Epidemiology for Public Health Practice

Response one
Toy Factory Cohort Study
If I were the state epidemiologist and I suspected that smoke from the local toy factory was connected to adverse health outcomes among the town’s residents I would conduct a retrospective cohort study to further investigate this concern. Retrospective cohort studies are used when participants already have a known disease or outcome and the residents of the town are suspected of having adverse outcomes or disease. This type of study can look back into the past to determine why participants have the disease and when they have been exposed. The concern of the towns residents is that smoke from the toy factory is causing adverse health outcomes among the town’s residents. In order to conduct this type of study I would use historical data to identify members of the population who have been exposed (or not exposed) to smoke from the local toy factory. These members would be assembled for me to study. Data on relevant events for each resident such as the exposure, the latent period, and the time of any subsequent occurrence of the outcome are collected from existing records and can be analyzed immediately to determine the relative risk of the cohort compared to the control group. This type of cohort study has many advantages as it requires less time to complete, are less expensive and are better for analyzing multiple data. Retrospective studies do have certain limitations as researchers must rely on others for accurate record keeping as they cannot control exposure or outcome assessment. Another cause for concern is significant biases may affect the selection of controls because some key statistics cannot be measured (Friis & Sellers, 2014).

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One of the first recognized retrospective cohort studies was Lane-Claypon’s 1926 study of breast cancer risk factors, titled “A further Report on Cancer of the Breast, With Special Reference to its Associated Antecedent Conditions.” This study contained the first published epidemiologic questionnaire. Data abstracted from the published contingency tables included age at menarche, age at menopause, parity, age at marriage, and duration of lactation for each childbirth. This study provided the first epidemiological evidence that low fertility increases breast cancer risk. Lane-Clayton’s study is an excellent example of how one investigator’s work can help develop a field of scientific inquiry (Press & Pharoah, 2010).
Friis, R. H., & Sellers, T. A. (2014). Epidemiology for Public Health Practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.
Press, D. J., & Pharoah, P. (2010). Risk Factors for Breast Cancer: A Reanalysis of Two Case-control Studies From 1926 and 1931. Epidemiology, 21(4), 566–572. Retrieved from http://www.jstor.org/stable/25680588
Response two.
As state epidemiologist with a town that has suspicion smoke from the local toy factory was connected to adverse health outcomes among the town’s residents’ I would set up an ambispective cohort study. This design would include retrospective features (historical data) to determine baseline exposure, and prospective features to determine disease developed in the future. A benefit of using historical data is that it is already available this can cut years off the amount of time it will take to conduct the research for the study. Follow-up studies can be conducted to complete gathering of current information of the entire cohort (residents of the town) being studied. In this case the residents of the town. Expense for this type of study is of consideration (Friis & Stellers, 2014). Ideally much of the research and analysis would be able to be done in house, keeping the expense down. A limitation of the study would be residents that have moved away and newer residents. Parameters would need to be identified for inclusion to the cohort based on length of residency. Our community has a lot of seasonal residents, this population should be identified to see if intermittent exposure has any effect on the health outcomes.
There would be immediate concerns from the town residents. These would need to be addressed at the same time. Air quality testing and emissions checks could be tested at the toy factory. Experts would need to be consulted to determine if there were any immediate concerns on a day to day basis. Public relations would need to work closely with the lead for the research. Residents would need to be reassured everything that could be done to maintain their health was being done and to determine if there were any concerns with long term exposure.
Ancona, Badaloni, Mataloni, Bolignano, Bucci, Cesaroni, Forastiere, (2015), conducted a similar study in Rome, Italy. In 2001, they decided to look into the possible health effects the incinerator that had been operating since the 1960’s may have had on the suburb of Rome. They conducted a population-based retrospective cohort study. A Lagrangian dispersion model was utilized to determine the exposure assessment. They examined mortality data and hospital records for admissions and followed the cohort until 2010. They were able to determine that exposure from the incinerator was associated with pancreatic cancer mortality in males and females (HR 1.40 95 percent CI 1.03 – 1.90 in med, HR 1.47 95 percent CI 1.12 – 1.93 in women) and breast mortality in women (HR 1.13 95 percent CI 1.00 – 1.27).
Ancona, C., Badaloni, C., Mataloni, F., Bolignano, A., Bucci, S., Cesaroni, G., … Forastiere, F.   (2015). Mortality and morbidity in a population exposed to multiple sources of air pollution: A retrospective cohort study using air dispersion models. Environmental     Research, 137, 467–474. https://doi-org.ezproxy.snhu.edu/10.1016/j.envres.2014.10.036
Friis, R. H., Sellers, T. A. (2014). Epidemiology for Public Health Practice. Burlington, MA:       Jones & Bartlett Learning.
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