Hypothesis Generation: Exploring Disease Distribution

1. Module 2 Introduction Context Content Area: Hypothesis Generation Essential Question (Generic): What hypotheses might explain the distribution of health-related events or states? Essential Question (Drug Abuse Specific): What hypotheses might explain drug abuse? Enduring Epidemiological Understanding: Clues for formulating hypotheses can be found by observing the way a health-related condition or behavior is distributed in a population. Synopsis In Module 2, students explore how descriptive epidemiological information on person, place, and time (PPT) are used to generate hypotheses to explain “why” a health-related event or state has occurred. Students begin to uncover and develop the following epidemiological concepts and skills: evaluating PPT information; developing hypotheses to explain that distribution; understanding that there may be more than one credible hypothesis; and recognizing when a particular hypothesis does NOT explain the PPT information. Lesson 2-1: Overview of PPT and What’s My Hypothesis? Lesson 2-2: In the News Lesson 2-3: Drug Abuse by “Person” Race / Ethnicity Lesson 2-4: Drug Abuse by “Place” States in USA Lesson 2-5: Drug Abuse by “Time” Boundary Effect

2. Module 2 - Hypothesis Generation • Lesson 2-1 Overview of PPT and What’s My Hypothesis? • Content • Introduction to using person, place, and time (PPT) to describe how a disease or other health-related condition is described in a population • Definition of “hypothesis” and explanation of how PPT is used to generate “educated guesses” based on observation • Example of a catastrophic event, and another example of an emerging disease, that illustrate the usefulness of PPT and provide practice for students to identify person, place, and time characteristics and generate hypotheses • Big Ideas • Person, place, and time (PPT) describes a disease or other health-related condition in terms of “who, where, and when” • Hypotheses that are suggested by PPT try to explain “why” a disease is distributed as it is • PPT information often leads to more than one reasonable hypothesis This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

3. Where are we? Essential Questions Enduring Understandings

4. Review - Definition of Epidemiology “… the study of the distribution and determinants of health-related states or events in specific populations and the application of this study to the control of health problems.”

5. Review - the Descriptive Part of Epidemiology “… the study of the distribution and determinantsof health-related states or events in specific populations and the application of this study to the control of health problems.”

6. Descriptive Epidemiology Epidemiologic studies that are concerned with characterizing the amount and distribution of health and disease within a population.

7. PPT Sheet Person: Place: Time: Descriptive Epidemiology Who? Where? When?

8. PPT Sheet Person: Place: Time: Descriptive Epidemiology Illicit Drug Use AIDS Influenza

9. Definition of Hypotheses An educated guess An unproven idea, based on observation or reasoning, that can be supported or refuted through investigation

10. Generate Test Descriptive Epidemiology Analytical Epidemiology Definition of Hypothesis Insert slide in this lesson if you wish to give students context about hypothesis testing versus generating. This will be covered in Module 3 Hypothesis An unproven idea, based on observation or reasoning, that can be supported or refuted through investigation An educated guess

11. Hypothesis Generation 2. Hypothesis Generation 2. What hypotheses might explain the distribution of disease? 2. What hypotheses might explain the distribution of drug abuse?

12. Person, Place, and Time (PPT) How is the disease or other health condition distributed? Who? Where? When?

13. Descriptive Epidemiology Person (Who?) Place (Where?) Time (When?) Sex Age Ethnicity Occupation Economic Group Residence Occupation Being at Specific Events Geographic Sites Era Year Season Day, Hour, etc. Date of Onset Duration

14. Practice int Hypothesis Generation SES

15. Practice in Hypothesis Generation SES

16. Practice in Hypothesis Generation SES

17. Descriptive Epidemiology SES

18. Descriptive Epidemiology

19. Descriptive Epidemiology

20. A Mysterious Ailment A Mysterious Ailment By Jerry Bishop, Staff Reporter of the Wall Street Journal A mysterious, often fatal illness is breaking out in epidemic proportions among young homosexual men and drug users. More than 180 cases of the strange illness have been reported since last summer to the federal Center for Disease Control in Atlanta. As of last Friday, at least 74 of the victims have died. All the victims are men and 90% of them are either homosexual or bisexual. Many of the victims are drug users. The illness is characterized by months of fever, malaise, and drastic weight loss. In almost all cases the patients develop overwhelming infections of one or more of a dozen different viruses, bacteria or protozoa. The infecting microbes are types that do not ordinarily cause overt human disease. Many of the patients also develop a rare type of cancer. To the astonishment of medical scientists, most of the patients appear to have recently developed a defect in their immune systems that prevents them from fighting off infections. The infections are extremely difficult to control with antibiotics and antiviral drugs. "We are reasonably confident that this is, in fact, a new medical problem," said Dr. Harold Jaffe, an epidemiologist on a new task force organized by the Center for Disease Control to search for the cause of the illness. In an effort comparable to that launched last year to unravel the mystery of toxic shock syndrome, the center's task force is trying to find out whether a new germ has emerged or whether something in the environment has changed to account for the sudden outbreak of the illness. For example, the task force is checking into the use of sexual stimulants by the victims on the possibility these chemicals can impair the immune system and leave the user vulnerable to infections. Among such stimulants are chemicals that are inhaled. These include amyl nitrate sold in glass vials, known by the street name "poppers" and isobutyl nitrate sold as "liquid incense." First hints that some unusual illness was breaking out came earlier this year when researchers in New York and Los Angeles reported cases of both a rare kind of pneumonia and a rare cancer called Kaposi's sarcoma occurring in a few young men. The men were either homosexual or drug users or both. The disease center alerted doctors and health officials around the country last summer to the strange ailment. This week's New England Journal of Medicine, published today, devotes three articles to describing 19 of the patients, six of whom died. Publishing three lengthy articles on the same illness is unusual for the medical

21. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Hypotheses

22. A Mysterious Ailment

23. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses

24. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses … a new germ has emerged …. … something in the environment …. … use of sexual stimulants ….

25. Shaking Hands Toilet seats Poppers Injection Needles Mosquito Bites Hypothesis Generation Whistles

26. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses Shaking hands caused the mysterious ailment.

27. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses Sitting on toilet seats caused the mysterious ailment.

28. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses Poppers caused the mysterious ailment.

29. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses Using injection needles caused the mysterious ailment.

30. A Mysterious Ailment Descriptive Epidemiologic Clues Person Place Time Young homosexual men Large cities 180 cases since last summer New York Months of fever, malaise and drastic weight loss Drug Users Los Angeles 90% are bisexual or homosexual Hypotheses Mosquito bites caused the mysterious ailment.

31. A Mysterious Ailment

32. A Mysterious Ailment Now No One Is Safe From AIDS

33. A Mysterious Ailment

34. Re-Cap • Big Ideas in this Lesson (2-1) • Person, place and time (PPT) describes a disease or other health-related condition in terms of “who, where, and when” • Hypotheses that are suggested by PPT try to explain “why” a disease is distributed as it is • PPT information often leads to more than one reasonable hypothesis This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

35. Next Lesson DZ exercise How is the “disease” (DZ) distributed? Why?