PHC 6016: Social Epidemiology

GENERAL INFORMATION
DESCRIPTION

This is an upper level graduate course focusing on social epidemiology – the study of social factors in the distribution and determinants of conditions in a population. This includes the association of social factors with disease, the impact of the social environment on health status, the mechanisms by which these factors are linked to actual pathological and disease processes, and health policies and model of health promotion which may impact health outcomes. This course explores the epidemiological aspects of health and medical care of the poor and disadvantaged population groups.

OBJECTIVES

Upon completion of this course, the student will be able to

  1. Understand the conceptual basis and role of social epidemiology in public health
  2. Describe the association of demographic and social factors with health and disease
  3. Describe the roles of stress, social change and social status as potential determinants of health and disease
  4. Critically read published research articles
  5. Discuss health promotion, social intervention and health policy modalities to improve health outcomes.

M
MPH CORE / CONCENTRATION-SPECIFIC COMPETENCIES

This course will assist students in developing the following MPH core competencies:

COMPETENCY / COURSE OBJECTIVE
Identify key sources of data for use in epidemiologic studies / 1, 2, 3
Critically evaluate reports of epidemiologic studies / 3, 4
Given a health problem, choose and implement an appropriate epidemiologic study design / 1, 3
COURSE PREREQUISITES

PHC6000 Introduction to Public Health Epidemiology

REQUIRED TEXTBOOK

Berkman LF, Kawachi I, Eds. Social Epidemiology. New York: Oxford University Press Inc., 2000. ISBN-13 978-0-19-508331-6.

Fadiman, A. The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux, 1998.978-0374525644

Fadiman is assigned to give context to social epidemiology in a tangible and human way. The book helps to illuminate the social context for disease at an individual and population level. The book is meant to inspire and engage.

Additional required readings are listed on the syllabus by date of each class.

OTHER RECOMMENDED SOURCES OF INFORMATION

Texts

Marmot M, Wilkinson RG, Eds. Social Determinants of Health.2nd Ed. Oxford, Great Britain: Oxford University Press, 2006.

Oakes JM, Kaufman JS. Eds. Methods in Social Epidemiology.1st Ed. San Francisco, CA: John Wiley & Sons, Inc, 2006.

Web Resources

1. The following document is downloadable at no charge: Centers for Disease Control & Prevention. Principles of Epidemiology.3rd Edition. Atlanta: U.S. Department of Health and Human Services.

2. (World Health Organization Homepage)

3. (Centers for Disease Control and Prevention)

4. (US Census Bureau)

5. (National Library of Medicine: Medline)

6. (Florida Department of Health)

9. (U.S. Department of Health and Human Services)

10. (U.S. Census)

CLASS POLICIES AND PROCEDURES

The class will meet once per week for two hours, 40 minutes with a 10-15 minute break in the middle of the session. This course will involve reading, critical thinking, analysis, and debate. The class sessions will consist of lectures, discussions, and oral presentations. Students will be responsible for reading all assignments prior to class and for being prepared to critique and discuss the readings. The instructor will use the lecture sessions for an overview, critical analysis and evaluation of each topic.

Disability

The University provides reasonable accommodations and services to all students on a nondiscriminatory basis consistent with legal requirements as outlined in the Americans with Disabilities Act as Amended (ADAAA) of 2008 and the Rehabilitation Act as Amended.. If you have disability and/or need special assistance during the course or exams, please make arrangements through the Office of Disability Services (305-348-4131).More information about the accommodation process is available at

EVALUATION AND GRADING

Students will be evaluated on the following basis:

Class participation / 20%
Paper and paper presentation / 45% (25% paper; 20% presentation)
Leading discussion of article / 10%
Final exam / 25%
Grading Scale
A / 92.6 – 100 / C / 72.6 – 76.5
A- / 89.6 – 92.5 / C- / 69.6 – 72.5
B+ / 86.9 – 89.5 / D+ / 66.9 – 69.5
B / 82.6 – 86.5 / D / 62.6 – 66.5
B- / 79.6 – 82.5 / D- / 59.6 – 62.5
C+ / 76.6 – 79.6 / F / < 59.5

Participation: Participation will be evaluated based on classroom attendance and participation in class (student participating fully in discussions, demonstrating that he or she has read the assigned materials). Two absences are granted for each student (excused or unexcused).

