of Epidemiology

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt
James Lind
Edward Jenner
Ignaz Semmelweis
John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.
Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses.
Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for succes.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Topic 1 DQ 1

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.

Topic 1 DQ 2

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.

 
 
Topic 2: Disease Surveillance and Measurement

Objectives:

Evaluate the effectiveness of disease surveillance in public health.
Apply measurement tools to assess the impact of disease, its burden, and associated risk factors.
Discuss the importance of validity and reliability.
Evaluate the steps for investigating the occurrence of disease.

Study Materials

Gordis Epidemiology

Types of Surveillance

WHO Report on Global Surveillance of Epidemic-Prone Infectious Diseases – Introduction

CDC 24/7 Fact of the Week

Two by Two Tables

Goodness of Measurement: Reliability and Validity

Compendium of Acute Foodborne and Waterborne Diseases

How to Create an Epidemic Curve

Know How to Interpret an Epidemic Curve?

National Notifiable Diseases Surveillance System (NNDSS)

Public Health Surveillance and Data

Oswego Outbreak Case Study

Read the “Oswego Outbreak Investigation,” located in the Topic Materials.
Part 1
Complete the following:

Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.
Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission?
Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale.

Part 2
In a 500-750 word paper, evaluate the situation and present your findings. Including the following:

Does this case meet the definition of an “outbreak?” Why or why not?
Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.
Discuss the possible routes of transmission for the expected agent.
Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies.

General Requirements
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

PUB-540-RS-OswegoLineListingWorkbook
PUB-540-RS-Creating2x2ContingencyTable
PUB-540-RS-OswegoAttackRateTable

