SEPTEMBER 2003 - MAY 2004
Thursdays 8:30-10:00am

JOURNAL CLUB

ASSEMBLING A SOCIAL EPIDEMIOLOGY TOOL KIT: DECONSTRUCTION OF THE ROLE OF SOCIAL TIES IN HEALTH AND ILLNESS

Carolyn Cannuscio, ScD
This two-part workshop will compare two modern and very different epidemics: cardiovascular disease and SARS, in order to examine the potentially beneficial and deleterious health effects of social ties. After reviewing reports from the scientific literature and lay press, the group will examine the following questions:

How strong is the evidence for a link between social ties and health benefits/risks?

Is there a causal relationship between social ties and health/illness?

What are the implications for social policy if close social ties can both prevent and cause disease?

The workshops will emphasize the central epidemiological principles of bias and confounding. Participants will be encouraged to engage and develop their skepticism regarding epidemiologic data-a crucial ingredient in the conduct and interpretation of even the best-designed epidemiologic studies.

Suggested readings:
Stansfeld SA. (1999) "Social Supports and Social Cohesion" Social Determinants of Health. (ed. M Marmot and RG Wilkinson), pp. 155-178. Oxford University Press, Oxford, UK.
Selected readings from coverage of the SARS epidemic in the New York Times and the Wall Street Journal.
Taubes G. "Epidemiology faces its limits." Science. 1995;269:164-169.

CAUSALITY AND INTERDISCIPLINARY PERSPECTIVE POPULATION APPROACHES TO HEALTH
Robby Aronowitz, MD
Sam Preston, PhD
This session will use historical analyses of the "epidemiologic transition" to explore the strengths and limitations of different models and styles of explaining change in population health. Among the most important themes will be multiple levels of explanation; contextual factors that influence models of causality (and their uses) and how health and disease are named and classified. Seminar participants should keep the following questions in mind as they prepare for the seminar:

What was the epidemiological transition? Why is its definition and explanation still important to us today?
Analysts have differed in the content, style and emphasis given to different putative explanations of dramatic changes in population health. How do different authors evaluate the role of science, technology, public health, and individual behavior change?

Suggested readings:
Thomas McKeown, "Dream, Mirage or Nemesis." Role of Medicine: dream, mirage, or nemesis? (Nuffield Provincial Trust, 1976). (selected chapters)Christopher Hamlin. "Could you starve to death in England in 1839? The Chadwick-Farr controversy and the loss of "social" in public health." American Journal of Public Health, 1995.Nancy Tomes, "The Private Side of Public Health: Sanitary Science, Domestic Hygiene, and the Germ Theory, 1970-1900." J.Leavitt and R. Numbers, eds., Sickness and Health in America (Wisconsin, 1997).

CAUSALITY AND POPULATION HEALTH
Jere Behrman, PhD
This seminar will explore how to make inferences about causal relations in population and health based on some studies using experimental design and others using behavioral/observational data.

Suggested readings:
I. Articles from the New York Times:Hormone Studies: What Went Wrong? April 22, 2003, by GINA KOLATA
What Some Much-Noted Data Really Showed About Vouchers, May 7, 2003, by MICHAEL WINERIP
II. Examples of studies that attempt to draw causal inferences from various types of data
Behrman, Jere R., Yingmei Cheng and Petra Todd, 2002, "Evaluating Preschool Programs when Length of Exposure to the Program Varies: A Nonparametric Approach," Philadelphia, PA. University of Pennsylvania, mimeo.
Behrman, Jere R. and Mark R. Rosenzweig, 2002,"Does Increasing Women's Schooling Raise the Schooling of the Next Generation?", American Economic Review 92:1(March 2002), 323-334.
Behrman, Jere R., Piyali Sengupta and Petra Todd, "Progressing through PROGRESA: An Impact Assessment of Mexico's School Subsidy Experiment," Philadelphia, PA: University of Pennsylvania,, processed, 2002.