Term paper: For the term paper you will select a topic discussing the relationship of a particular social factor to health outcome(s) (i.e. the effect of social capital on child abuse, the effect of discrimination on premature birth, etc). The subject chosen should be narrow enough to do an in-depth analysis but broad enough to utilize a minimum of 8 peer-reviewed references.

The paper will have three parts. In the first part you will describe the epidemiologic data regarding the relationship of the social factor to the health outcome. In the second part, you will identify and support at least one theory to answer the questions “how.” That is, what are the pathways in which the social factor impacts the health outcome? You will provide evidence for and against the theory as a plausible explanation of why the social factor impacts health. You should also answer the questions: What remains to be learned about this subject? What types of studies are needed? In the third part, you will discuss policies that would impact the social factor such that the health outcome would improve. You may discuss successful policies that have been implemented, if they exist.

The paper should be 10-15 double-spaced pages long not including tables, figures or references. You should also write an abstract which is not included in the page limit. You must choose your topic by February 2nd and bring to the library session a list of at least 3 peer-reviewed journal articles. You can ask the librarian for assistance in refining the search during that session.

Use APA style for referencing. You will turn in your paper to Turnitin.com. Turnitin.com will give you a score of the amount of overlap of your writing with references. Your score must be less than 30% (excluding the bibliography). Therefore, you should turn it in to Turnitin.com at least a week prior to your paper being due. If the score is over 30%, you will have to revise the paper by improving your paraphrasing. You can then resubmit the paper to turnitin.com. I will not consider any paper with a score higher than 30%. To be considered on time, your paper must be turned into me (in a paper and electronic form) no later than March 8th. You will lose 10 points per day after your paper is due. Exceptions are only for serious illnesses (e.g. hospitalization) that you or a family member has, and exceptions will only be granted with proper documentation. A copy of the evaluation form that will be used to grade your paper will be posted on the class web site.

If you need assistance with your writing, please visit FIU’s Writing Lab. See the Writing Lab’s website for details about the services that are provided:

For those students that need help with proper citation of sources, please see the following:

Oral Presentation: The oral presentation will summarize the results of your paper. The oral presentation should take no longer than 15 minutes. You should use Powerpoint software, and on the day of your presentation bring a hardcopy of your presentation (6 slides to a page) for the instructor. Send by e-mail an electronic copy on the day of your presentation so that it can be uploaded to the class website. A laptop and projector will be available for you on the date of the presentation. A copy of the evaluation form that will be used to grade your presentation will be posted on the class web site.

To prepare the presentation, consult the following website:

Population Reference Bureau.How to effectively present data. Tips on slide preparation available at

Leading class discussion: Students in groups of 2 will be assigned as discussion leaders for one of the articles in the syllabus. Groups may choose their article. The articles that may have student-led discussions are designated by an asterix in the syllabus. The assigned leaders will prepare questions for their classmates to answer. These questions must be e-mailed to the instructor no later than one week prior to class. For each day late 10 points is taken off of the leaders’ grades. Questions should include general questions such as “What was the rationale for the study?” “What were the study’s hypotheses?” “What methods did the authors use to test the hypotheses?” “Were the methods appropriate?” “What were the author’s main conclusions?” “Did the results support the authors’ conclusions?” “What were the limitations of the study?” “How could these have been better addressed in the study’s design or implementation?” “What does the study add to the literature?” The leaders should add additional questions relevant to the topic. The leaders should lead the class through the interpretation of each table/figure and be prepared to provide any background information about epidemiologic methods or statistical tests that their classmates may not be familiar with. It is expected that each discussion should take about a half hour. The leaders’ grades will be dependent on the timely submission of questions to the instructor and classmates, the degree of familiarity of the leaders with the article, and the level of preparedness of the leaders.