Oswego Outbreak Investigation
NOTE: The following resource was prepared for class use by replicating portions of the Centers for Disease Control and Prevention’s (CDC), “Oswego – An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide” (CDC, n.d.), except for the “Questions” section, with the understanding that the CDC document is in the public domain and available for educational use.
Background:
On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper held on the previous evening, April 18. Family members who did not attend the church supper did not become ill. Accordingly, Dr. Rubin focused the investigation on the supper. He completed interviews with 75 of the 80 persons known to have attended, collecting information about the occurrence and time of onset of symptoms, and foods consumed. Of the 75 persons interviewed, 46 persons reported gastrointestinal illness.
Clinical Description:
The onset of illness in all cases was acute, characterized chiefly by nausea, vomiting, diarrhea, and abdominal pain. None of the ill persons reported having an elevated temperature; all recovered within 24 to 30 hours. Approximately 20% of the ill persons visited physicians. No fecal specimens were obtained for bacteriologic examination.
Description of the Supper:
The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 p.m. and continued until 11:00 p.m. Food was spread out on a table and consumed over a period of several hours. Data regarding onset of illness and food eaten or water drunk by each of the 75 persons interviewed [are provided in the Excel “Oswego Line Listing Workbook” (CDC, n.d.)]. The approximate time of eating supper was collected for only about half the persons who had gastrointestinal illness.
Conclusion:
The following is quoted verbatim from the report prepared by Dr. Rubin:
The ice cream was prepared by the Petrie sisters as follows:
On the afternoon of April 17 raw milk from the Petrie farm at Lycoming was brought to boil over a water bath, sugar and eggs were then added and a little flour to add body to the mix. The chocolate and vanilla ice cream were prepared separately. Hershey’s chocolate was necessarily added to the chocolate mix. At 6 p.m. the two mixes were taken in covered containers to the church basement and allowed to stand overnight. They were presumably not touched by anyone during this period.
On the morning of April 18, Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix, and three ounces of vanilla and one can of condensed milk to the chocolate mix. Then the vanilla ice cream was transferred to a freezing can and placed in an electrical freezer for 20 minutes, after which the vanilla ice cream was removed from the freezer can and packed into another can which had been previously washed with boiling water. Then the chocolate mix was put into the freezer can which had been rinsed out with tap water and allowed to freeze for 20 minutes. At the conclusion of this both cans were covered and placed in large wooden receptacles which were packed with ice. As noted, the chocolate ice cream remained in the one freezer can.
All handlers of the ice cream were examined. No external lesions or upper respiratory infections were noted. Nose and throat cultures were taken from two individuals who prepared the ice cream.
Bacteriological examinations were made by the Division of Laboratories and Research, Albany, on both ice creams. Their report is as follows: “Large numbers of Staphylococcus aureus and albus were found in the specimen of vanilla ice cream. Only a few staphylococci were demonstrated in the chocolate ice cream.”
Report of the nose and throat cultures of the Petries who prepared the ice cream read as follows: “Staphylococcus aureus and hemolytic streptococci were isolated from nose culture and Staphylococcus albus from throat culture of Grace Petrie. Staphylococcus albus was isolated from the nose culture of Marian Petrie. The hemolytic streptococci were not of the type usually associated with infections in man.”
Discussion as to Source: The source of bacterial contamination of the vanilla ice cream is not clear. Whatever the method of the introduction of the staphylococci, it appears reasonable to assume it must have occurred between the evening of April 17 and the morning of April 18. No reason for contamination peculiar to the vanilla ice cream is known.
In dispensing the ice creams, the same scooper was used. It is therefore not unlikely to assume that some contamination to the chocolate ice cream occurred in this way. This would appear to be the most plausible explanation for the illness in the three individuals who did not eat the vanilla ice cream.
Control Measures: On May 19, all remaining ice cream was condemned. All other food at the church supper had been consumed.
Conclusions: An attack of gastroenteritis occurred following a church supper at Lycoming. The cause of the outbreak was contaminated vanilla ice cream. The method of contamination of ice cream is not clearly understood. Whether the positive Staphylococcus nose and throat cultures occurring in the Petrie family had anything to do with the contamination is a matter of conjecture.
Note: Patient #52 was a child who while watching the freezing procedure was given a dish of vanilla ice cream at 11:00 a.m. on April 18.
Addendum:
Certain laboratory techniques not available at the time of this investigation might prove very useful in the analysis of a similar epidemic today. These are phage typing, which can be done at CDC, and identification of staphylococcal enterotoxin in food by immunodiffusion or by enzyme-linked immunosorbent assay (ELISA), which is available through the Food and Drug Administration (FDA).
One would expect the phage types of staphylococci isolated from Grace Petrie’s nose and the vanilla ice cream and vomitus or stool samples from ill persons associated with the church supper to be identical had she been the source of contamination. Distinctly different phage types would mitigate against her as the source (although differences might be observed as a chance phenomenon of sampling error) and suggest the need for further investigation, such as cultures of others who might have been in contact with the ice cream in preparation or consideration of the possibility that contamination occurred from using a cow with mastitis and that the only milk boiled was that used to prepare chocolate ice cream. If the contaminated food had been heated sufficiently to destroy staphylococcal organisms but not toxin, analysis for toxin (with the addition of urea) would still permit detection of the cause of the epidemic. A Gram stain might also detect the presence of nonviable staphylococci in contaminated food.
Reference
Centers for Disease Control and Prevention. (n.d.). Oswego – An outbreak of gastrointestinal illness following a church supper: Student guide (Case No. 401-303). Retrieved from https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf
 
 

Topic 2 DQ 1

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?

Topic 2 DQ 2

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?

Topic 3: Causal Inference, Confounding, and Bias
Objectives:

Determine sources of bias within a study design.
Describe confounding relationships.
Evaluate the types of causal relationships associated with causation.
Assess measures of morbidity.

Study Materials

Gordis Epidemiology

Association or Causation: Evaluating Links Between Environment and Disease

Weak Associations in Epidemiology: Importance, Detection, and Interpretation

Causal Inference Based on Counterfactuals

Multicausality: Confounding

Sensitivity and Specificity – Explained in 3 Minutes

The Relationship Between Incidence and Prevalence

Creating a 2×2 Contingency Table

Measuring Morbidity: Prevalence and Incidence

Read the scenario below and complete the assignment as instructed.
Scenario
In Community X (population 20,000), an epidemiologist conducted a prevalence survey in January of 2012 and reported an HIV prevalence of 2.2%. Over the next 12 months, the department of health reported an additional 50 new HIV cases between February 2012 and January 2013. The total population stayed constant at 20,000.
Part 1

How many people had HIV in January 2012? Present or describe the formula you used to arrive at your answer.
Calculate the incidence rate assuming no HIV-related deaths over the 12-month period. Present or describe the formula you used to arrive at your answer. Be sure to clearly indicate the numerator and denominator used in your calculation and include an appropriate label for the rate.

