Teaching Epidemiology Teaching Epidemiology A guide for teachers in epidemiology, public health, and clinical medicine FOURTH EDITION Edited by Jørn Olsen Naomi Greene Rodolfo Saracci Dimitrios Trichopoulos 1 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2015 Te moral rights of the authors have been asserted First edition published (edited by Jørn Olsen and Dimitrios Trichopoulos) 1992 Reprinted 1993 Second edition published (edited by Jørn Olsen, Rodolfo Saracci, and Dimitrios Trichopoulos) 2001 Tird edition published (edited by Jørn Olsen, Rodolfo Saracci, and Dimitrios Trichopoulos) 2010 Fourth edition published (edited by Jørn Olsen, Naomi Greene, Rodolfo Saracci, and Dimitrios Trichopoulos) 2015 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2014953045 ISBN 978–0–19–968500–4 Printed in Great Britain by Clays Ltd, St Ives plc Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. Te authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. 9780199685004-Olsen.indb 4 11/03/15 5:48 PM Preface Teaching epidemiology requires teaching skills and knowledge. Te overriding requirement is knowledge of the subject matter. Te general advice is simple: if you are not an expert on a topic, you should enrich your background know- ledge before you start teaching. In this book we help you to locate the most important sources of information you need to study before you start. In addition, we provide expert teachers’ advice on how best to structure teaching—what has worked in their hands. You should not, however, expect that these guidelines will automatically work for you. You have to fnd your own personal style and use examples of relevance for your audience. It is, neverthe- less, always useful to make sure your teaching follows a predefned logical sequence. Te book will help you to set up this structure. Most experienced epidemiologists are able to write and present scientifc fndings by complying with the established rules for scientifc writing. Teaching is diferent because you also have to establish personal contact. Without per- sonal contact, teaching may well be replaced by reading or web-based courses. Personal contact requires that the teacher wants to teach and that the students are willing to learn, or at least to give it a try. Evaluation of your success as a teacher includes assessment of your knowledge and experience as well as how the teaching was received. Any serious evaluation takes both aspects into consideration. Epidemiology is an old discipline but its concepts and principles are evolving rapidly and, for that reason, a book like this needs frequent updating. Teachers have diferent ideas as to what the level of sophistication in methods should be and where to focus the attention of the students. We have not sought consensus when inviting the authors to contribute. Science is not driven by consensus but rather by diversity. We advise you to read and make your own judgements and develop your pre- ferred trajectory. But frst, see what older and more experienced colleagues have to ofer. Ten—but only then—you can throw it away. Tis book is a fourth edition of Teaching Epidemiology, frst published in 1992. Te content has changed substantially since the second version (2007). Te frst edition was published by Oxford University Press and the Commission of the European Communities. Later versions are published by Oxford Univer- sity Press in collaboration with the International Epidemiological Association vi PREFACE and the European Educational Programme in Epidemiology. Te second edi- tion of the book was awarded ‘Highly Commended in the Basis of Medicine Category’ at the 2002 BMA Medical Book Awards in London. We would like to thank all authors who agreed to share their experience and knowledge with their less experienced colleagues. Without their contributions there would not have been any book. We also thank Pernille Kümpel and Rikke Sinding for their important administrative support and technical skills. Jørn Olsen Naomi Greene Rodolfo Saracci Dimitrios Trichopoulos Acknowledgements Dimitrios Trichopoulos died 1 December 2014 at 75 years of age. We thank him for his valuable contribution to this book over the years and for his generosity as a teacher, scientist, and friend. Contents Contributors xi Part 1 Context 1 Introducing the history of epidemiology 3 Rodolfo Saracci 2 Important concepts in epidemiology 30 Olli S. Miettinen 3 Study design 37 Jørn Olsen and Olga Basso 4 Statistics in epidemiology 56 Per Kragh Andersen 5 Teaching a frst course in epidemiologic principles and methods 67 Kenneth J. Rothman and Sherri O. Stuver Part 2 Exposure-oriented epidemiology 6 Questionnaires in epidemiology 85 Jakob Bue Bjørner 7 Environment 98 Anders Ahlbom 8 Occupational epidemiology 105 Neil Pearce 9 Life course epidemiology 120 Yoav Ben-Shlomo and Diana Kuh 10 Pharmacoepidemiology 138 Susan Jick 11 Nutritional epidemiology 157 Walter C. Willett 12 Genetic epidemiology 177 Harry Campbell and Susan Service 13 Teaching molecular epidemiology 206 Betsy Foxman 14 Social inequalities in health 221 Nancy Krieger