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Epidemiology in Middle School: A Curriculum
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by Mark A. Kaelin
Ed.D.
Montclair State University
Montclair, New Jersey
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| | Detectives in the Classroom
Epidemiology is "the study of the distribution and the determinants of health-related states or events and the application of these methods to the control of health problems" (Gordis 2004). Courses in epidemiology are typically taught in graduate schools of public health. However, recognition of the value of teaching epidemiology to younger students is increasing. The Centers for Disease Control and Prevention (CDC) has taken the lead in promoting the integration of epidemiology teaching in grades K-12 (EpiMonitor, November 1997). The CDC program, called Excellence in Curriculum Integration Through Teaching Epidemiology (EXCITE), is based on the development of teaching modules that incorporate key aspects of epidemiology such as quantitative methods and causal reasoning.
Additionally, Robert Wood Johnson and the College Board are currently collaborating to develop Young Epidemiology Scholars competitions for high school teachers and students. In the teacher competition, teachers "compete by developing models for integrating epidemiology into the school curriculum or by mentoring students on epidemiology projects." The long-range goal of the student competition is to enhance students' "skills in critically evaluating complex problems" and for some students to "continue their studies in epidemiology, eventually making important contributions to the nation's health." A primary reason given for why the competitions are being supported by scientists is that "the skills and orientation of epidemiology -- critical thinking and a problem solving mentality -- are relevant across all sciences" (EpiMonitor, April 2002, page 1).
Mark Kaelin and Wendy Huebner have developed a middle school epidemiology curriculum called Detectives in the Classroom that complements these efforts.
A Pedagogical Framework for Teaching Epidemiology
Detectives is based on pedagogical principles suggested in Grant Wiggins and Jay McTighe's text, Understanding by Design (Wiggins and McTighe 1998). The authors explain how effective curricula can be built by identifying enduring understandings and essential questions. An enduring understanding is a big idea that resides at the heart of a discipline and has lasting value outside the classroom. An essential question is a question that can be answered when the enduring understanding is achieved. It is the curriculum developer's responsibility to create lessons that develop students' abilities to answer the essential question and, in doing so, to develop the enduring understanding.
Detectives is structured on five essential questions that epidemiologists attempt to answer as they do their work. The curriculum content that provides students with some of the knowledge and skills needed to answer each of these essential questions and develop the five enduring understandings is briefly described below.
Essential Question 1: Why do some people get sick, while others are remaining healthy?
By completing the Essential Question 1 investigations, students learn how clues for formulating causal hypotheses can be found by observing the way a disease is distributed in a group of people, in terms of person, place, and time. This is called descriptive epidemiology. Students review descriptions of disease distribution and formulate one or more hypotheses and realize that a given distribution can lead to the formulation of several different educated guesses. Students also realize that descriptive epidemiology is only the first step and that formulating a hypothesis is not the same as proving a hypothesis.
Essential Question 2: Is there an association between the hypothesized cause and the disease?
By completing the Essential Question 2 investigations, students learn that causal hypotheses can be tested by observing the exposures and diseases of people as they go about their daily lives. Testing is conducted by calculating and comparing risks, and determining whether or not the exposure and the disease turned up together, that is, whether or not the exposure and the disease are associated with each other. This is called analytic epidemiology. Students learn about the four basic study designs that epidemiologists use to test hypotheses and how a 2x2 table is used to numerically express the results of an analytic study.
Essential Question 3: Is this association causal?
By completing the Essential Question 3 investigations, students develop their abilities to interpret the results of analytical epidemiological studies, namely, the ability to evaluate why an association between an exposure and a disease has been found. Causation is only one explanation for finding an association between an exposure and a disease. Because observational studies are flawed, other explanations must also be considered, such as chance, confounding, reverse time order, and bias. Students also learn to evaluate evidence about an exposure-disease association in terms of a set of criteria and judge whether or not the association is causal.
Essential Question 4: What should be done when preventable causes of disease are found?
By completing the Essential Question 4 investigations, students learn that once epidemiological and other scientific evidence has been weighed and a judgment has been made that the association between the exposure and the disease is causal, it is theoretically possible to prevent the disease by removing the exposure. Students explore the role of epidemiology and other factors in the creation of disease prevention strategies. They learn about risk as a concept and as a reality by exploring their risk perceptions and those of their classmates and by examining ways to judge the acceptability of risks. Students appreciate how differences in perceptions and judgments about the acceptability of risk can influence the allocation of resources (time, energy, and money) for disease prevention strategies. Students create various strategies for preventing a specific health problem and assess the advantages and disadvantages of each strategy. In doing so, they uncover that decisions about possible disease prevention strategies are based on more than the scientific evidence and that social, economic, and political factors must also be considered.
Essential Question 5: Did the disease prevention strategy work?
The final section of the curriculum introduces students to the role of epidemiology in evaluating prevention strategies. Despite good intentions, a risk management strategy might not work. When students complete Essential Question 5 investigations, they understand how the effectiveness of a strategy can be evaluated by calculating and comparing risks of disease in populations of people who were exposed and were not exposed to the strategy. They are able to justify the need for evaluations, describe various study designs for evaluation, understand the similarities with epidemiological designs they studied in the Essential Question 2 investigations, design the evaluation of a prevention strategy, and describe the strengths and limitations of the approach.
Detectives helps students learn how epidemiologists study the distribution and the determinants of health-related conditions and apply that knowledge to the control of health problems. In doing so, they will be developing their critical thinking and problem-solving skills and will understand how the science of epidemiology empowers them to make personal and collective, evidence-based, health-related decisions.
References
EpiMonitor. November 1997. "CDC Launches Effort to Teach Epidemiology from Kindergarten Through High School."
EpiMonitor. April 2002. "New National Epidemiology Prize Competitions Being Created High School Students and Teachers."
Gordis, Leon. 2004. Epidemiology. Philadelphia: W. B. Saunders Company.
Wiggins, Grant, and Jay McTighe. 1998. Understanding by Design. Alexandria, Virginia: Association for Supervision and Curriculum Development.
This project is supported by Science Education Partnership Awards, Grant Numbers R25RR15281 and R25RR018584, from the National Center for Research Resources, National Institutes of Health.
Mark Kaelin, Ed.D., is an associate professor in the College of Education and Human Services at Montclair State University in New Jersey. He and his colleague, epidemiologist Wendy Huebner, Ph.D., had been teaching epidemiology to graduate students for 15 years when they read an EpiMonitor column entitled "CDC Launches Effort to Teach Epidemiology from Kindergarten Through High School." That article and a call to Donna Stroup, Ph.D., from the CDC's Epidemiology Program Office were the impetus for the creation of Detectives in the Classroom. Detectives has been pilot- and field-tested with seventh grade science teachers and their students from the Paterson and Montclair, New Jersey, school districts.
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