In a summary of 200-250 words, interpret the results and discuss the relationship between incidence and prevalence. Discuss whether or not the epidemiologist should be concerned about these new HIV infections, assuming a previous incidence rate of 0.5 per 1,000 person-years prior to this updated risk assessment.
Part 2
A rapid test used for diagnosing HIV has a sensitivity of 99.1% and a specificity of 90%. Based on the population prevalence of 2.2% in 2012, create a 2×2 table showing the number of true positives, false positives, false negatives, and true negatives. Calculate the positive predicative value and negative predictive value for this test. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.
In 200-250 words, discuss whether or not the epidemiologist should recommend this test as part of a universal HIV screening program. Provide rationale for your recommendation applying the positive and negative predictive values. Present or describe the formula you used to arrive at your answer.
General Requirements
APA style is not required, but solid academic writing is expected.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.

PUB-540-RS-Creating2x2ContingencyTable (2)

Topic 3 DQ 1

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?

Topic 3 DQ 2

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.

Topic 4: Study Designs I
Objectives:

Compare and contrast randomized trials and cohort studies.
Differentiate between experimental and observational categories of study designs.

Study Materials

Gordis Epidemiology

Randomized Control Trials and Confounding

2020 LHI Topics

Multicausality: Confounding – Assignment

Multicausality: Confounding – Assignment Solutions

Understanding Controlled Trials: Why Are Randomized Controlled Trials Important?

Multicausality: Confounding Assignment

These estimates include the influence of other extraneous variables, such as confounders. Confounding is often considered a type of bias, but it is a real relationship that requires an adjustment in the study design or analysis. Understanding how to identify confounding is important as most associations have multiple causal factors. Recognizing if a study adjusted for the appropriate confounding variables is important to determine the validity of the association. To assist your proficiency with the concept of confounding, and how it ultimately affects public health, this practice assignment has been provided.
Complete Problems 1 to 4 from the “Multicausality: Confounding – Assignment” by Schoenbach, located in your Topic Materials. Check your answers against the solutions presented in the “Multicausality: Confounding – Assignment Solutions” Topic Material.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
You are not required to submit this assignment to LopesWrite.

Topic 4 DQ 1

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.

Topic 4 DQ 2

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?

 
 
Topic 5: Study Designs II

Objectives:

Compare and contrast case control and cross-sectional studies.
Evaluate the strengths and weaknesses of study designs used in epidemiological assessments.
Select methods to evaluate public health programs.

Study Materials

Gordis Epidemiology

Cohort and Case Control Studies

Introduction to Study Designs – Cross-Sectional Studies

Cross-Sectional Studies

Section 7: Analytic Epidemiology

Effectiveness of Studies Used in Epidemiology

A premise of epidemiology is that health outcomes are not random occurrences within a population, but are linked to particular risk factors and diseases. Epidemiologists utilize a range of study design methods to evaluate evidence-based associations to understand and improve health outcomes. Use the specific Excel worksheets, located in the “Excel Study Design Workbook,” to complete this assignment. Principles of epidemiology.
Part 1: Study Design Comparison
Using the “Study Design Comparison Worksheet,” compare and contrast the characteristics of the different types of study design types discussed in this course. You will be able to use this as a reference throughout the program.
Part 2: Article Comparison
Consider an area of interest that you want to explore as a potential topic for your Epidemiological Profile project. Search for two articles that fit any two of the four study designs (randomized trial, cohort, case-control, and cross-sectional) pertaining to the interest area you chose. Review the articles provided in the “Study Design Resource Document” to practice identifying articles for each study design. (Do not use the actual articles listed in the “Study Design Resource Document” for this assignment Principles of epidemiology.) Complete the “Article Comparison Worksheet” to compare the study design characteristics in each of your two articles. Include details of any gaps in the characteristics or identify if information is missing.
General Requirements
Upon completion of both worksheets, submit the “Excel Study Design Workbook.”
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
APA style is not required, but solid academic writing is expected.
You are not required to submit this assignment to LopesWrite Principles of epidemiology.