THE ROLE OF COMMUNITY CHARACTERISTICS ON THE DEMAND FOR CARE AND HEALTH INSURANCE
Mark Pauly, PhD
This seminar will explore correlations between income distribution and health insurance coverage. Specifically, it will focus on why one is much more likely to be insured if he/she is a lower middle income person in a community where most people are insured than if he/she is in one where most people are not. This question will then will generalized: to what extent is the insurance people are likely to have, or the amount and type of care they use, dependent on the characteristics of others in the community? Hypotheses to explain relationships sometimes rely on the notion of "norms": physicians tend to treat all patients similarly as norms of care evolve; and consumers tend to be affected by what they observe others doing. The economic concept of "product differentiation" will also be explored as a possible explanation.

Suggested readings:
IOM report (March 6, 2003) "A Shared Destiny: Community Effects of Uninsurance."

GIS: OVERVIEW AND APPLICATIONS TO POPULATION HEALTH
PART 1 & 2.
Dennis Culhane, PhD
This two-part seminar will provide an overview of cartographic modeling techniques and their application to urban health related topics.

Session 1: Integrating Context into Health Research
(1) Why does context matter in health? What are the different theories/conceptualizations that link context to health outcomes? (stress, exposure, infection, broken windows, discrimination)
(2) What data can be used to capture context? Census, municipal data, foot & windshield surveys (systematic social observation). Issues of reliability and validity. Building indexes or factors/factor analysis.
(3) How can/should context/neighborhood be defined? Census geography (blocks, blockgroups, census tracts), administrative units (health districts, zipcodes), political geography (wards, council districts, congressional districts), raster cells; Modifiable Area Unit Problem (MAUP)
(4) What statistical methods can/should be used to model neighborhood effects? Multi-level models, logistic regression, Hierarchical Linear Models, random & fixed effects, PRIM/neural networks, spatial autocorrelation?

Examples from CML/UPenn projects (McDermott/McMackins/Fantuzzo; pre-term birth, HIV risk proposal; nutrition; gun violence)

Suggested readings:
(1) Cohen, Deborah A., Scribner, Richard A., and Farley, Thomas. (2000). "A Structural model of health behavior: A Pragmatic approach to explain and influence health behaviors at the population level," Preventive Medicine 30: 146-154.
(1) Macintyre, Sally, Ellaway, Anne, and Cummins, Steven. (2002). "Place Effects on health: how can we conceptualize, operationalise and measure them?" Social Science & Medicine 55: 125-139.
(3) Wong, David. (1996). "Aggregation Effects in Geo-referenced Data," in Sandra L. Arlinghaus, editor, Practical Handbook of Spatial Statistics, CRC Press, Inc., 83-106.

Session 2: Exploratory Spatial Data Analysis
What is spatial analysis? Approach to research that makes spatial relationships prominent.
What are the different types of spatial data?
" Raster vs. vector
" Points (events/locations)
" Lines (paths, streets, networks)
" Polygons (areas)
" Surfaces (raster/geostatistical/lattice)

What methods are appropriate for each type of data?
" Points: "hot spot" analysis/Ripley's K function
" Polygons: Spatial autoregression and spatial lag models, spatial poisson regression, geographically weighted regression
" Surfaces: map algebra, kernel densities, inverse distance-weighting/Kriging

What software is needed? What can GIS do? When do you need statistical analysis?
" ArcGIS
" SAS mapping
" Spatial Analyst extension
" Geostatistical Analyst extension
" CrimeStat extension
" Spacestate extension
" Matlab with Lesage/Smith programs
" S-Plus with SpatialStat Extension

Suggested readings:
Bailey, Trevor C. and Gatrell, Anthony. (1995). Interactive Spatial Data Analysis, Essex, England: Longman Scientific & Technical.
Chapter 1, "Spatial data analysis," pp. 1-39
Chapter 3, "Introductory methods for point patterns," pp. 75-109
Chapter 5, " Introductory methods for spatially continuous data," pp. 143-201

HISTORICAL DEMOGRAPHY PERSPECTIVE ON POPULATION HEALTH
Gretchen Condran, PhD
This session will provide an overview of the demographers' perspective on population health. Use of the Philadelphia mortality data set and the use of Philadelphia municipal services will be explored as an example of applying historical demography and social epidemiology methods to the study of population health.

