University of Massachusetts at Boston
McCormack School of Policy Studies

Epidemiological Thinking and Population Health

PPol G 753
Syllabus

Instructor: Peter Taylor, Critical & Creative Thinking Program
Email: peter.taylor@umb.edu
Phone: 617-287-7636
Office: Wheatley 2nd flr 143-09 (across from Counseling & School Psych office)
Class meetings: xx
Contact hours: xx (in office or by phone, by signup at http://cct.wikispaces.com/PTOfficeHours by email, or by arrangement)
Course Website:http://www.faculty.umb.edu/pjt/753-xx.html
Course wiki: http://sicw.wikispaces.com/Epi
Discussion Leading SignUp Sheet: http://sicw.wikispaces.com/EpiSignUp
Class email list: Emails sent to epicourse@googlegroups.com will go to everyone in the course.

Course description

Introduction to the concepts, methods, and problems involved in analyzing the biological and social influences on behaviors and diseases and in translating such analyses into population health policy and practice. Special attention given to social inequalities, changes over the life course, and heterogeneous pathways. Case studies and course projects are shaped to accommodate students with interests in diverse fields related to health and public policy. Students are assumed to have a statistical background, but the course emphasizes epidemiological literacy with a view to collaborating thoughtfully with specialists, not technical expertise.

SECTIONS TO FOLLOW IN SYLLABUS:

TEXTS AND MATERIALS

Gordis, L. (1996, 2000, or 2004). Epidemiology. Philadelphia, Saunders/ Elsevier. (Old editions are OK as a primer for the course.)
Readings on a password-protected site.
On reserve: Kirkwood, B. R. and J. A. C. Sterne (2003). Essential Medical Statistics. Malden, Blackwell.
A guide on technical matters of writing scholarly papers, such as, Turabian, K. L. (1996). A Manual For Writers of Term papers, Theses, and Disertations. Chicago: University of Chicago Press (also in library's reference section).
A searchable compilation of syllabi from epidemiology courses bookmarked at http://www.diigo.com/user/epicourse.

OVERVIEW AND MECHANICS OF COURSE

The syllabus is organized around a sequence of basic ideas in thinking like epidemiologists, especially epidemiologists who pay attention to possible social influences on the development and unequal distribution of diseases and behaviors in populations. The topic for any given class will be introduced through a mini-lecture during the last part of the previous class. The class itself begins with one (or two) student(s) (co-)leading discussion on one to three common readings, which are chosen not only to illustrate the topic (and pick up on topics of previous classes) but also to identify controversies or problems around the topic. The other students will be responsible for bringing into the discussion the key ideas from one supplementary reading or from an article that connects the topic to their own area of interest. On the course wiki students post an annotation of the one of the common readings (when the student is leading the discussion) or the supplementary or additional reference.
The middle period of each class -- between the discussion and the mini-lecture -- takes the form of a workshop in which each student prepares a sketch of ways that the concepts, methods, and problems of that week might be applied to a research or policy question in their own area of interest. The workshop period allows for one-on-one interaction with instructor and peer input/support/coaching. It is expected that the definition of the research/policy question will not be clear at the start but will become focused as the course proceeds. The sketches are assembled into an evolving portfolio, which will also include weekly additions to glossary of terms from chapters of the Gordis text illustrated by examples from the student's field. Students are encouraged to prepare the sketches and glossary as a personal wiki that they revise as their understanding increases and as they respond to comments from other students in the course who view their pages when invited to. At the end of the course, students select highlights from their portfolio and intoduce them with an essay that explains the development of their thinking to an outside reader.
The course as a whole aims to cultivate skills and dispositions of critical thinking and of life-long, cooperative learning facilitated by the resources of the internet. The use of controversies follows an idea central to critical thinking that we understand ideas better by holding them in tension with alternatives.

ASSESSMENT & REQUIREMENTS

Notes on teaching/learning interactions (incl. rationale for Assessment Requirements).

Written assignments, 3/4 of course grade Participation and contribution to the class process, 1/4 of course grade Overall course grade. If you complete at least 30 of the written assignments and at least 15 participation items you get 80 points. (If you do fewer of either, you get 2 points for each written assignment & 1.25 for each participation item up to a maximum of 80.) The rubric below is used at the end of the course to add further points.
For each quality "fulfilled very well" you get 3 additional points. If you "did an OK job, but there was room for more development/attention," you get 1.5 points.
1. Written assignments submitted weekly (and revisions timely),
2. often revised thoroughly and with new thinking in response to comments,
3. showing progressive growth in ability to translate epidemiological thinking into your own area of interest, and resulting in
4. final portfolio with well-selected examples and a well-structured essay that explains your development during the semester and future plans.
5-7. Consistent work outside class connecting topics to your own interests, as evidenced in 8. Active, prepared participation and building class as learning community.

Minimum points for letter grades: A >= 95 points, A- 87.5, B+ 80, B 72.5, B- 65, C+ 57.5, and C 50.


