Journal Article On Public Health Problem: Epidemiology Assignment 3 Answer

Epidemiology Assignment 3

Instructions

Individually, you are required to answer questions pertaining to two or more peer-reviewed journal articles that address a specific public health problem. You should be able to apply the knowledge gained throughout this subject to examine and synthesise epidemiological evidence from multiple sources on a public health issue. You will need to:

• Contrast and summarise epidemiological evidence from two or more sources
• State your position on a public health intervention
• Justify your position based on the epidemiological evidence provided to you in the case study
• Communicate your findings to different audience

The exact case study with detailed marking rubric per question is below:

For this assignment, students will need to apply what they have learned in epidemiology to inform public health l practice. One of the main tasks of a public health practitioner is to examine the evidence obtained from epidemiological studies for its accuracy and public health relevance. Imagine that you are a World Health Organisation (WHO) consultant in the Solomon Islands. The Ministry of Health is becoming concerned about the levels of overweight and obesity in children in the city of Honiara. You plan a project over a period of three years to address this issue.

Notes on completing this assignment:

.This Assignment is 2000 words.

• Please use 12-point font
• Don’t repeat the questions in your completed assignment. Just number each answer.
• Your answers should be brief. You can use dot points where appropriate.
• Please answer the questions in order.
• Unless specified otherwise, justify all answers.
• Ensure that you cite your sources in accordance with the APA author-date system for referencing. Up to two marks will be deducted for incorrect referencing.
• Follow the guidelines you are given to help you decide how many decimal places to report
• You need to submit a pdf of your assignment. You can create pdfs from Word. In Word 2016 for Windows, you can print to the printer "Microsoft Print to PDF". On the Mac version of Word 2016, when you click File/Print, you will see "PDF" at the bottom left of the dialog box. Click this, then "Save as PDF". Word online has a print option to "Save as PDF". Every University of Melbourne Student can get Office 365 for free.

Assignment Questions

First year: Surveillance (25%, 500 words) – Plan a study

Cross-sectional study (25%, 500 words)

You notice that the levels of overweight and obesity in children in Honiara is unknown as the last survey as the part of WHO surveillance was conducted in 1992, three decades ago. You look at the Global Burden of Disease study and find that there are projected national estimates for overweight and obesity but not specifically for Honiara. In less than 500 words, make a case to the Head of the Public Health Panel (that includes epidemiologists) in the Ministry of Health to set-up a cross- sectional study to examine levels of overweight and obesity in school aged children.

Your answer should include:

1. What percent of global and Disability Adjusted Life Years (DALYs) in the Solomon Islands did high Body Mass Index (BMI) account for among children aged five to fourteen years in 2019? (Use the GBD results tool)
2. Has the percentage contribution to overall DALYs due to high Body Mass Index (BMI) among children aged five to fourteen years in the Solomon Islands increased between 1990 and 2019? (Use the GBD results tool)
3. Write the research question for the proposed cross-sectional study?
4. What will be your target and source population?
5. What are the potential sources of selection bias that you must consider in the design of your cross-sectional survey?
6. What strategies will you apply to minimise misclassification of obesity using BMI in the proposed study?

Second year: Sugar sweetened beverages and obesity (50%) (1000 words)

You find it difficult to convince the schools and their authorities in the area to adopt nutrition policies that reduce access to sugar sweetened beverage for preventing overweight and obesity in children and adolescents. You know anecdotally that an unhealthy and high calorigenic diet, inclusive of sugar sweetened beverages is a key risk factor of overweight and obesity in children and adolescents, which in turn is associated with high cardiovascular disease risk. You come across two papers (a cohort study and a systematic review) that may help build a stronger case to curb SSB intake within the schools. But, with your Epi 1 knowledge, you want to be sure that these papers provide accurate and unbiased information.

Ambrosini GL, Oddy WH, Huang RC, Mori TA, Beilin LJ, Jebb SA. Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents. Am J Clin Nutr. 2013 Aug;98(2):327-34. doi: 10.3945/ajcn.112.051383. Epub 2013 May 29. PMID: 23719557; PMCID: PMC3712546.

QinP, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M. Sugar and artiicially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose- response meta-analysis of prospective cohort studies. Eur J Epidemiol. 2020 Jul;35(7):655-671. doi: 10.1007/

s10654-020-00655-y. Epub 2020 Jun 11. PMID: 32529512.

Cohort study (25%) (500 words)

Answer the following questions based on this study:

Ambrosini GL, Oddy WH, Huang RC, Mori TA, Beilin LJ, Jebb SA. Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents. Am J Clin Nutr. 2013 Aug;98(2):327-34. doi: 10.3945/ajcn.112.051383. Epub 2013 May 29. PMID: 23719557; PMCID: PMC3712546.