Final exam: The exam will test students’ knowledge of social determinants of health. The questions will be written around the objectives that will be given for each lecture. In addition, questions will be written around the contextual objectives of the Fadiman book. The format will be primarily essay and short answer.

FIU HONOR CODE

Florida International University is a community dedicated to generating and imparting knowledge through excellent teaching and research, the rigorous and respectful exchange of ideas and community service. All students should respect the right of others to have an equitable opportunity to learn and honestly to demonstrate the quality of their learning. Therefore, all students are expected to adhere to a standard of academic conduct, which demonstrates respect for themselves, their fellow students, and the educational mission of the University. All students are deemed by the University to understand that if they are found responsible for academic misconduct, they will be subject to the Academic Misconduct procedures and sanctions, as outlined in the Student Handbook.

Misconduct includes: Cheating – The unauthorized use of books, notes, aids, electronic sources; or assistance from another person with respect to examinations, course assignments, field service reports, class recitations; or the unauthorized possession of examination papers or course materials, whether originally authorized or not. Plagiarism – The use and appropriation of another’s work without any indication of the source and the representation of such work as the student’s own. Any student who fails to give credit for ideas, expressions or materials taken from another source, including internet sources, is responsible for plagiarism. All students are expected to abide by the Florida International University Honor Code. Any violation will be reported.

In addition, for this course, students are required to sign an honour code at the end of all assignments and exams. The honour code should state “I have neither given nor received any unauthorized aid on this [assignment, exam]”. Please sign after the statement.

Student conduct

Students are responsible for knowing and complying with all FIU Policies and Regulations which are listed in the Student Handbook and also at the following link: The following are excerpts:

Reason for the policy:

“Graduate students at Florida International University are expected to adhere to the highest standards of integrity in every aspect of their lives. Honesty in academic matters is part of this obligation. Academic integrity is the adherence to those special values regarding life and work in an academic community. Any act or omission by a graduate student which violates this concept of academic integrity and undermines the academic mission of the University shall be defined as academic misconduct and shall be subject to the procedures and penalties that follow.”

Definition of academic misconduct:

Academic misconduct is defined as the following intentional acts or omissions committed by any FIU graduate student:

“Cheating: The unauthorized use of books, notes, aids, electronic sources; or unauthorized use of on-line exams, library materials or assistance from another person with respect to examinations, course assignments, field service reports, class recitations; or the unauthorized possession of examination papers (or on-line examinations) or course materials, whether originally authorized or not. Any student helping another cheat may be found guilty of academic misconduct”

Plagiarism: The deliberate use and appropriation of another's work without any indication of the source and the representation of such work as the student's own. Any student, who fails to give credit for ideas, expressions or materials taken from another source, including internet sources, is guilty of plagiarism. Any student helping another to plagiarize may be found guilty of academic misconduct.

Misrepresentation: Intentionally lying to a member of the faculty, staff, administration, or an outside agency to gain academic advantage for oneself or another, or to misrepresent or in other ways interfere with the investigation of a charge of academic misconduct.

Misuse of Computer Services: The unauthorized use of any computer, computer resource or computer project number, or the alteration or destruction of computerized information or files or unauthorized appropriation of another's program(s).

Bribery: The offering of money or any item or service to a member of the faculty, staff, administration or any other person in order to commit academic misconduct.

Conspiracy and Collusion: The planning or acting with one or more fellow students, any member of the faculty, staff or administration, or any other person to commit any form of academic misconduct together.

Falsification of Records: The tampering with or altering in any way of any academic record used or maintained by the University.