ACCOMMODATIONS: Sections 504 and the Americans with Disabilities Act of 1990 offer guidelines for curriculum modifications and adaptations for students with documented disabilities. If applicable, students may obtain adaptation recommendations from the Ross Center (287-7430). The student must present these recommendations to each professor within a reasonable period, preferably by the end of the Drop/Add period.

Students are advised to retain a copy of this syllabus in their personal files.

This syllabus is subject to change, but workload expectations will not be increased after the semester starts.
Version 6 February '08

Acknowledgements: The assistance of Jan Coe and Louisa Holmes, the advice of Yoav Ben-Shlomo, and the hospitality of the Department of Social Medicine, University of Bristol have been helpful in the development of this syllabus.

SCHEDULE of CLASSES and PREPARATION

Recommended reading in advance of the course: see readings for Class 1 (below)
1a. The course as a learning community
Idea: Developing epidemiological literacy requires collaboration with others (of differing skills and interests) and reflection on personal and professional development.
  • Students identify personal, intellectual, professional interests in relation to central themes about inequality, pathways of development, and policy (worksheet, followed by spoken introductions).
    1b. Reading strategies, part 1
  • Taking note of popular reports, but scrutinizing the translation that happens from research to technical papers to popular reports.
    Case: MAOA Gene-Childhood Maltreatment-Adult anti-social behavior – precirculated) (instructions)
    Readings: Caspi 2002, Stokstad 2002, Radford 2002, Morris 2007
    Mini-lecture to set the scene for the topic of week 2. (ditto for subsequent weeks)

    2. Phenomena: Exploring the "natural history" of disease
    Idea: Detailed observation (like a naturalist) or detective work--albeit informed by theoretical ideas--may be needed before we can characterize what the phenomenon is we are studying, what questions we need to ask, and what categories we need for subsequent data collection and analysis.
    Common reading and cases: Brody 2000 (John Snow on cholera), Barker 1971 (buruli disease)
    Supplementary Reading: Barker 1998,pp1-12, 167-172, Barker 1999, Oxford 2005, PBS Video on 1918 flu epidemic
    Idea (behind glossary): Non-specialists need to become comfortable with the fundamental ideas and basic vocabulary of epidemiology in order to converse intelligently with specialists in epidemiology and biostatistics. One way to move in that direction is to practice making the ideas accessible to the layperson.
    Initial Workshop, which will cover glossary entries (instructions) and formulation of a useful project to pursue through the workshop sessions, as well as the translation of this week's concepts, methods, and problems into your own areas of interest.
    Also: Questions on syllabus and course mechanics, including coaching each other on use of wiki.
    (Workshop sessions will be held in future weeks even though not listed explicitly from this point on.)

    3. The scope and challenges of epidemiology
    Idea: The uses of epidemiology are many, but shift over time, and are subject to recurrent challenges from inside and outside the field.
    Idea: In advising on the most effective measures to be taken to improve the health of a population, epidemiologists may focus on different determinants of the disease than a doctor would when faced with sick or high-risk individuals.
    Common readings: Davey-Smith 2001 (uses of epidemiology), Rose 1985 (population health)
    Supplementary Reading: TBA (Susser, Schwartz, Pearce, Krieger)

    4. Categories
    Idea: Collecting and analyzing data requires categories: Have we omitted relevant categories or mixed different phenomena under one label? What basis do we have for subdividing a continuum into categories? How do we ensure correct diagnosis and assignment to categories? What meaning do we intend to give to data collected in our categories?
    Common readings and cases: Davey-Smith et al. 2000 (Comparative methods for studying socioeconomic position and health in different ethnic communities), Dohrenwend 1993 (or 1984 or 1990 TBA) (surveys vs. intensive interviews in Life events and difficulties research)
    Supplementary Reading: Hymowitz 2007, Birley and Goldberg 2000, Poland 2004.

    5. Associations, Predictions, Causes, and Interventions
    Idea: Relationships among associations, predictions, causes, and interventions run through all the cases and controversies in this course. The idea introduced in this session is that epidemiology has two faces: One from which the thinking about associations, predictions, causes, and interventions are allowed to cross-fertilize, and the other from which the distinctions among them are vigorously maintained, as in "Correlation is not causation!" The second face views Randomized Control Trial (RCTs) as the "gold-standard" for testing treatments in medicine. The first face recognizes that many hypotheses about treatment and other interventions emerge from observational studies and often such studies provide the only data we have to work with. What are the shortcomings of observational studies we need to pay attention to (e.g., systematic sampling errors leading to unmeasured confounders-see next class)?
    Common readings and cases: Ridker 2007 (Cardiac risk factors), Stampfer 1991, 2004 (Hormone replacement therapy)
    Supplementary Reading: Jick 2000, Alzheimer Research Forum 2004, Petitti 2004, Davey-Smith & Ebrahim 2007,pp2-8, Lawlor 2004

    6. Confounders & conditioning of analyses
    Idea: Statistical associations between any two variables generally vary depending on the values taken by other "confounding" variables. We need to take this dependency (or conditionality) into account when using our analyses to make predictions or hypothesize about causes, but how do we decide which variables are relevant and real confounders?
    Common readings and cases: Davey-Smith 1997 (Control at work and mortality), Davey-Smith & Ebrahim 2007 (Mendelian randomization to analyze environmental exposures)
    Supplementary Reading: Egede 2003, Prentice 2005, Petitti 2005, Huxley 2002, Davies 2006,