1. Describe the objective and the hypothesis of the study.
2. Are you confident that this was a disease- or outcome-free cohort? Justify your answer? Why do you think this is important?
3. Are you confident that differential misclassification of exposure with respect to the outcome was not present in the study? Justify your answer.
4. Which confounding factors did author account for when they tested the association between SSB intake and overweight/ obesity. Draw a DAG to present this.
5. Do you think the selection of confounding factors was justified in the study.

Authors of the study mention a limitation:

“A limitation of this study was the reduced number of participants who completed the FFQ at the second follow-up. At 17 y of age, study adolescents were asked to complete the FFQ rather than their parent or guardian (when study adolescents were 14 y of age), which may partly explain the reduced response and may have contributed to more dietary underreporting. The slightly lower response may have also led to a selective sample at 17 y that was biased toward cohort members who were more health conscious, which would make the findings less generalizable. However, if true, this bias would raise the possibility that our observations may have been underestimates of true associations between SSB and cardiometabolic risk factors in this cohort. ”

1. Do you think that there is potential for selection bias in the study due to attrition?
2. What information could the authors provide to make a sound judgement on whether selection bias exists due to attrition or not?
3. In Table 3 of the study, authors reported the following odds ratio (data slightly modified here)

Is there a dose-response relationship between SSB intake and risk of overweight/ obesity, if yes then for which group? Justify your answer.

1. Is dose response relationship a necessary criterion for the causal effect of SSB intake on overweight/obesity?
2. Comment on the internal validity of the estimates for the negative effect of SSB intake on overweight/obesity from this study based on your findings above.
3. Systematic review: SSB and obesity (25%) (500 words) QinP, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M. Sugar and artiicially sweetened beverages and risk of obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality: a dose- response meta-analysis of prospective cohort studies. Eur J Epidemiol. 2020 Jul;35(7):655-671. doi: 10.1007/

s10654-020-00655-y. Epub 2020 Jun 11. PMID: 32529512.

Qin et al. reviewed the evidence from seven prospective cohort studies on SSB intake and obesity. For this assignment focus only on the association between SSB intake and obesity and ignore others.

1. In your own words and in less than fifty words summarise why did the authors conduct this systematic review.
2. On pages 657-658, authors reported two different pooled relative risk for the exposure of SSB consumption and risk of obesity: 1.20 (95% CI: 1.10 – 1.31) and 1.12 (95% CI: 1.05 – 1.19). Once SSB consumption was considered as a categorical variable (high compared to low) and once as a continuous variable (per 250-mL/d increase (a standard can of SSB)). Summarise the two pooled effect estimates in your own words.
3. Authors reported that all studies were of good methodological quality, presumably meaning they determined these studies had a low risk of bias. How did the authors examine the risk of bias and are there any issues with using such tools for assessing risk of bias?
4. Comment on the level of heterogeneity (not important, moderate, substantial or, considerable), the source of heterogeneity and publication bias as reported in the review when the exposure was SSB intake (per 250-mL/d increase) and obesity.
5. The review has an eligibility criterion of including studies conducted on adults over the age of 18 years. Comment if this may cause issues with external validity when applied to school going children in Honiara.

Third year: Communicating epidemiological findings (25%) Suppose that the cross-sectional study you conducted found that in 2021 the prevalence of overweight was 20% and of obesity was 10%. You found that 35% of school-going children consume SSBs on a daily basis.

A news article (10%) (250 words)

A journalist of the health section of the leading newspaper in comes across your work over the last two years in Honiara. He approaches you to write a small piece (250 words) communicating the risk of obesity in Honiara among school- going children. Based on your findings from the cross-sectional study and the review of evidence from the second year of the project, write a small piece on negative effects of SSBs on obesity among school-based children.

• Your answer should avoid technical jargon that citizens of Honiara can not understand.
• You are strongly encouraged to use the evidence from the cohort study and the systematic review and meta-analysis of prospective cohort studies.
• You are not required to, but you can use other references to support strategies for preventing obesity among children in Honiara.

Short letter to the panel next steps (15%) (250 words) The public health panel has announced that they have $50,000 US Dollars available to consider a pilot intervention study to examine potential school-based interventions to reduce SSB consumption among school-aged children based on your findings. In less than 250 words write a letter to the panel that outlines:

1. a school-based intervention to reduce SSB consumption in school-aged children in Honiara (this must be an evidence- based intervention and the source must be referred to in the letter),
2. propose an appropriate study design,
3. justify the study design based on strengths and weakness of the proposed study design over other study designs,
4. Write the research question using PICOT criteria
5. the potential benefits to school-aged children in Honiara.