Suggested readings:
Gretchen Condran, Henry Williams, and Rose Cheney. "The decline in morality in Philadelphia from 1870 to 1930 : the role of Municipal Services." J. Leavitt and R. Numbers, eds., Sickness and Health in America (Wisconsin, 1997).

PUBLIC HEALTH COMMUNICATION & ALTERNATIVE MODELS OF BEHAVIOR CHANGE
Robert Hornik, PhD
The session will provide overviews of two related areas: theories of health behavior change and the role of deliberate public health communication interventions in influencing health behavior; the discussion will include case study presentations from a variety of programs including anti -smoking and anti-drug use interventions and developing country child survival programs among other projects.

Suggested readings:
Robert Hornik "Public Health Communication: Making Sense of Contradictory Evidence" in Public Health
Communication: Evidence for Behavior Change (ed.) Mahwah, NJ: Lawrence Erlbaum, 2002.
Robert Hornik "Alternative Models of Behavior Change" in J. Wasserheit, K. Holmes & S. Aral (eds.) Research
Issues in Human Behavior and Sexually Transmitted Disease in the AIDS Era. Washington: American Society for
Microbiology, 1991.

ASSEMBLING A SOCIAL EPIDEMIOLOGY TOOL KIT Part II: DECONSTRUCTION OF THE ROLE OF SOCIAL TIES IN
HEALTH AND ILLNESS
Carolyn Cannuscio, ScD
This two-part workshop will compare two modern and very different epidemics: cardiovascular disease and SARS, in order to examine the potentially beneficial and deleterious health effects of social ties. After reviewing reports from the scientific literature and lay press, the group will examine the following questions:

How strong is the evidence for a link between social ties and health benefits/risks?

Is there a causal relationship between social ties and health/illness?

What are the implications for social policy if close social ties can both prevent and cause disease?

The workshops will emphasize the central epidemiological principles of bias and confounding. Participants will be encouraged to engage and develop their skepticism regarding epidemiologic data-a crucial ingredient in the conduct and interpretation of even the best-designed epidemiologic studies.

Suggested readings:
Background: Stansfeld SA. (1999) "Social Supports and Social Cohesion" Social Determinants of Health. (ed. M Marmot and RG Wilkinson), pp. 155-178. Oxford University Press, Oxford, UK.
Selected readings from coverage of the SARS epidemic in the New York Times and the Wall Street Journal.
Taubes G. "Epidemiology faces its limits." Science. 1995;269:164-169.
CONSUMERS DECISION-MAKING PROCESSES FOR
MEDICAL DECISIONS
Barbara Kahn, PhD

In this seminar Scholars will explore what population health investigators might need to know about marketing, and patients decision making based on a case in mammography.

Suggested readings:
Luce, M. F. and B. E. Kahn, "Avoidance or Vigilance: The Psychology of False Positive Test Results," Journal of Consumer Research (1999) Dec, Vol. 26, Iss. 3. 242-260.
Kahn, B. E. and Luce, M. F., "Understanding High Stakes Consumer Decisions: The Problem of Mammography Adherence Following False Alarm Test Results," Marketing Science. (forthcoming)
Miller, E. G., Luce, M. F., Kahn, B. E., and Conant, E., "The Emotional Costs of Mammography Efficacy," Journal of Applied Social Psychology. (this manuscript is on my website http://www.wharton.upenn.edu/faculty/kahn.html)

JOURNAL CLUB

TURNING RESEARCH INTO ACTION
Flaura Winston, MD, PhD

THE CULTURE AND PRACTICE OF SAFETY
Charles Bosk, PhD
This seminar will concentrate on what makes safe systems and what contributions such systems can make to population health. The focus would be on theories of safety, strategies for adopting safer practices, resistances to those strategies etc.