    7. Variations in health care (by place, race, class, gender)
    Idea: Inequalities in people's health and how they are treated are associated with place, race, class, gender, even after conditioning on other relevant variables.
    Common readings and cases: Krieger 2005 (Variation in mortality across communities), Alter 1999 (Access to cardiac procedures)
    Supplementary Reading: Egede 2003, Roger 2000, Davey-Smith 2000, Bassuk 2002

    Mid-semester self-assessment

    8. Heterogeneity within populations and subgroups
    Idea: How people respond to treatment may vary from one subgroup to another--When is this a matter of chance or of undetected additional variables? How do we delineate the boundaries between subgroups?
    Common readings and cases: Regan 2005 (Forms of breast cancer), Lagakos 2006 (Statistical concerns)
    Supplementary Reading: Eikelboom 2003, Gum 2003, Nelson 2005

    9. Placing individuals in a multileveled context
    Idea: Different or even contradictory associations can be detected at different levels of aggregation (e.g., individual, region, nation), but not all influences can be assigned to properties of the individual—Membership in a larger aggregation can influence outcomes even after conditioning on the attributes of the individuals.
    Common readings and cases: Freedman 2001 (Ecological and atomistic fallacies), Diez-Roux 2002a, b (Neighborhood effects), Marcelli 2006 (Obesity)
    Supplementary Reading: Coulton 1999, Korbin 2000, Marcelli 2005, Balfour 2002, Lawlor 2005

    10. Life course epidemiology
    Idea: How do we identify and disentangle the biological and social factors that build on each other over the life course from gestation through to old age?
    Common readings and cases: Ben-Shlomo 2002 (Life course development of disease), Brown 1978 (Life Events and Difficulties)
    Supplementary Reading: Barker 1998,pp43-80, Lynch 2005, Davey-Smith 2007, Berney 2000.

    11. Multivariable "structural" models of development
    Idea: Just as standard regression models allow prediction of a dependent variable on the basis of independent variables, structural models can allow a sequence of predictive steps from root ("exogeneous") through to highest-level variables. Although this kind of model seems to illuminate issues about factors that build up over the life course, there are strong criticisms of using such models to make claims about causes.
    Common readings and cases: Kendler 2002 (pathways to depression in women), Freedman 2005 (Structural models as causal models?)
    Supplementary Reading: Ou 2005

    12. Heritability, heterogeneity, and group differences
    Idea: As conventionally interpreted, heritability indicates the fraction of variation in a trait associated with "genetic differences." A high value indicates a strong genetic contribution to the trait and "makes the trait a potentially worthwhile candidate for molecular research" that might identify the specific genetic factors involved. I contest the conventional interpretation and contend that there is nothing reliable that anyone can do on the basis of estimates of heritability for human traits. While some have moved their focus to cases in which measurable genetic and environmental factors are involved, others see the need to bring genetics into the explanation of differences among the averages for groups, especially racial groups.
    Common readings and cases: Plomin 2006 (Heritability and environmental effects), Moffitt 2005 (Interaction of measured genes and measured environments)
    Supplementary Reading: Turkheimer 2000, Taylor 2007, Caspi 2002, Rutter 2002, Dickens 2001, Rushton 2005

    13. Genetic diagnosis, treatment, monitoring, and surveillance
    Idea: Genetic analysis has begun to identify genetic risk factors. We need to consider the social infrastructure needed to keep track of the genetic and environmental exposures with a view to useful epidemiological analysis and subsequent healthcare measures. Even in cases where the condition has a clear-cut link to a single changed gene and treatment is possible, there is complexity in sustaining that treatment.
    Common readings and cases: Khoury 2007 (Many genes as small risk factors), Paul 1998 (Complexities of social support after PKU diagnosis)
    Supplementary Reading: Bowcock 2007, Frank 2005

    14a. Popular epidemiology and health-based social movements
    Idea: The traditional subjects of epidemiology become agents when: a. they draw attention of trained epidemiologists to fine scale patterns of disease in that community and otherwise contribute to initiation and completion of studies; b. their resilience and reorganization of their lives and communities in response to social changes displaces or complements researchers' traditional emphasis on exposures impinging on subjects; and c. when their responses to health risks displays rationalities not taken into account by epidemiologists, health educators, and policy makers.
    Common readings and cases: Brown 1992 (Popular epidemiology), Davison 1991 (Lay epidemiology)
    Supplementary Reading: Brown 2006, Epstein 1995; Schienke 2001, Lawlor 2003, Black 2001

    14b. Taking Stock of Course: Where have we come and what do we need to learn to go further?
    Idea: In order to move ahead and continue developing, it is important to take stock of what went well and what needs further work.
  • Comparison of initial plans and current position. Revision of plans for personal and professional development.
  • Instructor's and formal course evaluations.

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