EPI 504D Final Projects Descriptions

EPID 504D Final projects
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Project  1 – Outbreak investigation
On June 20, 2013, the Department of Homeland Security notified the State Department of Health of a
fire station that reported gastrointestinal illness among a substantial percentage of their workers,
causing missed workdays and one hospitalization as a result of cryptosporidiosis. All ill firefighters had
responded to a fire occurred in a barn housing approximately 240 week‐old calves. Local hydrant water
and onsite swimming pond water were used to extinguish the fire.
Part 1. What are potential causes of cryptosporidiosis? What exposures have caused previous
outbreaks? What study design would you choose to investigate the outbreak? What are the
advantages and disadvantages of your study design?
Part 2. Based on the summary data, what exposure caused the outbreak?
Part 3. What do you conclude? What are your recommendations?

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Project 2 –Electronic cigarettes
Electronic cigarettes, or e‐cigarettes, are battery‐powered devices that provide doses of nicotine and
other additives to the user in an aerosol. Depending on the brand, e‐cigarette cartridges typically
contain nicotine, a component to produce the aerosol (e.g., propylene glycol or glycerol), and flavorings
(e.g., fruit, mint, or chocolate). Potentially harmful constituents also have been documented in some e‐
cigarette cartridges, including irritants, genotoxins, and animal carcinogens. Use of e‐cigarettes has
increased among U.S. adult current and former smokers in recent years. However, their potential health
effects are currently being debated in the public health community.
Part 1. Provide a brief background on e‐cigarettes. How are they different from tobacco
products or smoking cessation products? What are the potential health effects? What study
design would you choose to investigate potential health effects? What are the advantages and
disadvantages of your study design?
Part 2. Based on the summary data, what are the estimates of effect for potential health
outcomes?

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Project 3 – Suicide among Laughistan refugees
Laughanistan, a small country in South Asia, is reportedly one of the happiest places on Earth. During the
period March 2008–March 2011, the Office of Refugee Resettlement of the U.S. Department of Health
and Human Services reported 22 suicides among the approximately 45,000 Laughistan refugees who
had resettled in the United States since 2004. In 2013, the office requested assistance from your team to
identify risk factors that might be associated with suicidal ideation among Laughistan refugees.
Part 1. What do we know about suicide globally and in the United States? What is known about
suicide among refugees to the United States? What is the incidence of suicide in this
population? Is it higher than expected? What study design would you choose to investigate
suicidal ideation? What are the advantages and disadvantages of your study design?
Part 2. Based on the summary data, what are the risk factors for suicidal ideation among these
refugees?

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Project  4 – Pre‐exposure prophylaxis to prevent HIV
An estimated 2.5 million people contracted HIV in 2011. One in ten of these new HIV infections was
probably caused by injecting drug use; in some countries in eastern Europe and central Asia, more than
80% of all HIV infections are related to drug use. Safe and effective interventions to prevent HIV
infection in this population are needed. The use of antiretrovirals to prevent HIV infection (pre‐exposure
prophylaxis) is a promising new strategy to end the HIV/AIDS epidemic.
Part 1. What is pre‐exposure prophylaxis (PrEP)? What study design would you choose to
investigate PrEP among injecting drug users? What are the advantages and disadvantages of
your study design?
Part 2. Based on the summary data, what is the estimated effect of PrEP on HIV acquisition?
What is the potential population attributable fraction?

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Project 5 – Neural tube defect cluster
A health‐care provider in central Montana alerted the Montana State Department of Health about an
excessive number of anencephaly births at a local hospital. Case findings included a review of area
hospital discharge records; vital statistics reports; and perinatology office records. From these sources,
27 confirmed neural tube defects‐affected pregnancies occurring during January 2010–January 2013
were identified among women residing in a three‐county area. Twenty‐three pregnancies were affected
by anencephaly. The anencephaly rate was 8.4 per 10,000 live births, compared with a national estimate
of 2.1 per 10,000 live births.
Part 1. Provide a brief background on anencephaly. What are the risk factors? Is it preventable?
What study design would you choose to investigate anencephaly? What are the advantages and
Part 2. Based on the summary data, what are the risk factors identified for anencephaly?