SCHOLARS RESEARCH IN PROGRESS

CLINICAL RESEARCH METHODS
Brian Strom, MD, PhD
This seminar will give an overview of clinical research methods and available research design, and will focus on current population-based case-control studies of cancer

Suggested readings:
Strom Brian, L. Pharmacoepidemiology, 2000, 3rd Edition, John Wiley and Sons, Ltd
Chapter 1, "What is Pharmacoepidemilogy?" pp. 3-15
Chapter 2, "Study Designs Available for Pharmacoepidemilogy Studies," pp. 17-29

POPULATION HEALTH APPROACHES TO OBESITY
Shiriki Kumanyika, PhD
The already high and still increasing prevalence of obesity in U.S. children, adolescents, and adults poses a major threat to our society. This epidemic, although enabled by innate predispositions to gain weight, is driven by a plethora of obesity-promoting forces in the social structural and environmental contexts for individual eating and physical activity behaviors. This seminar will address the importance, for effective long-term obesity prevention and control, of developing intersectoral policy and environmental initiatives. Ways in which interdisciplinary population health scientists can gain leverage within the various non-health sectors that are involved, e.g., transportation, education, urban planning, and commerce, will be discussed. Factors responsible for "the epidemic within the epidemic" -disproportionately high rates of obesity in several ethnic minority populations, will be considered.

The challenges posed by the obesity epidemic within the United States must be analyzed in global perspective. The obesity epidemic affects both industrialized and developing nations worldwide with major implications for the global food supply, global food marketing, and those with vested interests in the current food and restaurant industries. The seminar discussion will include comparisons and contrasts with other large scale public health initiatives such as tobacco cessation.

Suggested readings:
Chopra M, Galbraith S, Darnton-Hill I. "A global response to a global problem: the epidemic of overnutrition." Bull World Health Organ 2002;80(12):952-8
Economos C.D., Brownson R.C., DeAngelis M.A., Novelli P., Foerster S.B., Foreman C.T., Gregson J, Kumanyika S.K., Pate R.R., "What lessons have been learned from other attempts to guide social change?" Nutr Rev. 2001 Mar;59(3 Pt 2):S40-56; discussion S57-65.
Streets J., Levy C., Erskine A., Hudson J. "Absolute risk of obesity. Food and drink companies not so defensive?" Global Equity Research. UBS Warburg's Q-Series. 27 November 2002.

ISSUES IN GENETIC EPIDEMIOLOGY
Tim Rebbeck, PhD
The overall goal of this seminar is to provide scholars with an understanding of the tools used by molecular and genetic epidemiologists, and the integration of genetic data into traditional epidemiologic study designs. There is an increasing need for epidemiologists and biostatisticians to understand the genetic basis of disease, and incorporate the collection and analysis of genetic information into studies of disease etiology. The specific objectives of the lecture are to provide Scholars with an understanding of: 1) basic genetics as they are applied to epidemiological studies 2) the research tools used by molecular and genetic epidemiologists, and 3) the integration of genetic data into traditional epidemiologic study designs.

INDIVIDUAL VS. POPULATION DECISION MAKING
David Asch, MD, MBA
In this session we will discuss methodological and ideological tensions between the development and assessment of health programs aimed at individuals and aimed at populations.

Suggested readings:
Rose, G., "Sick individuals and sick populations." International Journal of Epidemiology. 1985;14:32-38
Asch D.A., Hershey J.C., "Why some health policies don't make sense at the bedside." Annals of Internal Medicine. 1995; 122:846-50.
Asch D.A., "From boardroom to bedside: bioethical implications of policy research for clinical practice." Journal of Investigative Medicine. 1999;47:273-7.
Diamond GA, Denton TA. "Alternative perspectives on the biased foundations of medical technology assessment." Annals of Internal Medicine 1993;118:455.