Study Design Resource Document
 
Case-Control Study Examples

Carton M, Barul C, Menvielle G, et al. (2017) Occupational exposure to solvents and risk of head and neck cancer in women: a population-based case-control study in France. http://bmjopen.bmj.com/content/7/1/e012833
Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB. (2005) Diabetes increases the risk of hepatocellular carcinoma in the United Sates: a population based case control study. https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC1774454/
Cramer DW, Vitonis VF, Terry KL, Welch WR, Titus LJ. (2016) The association between talc use and ovarian cancer: a retrospective case-control study in two US states. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/

 
Cross-Sectional Study Examples

Nilsen P, Holmqvist M, Nordqvist C, Bendsten P. (2007) Linking drinking to injury – a causal attribution of injury to alcohol intake among patients in a Swedish emergency room. http://www.tandfonline.com.lopes.idm.oclc.org/doi/abs/10.1080/17457300701374759
Johnson JV, Hall EM. (1988) Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC1349434/
Elliott AM, Luo N, Tembo, G, et al. (1990) Impact of HIV on tuberculosis in Zambia: a cross sectional study. http://search.proquest.com.lopes.idm.oclc.org/docview/1776431657?accountid=7374

PUB 540 – Article Comparison Worksheet

Topic of Interest:

Search Terms:

Article #1
Article #2

Author, Year, Title

Article importance

Study design type

How were participants selected or recruited?
Principles of epidemiology

How many participants? (state the number of cases and controls or exposes and unexposed)

If appropriate, how long was the average length of follow-up?

What sources of data were used to measure the exposure and outcome(s)?

How was the exposure  defined or measured?

How was the outcome defined or measured?

What was the primary measure of association or statistical method used? (relative risk, odds ratio, logistic regression, etc.)

How did the authors control for bias and confounding?

What were the strengths of the study?

What were the weaknesses of the study?

What were the primary findings and conclusions?
Principles of epidemiology

Topic 5 DQ 1

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 Principles of epidemiology.

Topic 5 DQ 2

Discuss the strengths and weaknesses of cross-sectional studies and examples of how they can be “descriptive” or “analytic” study designs Principles of epidemiology. 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.

 
Topic 6: Measures of Association and Application
Objectives:

Differentiate between association and causal relationships.
Determine the relative risk and odds ratio as measures of association.
Evaluate the utility of the population attributable risk.
Evaluate the types of causal relationships and associated guidelines for establishing causality.

Study Materials

Gordis Epidemiology

Causation in Epidemiology: Association and Causation

Section 5: Measures of Association

BRFSS Web Enabled Analysis Tool

Multicausality: Confounding

How to Calculate Relative Risk

How to Calculate an Odds Ratio

Calculating Odds Ratio

 Principles of epidemiology

Data can be qualitative or quantitative. Qualitative data is helpful to generate a hypothesis and gather information if little is known about an expected association. Focus groups, key informant interviews, and case studies are types of qualitative data collection methods used to identify common themes from which to build a hypothesis. Quantitative data collection and analysis is used to test a hypothesis and make comparisons to determine the direction and strength of a potential association. The Behavioral Risk Factor Surveillance System (BRFSS) is cross-sectional panel survey used to collect quantitative data on adult behaviors and risk factors. It is one of the largest U.S. health data collection efforts. The data can be used to analyze associations on a state or country level. Follow the steps to obtain a 2×2 contingency table (also known as a “cross tabulation”) crossing binge drinking with depression.

Retrieve the “BRFSS Web-Enabled Analysis Tool” resource provided in the Topic Materials.
Select “Cross Tabulation.”
Select “2015” for the year.
Select “Arizona” for the state.
Select “Alcohol Consumption: Binge drinkers (males having five or more drinks on one occasion, females having four or more drinks on one occasion)” for Step 2 Select Row.
Select “Chronic Health Conditions: Ever diagnosed with a depressive disorder, including depression, major depression, dysthymia, or minor depression” for Step 3 Select Column.
Skip Steps 4 and 5. Principles of epidemiology
Select “Sample Size” for Step 6 Select Statistics and run the report for the cross tabulation.

Part 1
Using the data from the cross tabulation results, calculate the odds ratio for depression among those exposed to binge drinking. Interpret the odds ratio and discuss if the odds ratio is a good estimate of the relative risk in this situation. Why or why not? Show your 2×2 table and all calculations. Present or describe the formula you used to arrive at your answer.
Part 2
Use the Topic Material, “BRFSS Web-Enabled Analysis Tool,” located on the CDC website, and run a report for two variables of interest to you. Create a 2×2 table and calculate the odds ratio for this association. Interpret the odds ratio and discuss the public health importance of the association. Show your 2×2 table. Present or describe the formula you used to arrive at your answer.
Refer to the “Creating a 2×2 Contingency Table” resource for guidance in creating 2×2 contingency tables.
General Requirements
APA style is not required, but solid academic writing is expected. Principles of epidemiology
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar wit