Epidemiology

Epidemiology seeks to describe and to understand patterns of disease occurrence in human populations. This book is an expanded introduction to the concepts and tools of epidemiologic research. The book offers clear descriptions of key concepts and is rich with examples illustrating how these concepts are applied. Some examples are drawn from classic studies in the field—the work of Snow, Semmelweis, Goldberger, Doll and Hill, and others—while many other examples concern modern-day epidemiologic studies on problems of current public health importance. Most chapters include exercises (with answers provided) to help readers gain practice in applying new ideas and techniques. The book's chapters are organized around three main themes: general concepts and tools of epidemiology; major specific study designs; and special topics, including screening, outbreak investigation, and evaluating policies and programs.

There is a large body of scientific evidence—much of this coming from epidemiologic studies—clearly documenting the benefits of physical activity for better health and increased longevity. Physical activity has been described as a “magic bullet” for health, and a “best buy” for public health. While early studies contented themselves with understanding whether physical activity can reduce the risk of particular diseases, contemporary studies also seek further details and nuances that inform public health recommendations, including details on the amount, kinds, duration, and frequency of physical activity needed. This book provides information regarding epidemiologic methods used in studies of physical activity, and is divided into four sections. The first section provides a personal, historical accounting of early research in the field. The second section covers methodologic issues in epidemiologic studies of physical activity and health (including issues in physical activity measurement; assessing dose-response relationships; the role of genetics; design, conduct, and analysis of data from cohort studies; and surveillance of physical activity and inactivity). The third section provides data on the relations between physical activity and several major health outcomes, while illustrating the methodologic issues described in section two. The last section focuses on physical activity promotion, describing the evolution of physical activity recommendations over time and discussing methodological issues in designing and evaluating interventions to increase physical activity at a population level.

This book details the various ways in which epidemiologic methods can improve food safety. Starting with a history and background of food-borne illness, the book continues by describing the means of investigating an outbreak and measuring exposure, and concludes by looking at the regulatory context in the United States.

Life course epidemiology is developing rapidly in the context of new knowledge about the biology of development and ageing and gene-environment interplay. This book is concerned with design, measurement, and analysis of life course data. Study design chapters are concerned with models of the life course development of risk, the effect of individual differences, the study of genetic effects, and intervention in life course designs. Analysis chapters deal with time-varying exposure, missingness, analysis of multivariate outcomes, estimation of causality, structural equation modelling, and trajectory analysis. The intention is to provide a guide to the evaluation of interacting developmental, environmental, and genetic effects in studies of the processes and origins of risk, resilience, and ageing.

Epidemiology is often referred to as the science of public health. However, unlike other major sciences, its theoretical foundations are rarely articulated. While the idea of epidemiologic theory may seem dry and arcane, it is at its core about explaining the people's health. It is about life and death. It is about biology and society. It is about ecology and the economy. It is about how myriad aspects of people's lives—involving work, dignity, desire, love, play, conflict, discrimination, and injustice—become literally incorporated into our bodies and manifest in our health status, individually and collectively. And it is about essential knowledge critical for improving the people's health and minimizing inequitable burdens of disease, disability, and death. Tracing the history and contours of epidemiologic from ancient societies on through the development of—and debates within—contemporary epidemiology worldwide, this book shows how epidemiologic theory has long shaped epidemiologic practice, knowledge, and the politics of public health. Outlining an ecosocial theory of disease distribution that situates both population health and epidemiologic theory in societal and ecologic context, it offers a more holistic picture of how we embody the human experience.

This book provides an historical overview of epidemiology and its evolution. This book includes a section of conceptual chapters, including chapters on the relation of concepts to causes, the concept of environment, and numeracy in epidemiology. It then discusses history more specifically, with chapters on the French Enlightenment, the British Sanitary Movement, bacteriology, and germ theory. It concludes with a section on epidemiology as it emerged into an academic discipline, after World War II, and discusses future directions for the field.

In the ten years since the first edition of this book was published, there have been many important ethical developments in epidemiology and related fields in public health and medicine. These developments include implementation of the HIPAA privacy rules, the completion of the American College of Epidemiology (ACE) ethics guidelines and ACE policy statements on sharing data from epidemiologic studies, and the drafting of a public health code of ethics. This revised edition of the text includes selected chapters from the first edition, which have been updated and revised, along with several new chapters on issues concerning the ethics of public health practice, international health research, and genetic epidemiology. The chapters are organized topically and divided into four parts. The first part is titled “Foundations” because the chapters introduce basic and recurring concepts and principles. The subsequent parts deal with “Informed Consent, Privacy, and Confidentiality,” “Balancing Risks and Benefits,” and the “Regulatory Context and Professional Education.” The latter subject includes discussion of the institutional review board (IRB) system and issues surrounding scientific misconduct in epidemiologic research. The objective of this work foster greater awareness of situations that require moral reflection, judgment, or decision, while pointing to ways in which justified moral conclusions can be reached.

Most of the industrialized world now comprises of multi-ethnic societies, with people from widely varying ancestry, cultures, languages, and beliefs. With globalization of trade, increasing international travel, and migration, the whole world is destined to become multi-ethnic within the next twenty or thirty years. This poses huge challenges for doctors, nurses, public health practitioners, health care managers, and policy makers who have to meet legal and policy obligations to deliver health outcomes, and provide health care of equal quality and effectiveness. To achieve this, they need a solid understanding of the underlying concepts of race and ethnicity, and how these are applied to achieve better health for ethnic minority populations. They also need to have an awareness of the misuses of these concepts, particularly taking into account the history of racism that permeates many societies to this day. This book provides an introduction to these complex issues. The key concepts of race and ethnicity are explained in this book, including their uses and misuses. The strengths and weaknesses of these concepts in terms of epidemiology, policy making, health service planning, research, health care, and health promotion are illustrated. The book emphasises theory, ideas, and principles, and its aims are to help counteract the unethical and atheoretical methods often used to study ethnicity. Practical application of the theory is demonstrated through the use of examples. The conceptual frameworks of ethnicity and race required by practitioners and researchers are slightly different, including the nature of research questions, the relative value of various methods of classification, and the approach to data analysis, presentation, and interpretation, and these differences are made explicit.

Health promotion is a relatively new discipline and there is little in the way of practical help choosing and implementing appropriate evaluation methods. As the demands for rigorous evaluation and evidence-based decision-making increase, health promotion cannot ignore the need for accurate, reliable, and valid methods to carry out evaluation. This book provides descriptions (with plentiful practical examples) of such methods, and the problems that can arise from their implementation. The book sets the concepts of health promotion and evaluation in their historical context and highlights key issues in the evaluation of health promotion interventions. Both qualitative and quantitative methods that are commonly used are described and the problems and benefits that arise with their use are explained. Experiences in the practical implementation of evaluation are explained, with examples from a variety of different social, economic, and cultural contexts. In this edition new examples including evaluating social marketing and the difficulties of evaluating “hidden” problems such as intimate partner violence are explored.

This book aims to show the value of developing and applying an evidence base to public health. The application of evidence to clinical practice is well established, and the field of evidence-based medicine accepted as a basic clinical science, not so for public health. The book examines the methods used for Evidence Based Medicine, and shows how these can be applied to public health. In the process, a number of new measures are necessary to extend clinical measures to the population. Population impact measures are described and their value in public health policy-making described and discussed. The book identifies evidence for population health as an appropriate field of study. The chapters are divided in three sections to follow the structure of the Population Health Evidence Cycle: Ask the question, Collect the evidence, and Understand and use the evidence.