GENETIC INFLUENCES ON SMOKING BEHAVIOR: FROM BIOLOGY TO SOCIETY
Caryn Lerman, PhD
Abundant data from animal studies and human twin studies have established that smoking behavior is, in part, heritable. With advances in molecular genetics, recent studies have sought to identify specific genes associated with different smoking phenotypes. Initial studies have found associations of smoking behavior with genes involved in the catecholamine pathways, supporting a more general genetic susceptibility to addictive behavior. Other studies have provided evidence relating smoking behavior to genes in pathways that are more specific to nicotine, such as nicotine metabolism and receptor polymorphisms. The emerging field of pharmacogenetics has the potential to advance the science of nicotine addiction and smoking cessation treatment further by generating new knowledge about genetic factors that influence clinical treatment outcome. The basic premise of this approach is that inherited differences in drug metabolism and drug targets have important effects on treatment toxicity and efficacy. This presentation will review evidence supporting genetic influences on smoking behavior and the potential utility of a pharmacogenetic approach to smoking cessation treatment. Implications for health policy and emerging bioethical concerns will also be addressed.

Suggested readings:
Supported by a Transdisciplinary Tobacco Use Research Center Grant P5084718 from NCI, NIDA, and RWJ and NCI RO1 CA63562.
Suggested readings:
Lerman C., and Berrettini W., "Elucidating the role of genetic factors in cigarette smoking." Journal of Medical Genetics (Neuro-Psychiatric Genetics) American 2003;118B:48-54.

INJURY AND THE PUBLIC'S HEALTH
Charles Branas, PhD
This session offers an introduction to the field of injury and violence prevention, a major cause of death and disability throughout the world. Prominent types of injury to be discussed include those relating to motor vehicles, falls, and firearms. Biological, behavioral, economic and social issues concerning the implementation of injury reduction policies will be discussed.

JOURNAL CLUB

LITERACY AND POPULATION HEALTH
Judy Shea, PhD
This session will examine the impact of literacy on health outcomes.

WORK IN PROGRESS
Sonya Grier, PhD

CULTURE AND POPULATION HEALTH
Rebecca Huss-Ashmore, PhD
There is a great deal of variation among populations in the incidence of and mortality from most major diseases. While biological and social factors account for some of this variation, there is increasing evidence that behavior, and the cultural and explanatory models that underlie behavior, play an important role. Culture affects population health through exposure to disease, susceptibility to disease, recognition of disease, and methods of treatment. This session looks the role of culture in defining, recognizing, and treating disease and illness. We focus on shared belief systems or cultural models, and on research strategies derived from cognitive and linguistic anthropology.

Suggested readings:
de Munck, Victor (2000). "Culture, Self, and Meaning. " Waveland Press, Prospect Heights, IL.(Chapter 2, Where is culture located?)
Aronowitz, Robert (1998). "Making Sense of Illness." Cambridge University Press, Cambridge. (Ch. 3, Lyme
disease: the social construction of a new disease and its social consequences.)

JOURNAL CLUB

OBESITY PREVENTION IN LOW-INCOME PRESCHOOL CHILDREN: MATCHING FEDERAL POLICY WITH FAMILY PERCEPTIONS
Robert Whittaker, PhD

UNDERSTANDING AND ELIMINATING ETHNIC DISPARITIES IN PSYCHIATRIC CARE
Trevor Hadley, PhDThe focus of this seminar is on current policy issues that define and influence the care and treatment of persons with mental illness. The primary social, political, economic, legal and philosophical forces that have influenced mental health delivery in the US resulting in particular organizational, financial, administrative, and management structures of mental health service delivery systems will be examined. The interface with other major service delivery systems, including welfare, criminal justice, primary health care, and social security will be addressed.

ENVIRONMENTAL DETERMINANTS OF POPULATION HEALTH: CASE STUDY OF LEAD
Robert Geigengack, PhD
Elaine Wright
This seminar will examine the patterns of childhood Pb poisoning due to the contamination of dust and soil, the number one health threat facing the population of young children in the US today.

JOURNAL CLUB

Back to Curriculum Main Page