COURSE SCHEDULE AND ASSIGNMENT
DATE / TOPIC / ASSIGNMENT
INTRODUCTION
Objectives: The student will be able to
  • Describe instructor’s expectations of students during course
  • Contrast traditional epidemiology with social epidemiology
  • List social determinants of health
  • Contrast idea of society with that of culture
  • List some key concepts in social epidemiology
/ Readings: Chapter 1 of text
SOCIAL EPIDEMIOLOGY THEORIES
Objectives: The student will be able to
  • Compare and contrast psychosocial, ecosocial, and social production of disease and/or political economy of health theories
  • Describe the contribution of a life-course perspective to the understanding social factors effects on health phenomena
/ Read prior to this class
  • Krieger N. A glossary of social epidemiology. J Epidemiol Community Health 2001;55:693-700.
  • Krieger N. Theories for social epidemiology in the 21st century. International J Epidemiol 2001;30:668-677. Available at:

SOCIAL EPIDEMIOLOGY METHODS
Objectives: The student will be able to
  • Explain how a multilevel analysis differs from an ecologic analysis
  • Give an example of when a theory would lend itself to individual-level analysis vs. ecologic analysis
  • Give an example of a compositional and a contextual explanation for the distribution of a disease
/
  • List of 3 peer-reviewed journal articles due. Bring to the library session and ask questions to help refine your search.
  • Read prior to this class
  • Chapter 13 of text
  • Hemmingway H, Shipley M, Mullen MJ. Social and psychosocial influences on inflammatory markers and vascular function in civil servants (The Whitehall II Study). Am J Cardiol 2003;92:984-987. Article on reserve.

REVIEW OF MEDLINE SEARCHING AND SOCIAL BIOLOGY
MEETING IN ACH3 ROOM 212 WITH LIBRARIAN
Objectives: The student will be able to
  • Define stress within the context of social epidemiology
  • Describe short term effects of the sympatho-adrenal and HPA pathways
  • Discuss at least two examples of how psychosocial factors may lead to cardiovascular disease via a biologic pathway
  • Distinguish between direct and indirect pathways of how psychosocial factors may lead to cardiovascular disease
  • Conduct a literature search using several different Medline search engines
/
  • List of 3 peer-reviewed journal articles due. Bring to the library session and ask questions to help refine your search.
  • Read prior to this class
  • Chapter 13 of text
  • Hemmingway H, Shipley M, Mullen MJ. Social and psychosocial influences on inflammatory markers and vascular function in civil servants (The Whitehall II Study). Am J Cardiol 2003;92:984-987. Article on reserve.

MEASURING SOCIOECONOMIC POSITION
Objectives: The student will be able to
  • Define and interpret measures of socio-economic position (SEP)
  • Discuss limitations of SEP measures
Note: Assigning of papers for leaders to present to class. /
  • Chapter 2 of text
  • Glymour MM, Avendano M, Haas S, Berkman LF. Lifecourse social conditions and racial disparities in incidence of first stroke. Ann Epidemiol 2008;18:904-912. Available on reserve.
  • Oakes JM, Rossi PH The measurement of SES in health research: current practice and steps toward a new approach. 2003; SocSci Med 56:769-84.
Available on reserve.
INCOME INEQUALITY AND HEALTH
Objectives: The student will be able to
  • Discuss the evidence for income inequality affecting health
  • Describe pathways by which income inequality may affect health
  • Compare and contrast the Gini Coefficient and Robin Hood Index
  • Critically review a meta-analytic study
/
  • Chapter 4
  • *Kondo N, Sembajwe G, Kawachi I, et al. Income inequality, mortality, and self-rated health: meta-analysis of multilevel studies. Brit Med J 2009;3339:b4471. Available at:
  • Suggest having read Fadiman Chap 1-8