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Project 6 – Diet and exercise to prevent cardiac conditions among diabetics
Weight loss is recommended for overweight or obese patients with type 2 diabetes. This
recommendation is based on short‐term studies showing numerous benefits of weight loss, including
improvements in glycemic control, risk factors for cardiovascular disease, quality of life, and other
obesity‐related coexisting illnesses. However, it is unknown whether weight loss reduces the risk of
cardiovascular morbidity and mortality in patients with type 2 diabetes. Epidemiologic studies involving
patients with diabetes have had conflicting results, perhaps because of confounding from unintentional
weight loss. A meta‐analysis of cohort studies concluded that moderate intentional weight loss was
associated with reduced mortality among patients who were classified as “unhealthy,” including those
with diabetes.
Part 1. Provide a brief background on heart disease among diabetics and the role of diet and
exercise in prevention. What study design would you choose to investigate an intensive lifestyle
intervention designed to achieve weight loss through caloric restriction and increased physical
activity decrease cardiovascular morbidity and mortality among overweight or obese adults with
type 2 diabetes? What are the advantages and disadvantages of your study design?
Part 2. Based on the summary data, what is the estimated effect of the intervention on
cardiovascular morbidity and mortality? What is the potential population attributable fraction?

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Project 7 – Youth motorcycle‐related brain injury and helmet laws
Motorcyclists are 35 times more likely than passenger‐car occupants to die in a motor vehicle traffic
crash and 8 times more likely to be injured per vehicle‐mile. Among young riders aged 12 to 20 years,
motorcyclist death rate increased 88% from 1998 – 2006. The numbers of motorcycle deaths and
injuries are rising because of increased use of motorcycles for recreation, more powerful motorcycles,
more older riders, and the desire for fuel‐efficient travel. An additional factor is the repeal of universal
(all‐age) helmet laws. Currently, 20 states and the District of Columbia (51% of the US population) have
universal helmet laws. Three states (6% of the population) have no helmet laws; 27 remaining states
(43% of the population) have retained age‐specific laws.
Part 1. Provide a brief background on motorcycle injuries and the relationship to helmet laws.
What study design would you choose to investigate the null hypothesis that age‐specific helmet
laws are as effective as universal laws? What are the advantages and disadvantages of your
study design?
Part 2. Based on the summary data, what is the estimated effect of age‐specific helmet laws on
motorcycle‐related morbidity and mortality? What is the potential population attributable
fraction?

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Project 8 – Relation Between Clinical Depression Risk and Physical Activity and Time Spent Watching
Television in Older Women
Major depressive disorder is a chronic and recurrent illness that affects 2 times more women than men.
In the United States, about 20% of the women will be affected during their lifetimes. Since Hippocrates’
time, physical activity (PA) has been recommended by physicians to prevent depression. Although lack
of regular PA is often associated with depressive symptoms, few studies have analyzed the joint
association between sedentary behavior and PA in relation to clinical depression, and only 1 study has
considered the relation between television watching and depression.
Part 1. Provide a brief background on physical activity and the relationship to depression. What
study design would you choose to investigate the hypothesis that PA and television watching are
independently associated to depression risk among older women? What are the advantages and
Part 2. Based on the summary data, what is the estimated effect of television watching on
depression?

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Project 9 – Reduced Melanoma After Regular Sunscreen Use
The need for more effective prevention of melanoma is recognized around the world as climbing
incidence and high mortality in white populations persist.
In the United States, approximately 68,700
new melanoma occurrences and more than 8,600 deaths were expected to occur in 2009.
Exposure to
solar ultraviolet (UV) radiation is the only established modifiable cause of melanoma. Despite the known
etiologic role of sun exposure, the question regarding sunscreen use to prevent melanoma remains
open and controversial.
Part 1. Provide a brief background on sunscreen and the relationship to melanoma. What study
design would you choose to investigate the hypothesis that sunscreen can reduce the risk of
melanoma? What are the advantages and disadvantages of your study design?
Part 2. Based on the summary data, what is the estimated effect of sunscreen on melanoma?
What is the potential population attributable fraction?

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Project 10 – Influenza Vaccine for Preventing Influenza Virus Illness Among Pregnant Women.
Because pregnant women appear to be vulnerable to severe disease and secondary complications from
influenza, vaccination with trivalent inactivated influenza vaccine (TIV) is recommended for all pregnant
women in the United States. TIV coverage in this population has risen to about 50% in the United States,
but no vaccine effectiveness (VE) studies of TIV among pregnant women have assessed laboratory‐
confirmed influenza outcomes. Although several studies have found a similar antibody response to the
vaccine among pregnant and nonpregnant women, previous studies have only compared rates of
nonspecific respiratory illness among vaccinated and unvaccinated pregnant women, with mixed results.
Part 1. Provide a brief background on influenza vaccination and effectiveness. What study
design would you choose to investigate TIV vaccine effectiveness? What are the advantages and
Part 2. Based on the summary data, what is the estimated vaccine efficacy?

EPI 504D Final Projects Descriptions

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EPI 504D Final Projects Descriptions