RACE/ETHNICITY CLASSIFICATIONS
Objectives: The student will be able to
  • Compare and contrast the terms race and ethnicity
  • Explain how data on race are collected in the US Census and on birth and death certificates
  • Discuss limitations of race and ethnic classifications
  • Discuss advantages and disadvantages of the use of race and ethnicity in analyses of health problems
/
  • Bhopal R, Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in research on race, ethnicity, and health. Am J Public Health 1998; 88(9):1303-7. Available at:
  • Goodman AH. Why genes don’t count (for racial differences in health). Am J Public Health 2000; 90(11):1699-1702. Available at:
  • Fullilov MT. Comment: abandoning “Race” as a variable in public health research—an idea whose time has come Am J Public Health 1998; 88(9):1297-1298.
  • Kaplan JB, Bennet T. Use of race and ethnicity in biomedical publication JAMA 2003; 289(20):2709-2716. Available at

  • Kaufman JS, Cooper RS. Commentary: considerations for use of racial/ethnic classifications in etiologic research. 2001; Am J Epidemiol 154:291-8. Available at

DISCRIMINATION AND HEALTH
Objectives: The student will be able to
  • Discuss aspects of discrimination that should be considered when measuring discrimination in epidemiologic studies
  • Describe pathways in which discrimination can be embodied
  • Given a scenario, illustrate how three different epidemiologic approaches could be used to explore the relationship between discrimination and health
  • Interpret the index of dissimilarity
/
  • Chapter 3
  • *Borrell C, Muntaner C, Gil-Gonzalez D, et al. Perceived discrimination and health by gender, social class, and country of birth in a Southern European country. Preventive Medicine 2009, doi:10.1016/j.ypmed.2009.10.016. Available on reserve.
  • *Cooper RS, Kennelly JF, Durazo-Arizu R, Hyun-Joo Oh, HF, Kaplan G, Lynch J. Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas. Public Health Reports 2001;116:464-473. Available at:
  • *Collins J: Very low birthweight in African American Infants: the role of maternal exposure to interpersonal racial discrimination. Am J Public Health 2004;94:2132-2138. Available at:
  • *Trivedi AN, Ayanian JZ. Perceived discrimination and use of preventive health services. J Gen Intern Med 2006;21:553-558. Available at:
-
WORK
Objectives: The student will be able to
  • Discuss importance of work for individuals
  • Explain models of job demand-control and effort-reward imbalance
  • Describe policy implications for evidence of psychosocial work conditions associated with health
/
  • Chapters 5 and 6 of text
  • *Hasselhorn H, Tackenberg P, Peter R. Effort-reward imbalance among nurses in stable countries and in countries in transition. Int J Occup Environ Health 2004;10:401-408. Available on reserve.
-
No class. Spring Break
SOCIAL SUPPORT /
  • Chapter 7 of text
  • *Goodwin JS, Hunt WC, Key CR, Samet JM. The effect of marital status on stage, treatment and survival of cancer patients. JAMA 1987;258(21):3125-3130. Available at
  • *Richmond CAM, Ross NA, Egeland GM. Social support and thriving health: a new approach to understanding the health of indigenous Canadians. Am J Public Health 2007;97:1827-1833. Available at
  • Suggest having read Fadiman Chap 9-14

NEIGHBORHOODS: SOCIAL AND PHYSICAL ENVIRONMENT
Objectives: The student will be able to
  • List characteristics of neighborhood to consider in studies of neighborhood and health
  • Discuss how housing is related to neighborhood and SEP
  • Compare and contrast the terms social cohesion and social capital
/
  • Chapters 8 and 14 of text
  • *Browning CR, Cagney KA. Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. 2002; Journal of Health and Social Behavior 2002;43:383-399. Available on reserve.
  • *Cohen D, Spear S, Scribner R, Kissinger P, Mason K, Wildgen J. Broken windows and the risk of gonorrhea. Am J Public Health 2000;90(2):230-6.
  • *Sampson RF, Raudenbusch SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 1997; 277:918-924. Available at:

ORAL PRESENTATIONS
ORAL PRESENTATIONS
HEALTH AND SOCIAL POLICY
Objectives: The student will be able to
  • Discuss the political and social challenges in creating social policy that favors good health
  • Explain the role of epidemiologists in advancing social policies that favor good health
/
  • Chapter 16 of text
  • Suggest having read Fadiman Chap 15-19

FINAL

NOTE