© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © PhotoAlto/Laurence Mouton/Getty Images© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NutritionalNOT FOR SALE OR DISTRIBUTION EpidemiologyNOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEand OR DISTRIBUTION Research MethodsNOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ Introduction ■ Epidemiology in Community Health ■ Nutritional Epidemiology ■ Interpretation of Cause and Effect in Nutritional Epidemiology © Jones■ Types & of Bartlett Public Health Learning, Nutritional LLCEpidemiology Research © Jones & Bartlett Learning, LLC NOT■ FORDescriptive SALE Measures OR DISTRIBUTION of Community Health NOT FOR SALE OR DISTRIBUTION ■ The Epidemiological Methods ■ Quantitative and Qualitative Methods ■ Types of Sampling ■ Concepts of Collaborative Research © Jones & Bartlett■ Reporting Learning, Research LLC Results © Jones & Bartlett Learning, LLC ■ Epidemiological Approaches to Community Health Assessment NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION LEARNING OBJECTIVES ■ Define nutritional© Jones epidemiology. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■ Discuss theNOT different FOR types SALE of epidemiological OR DISTRIBUTION research. NOT FOR SALE OR DISTRIBUTION ■ Discuss the difference between quantitative and qualitative research methods. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 83 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284348286_CH03_083_104.indd 83 08/06/17 7:36 PM 84 Chapter 3 Nutritional Epidemiology and Research Methods 6 © Jones▸ & Bartlett Learning, LLC © Joneshealth. &e Bartlett science ofLearning, epidemiology LLC is important to Introduction community and public health nutritionists because it can NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Community and public health nutrition research has be utilized to assess and understand health, diseases, and increased over the years, but nutritionists must continue injury in a community or target population. Epidemi- to increase the scientic knowledge base that is unique ology is a population-focused applied science that uses to their practice to provide high-quality, scientically research and a statistical data collection methodology oriented, evidence-based© servicesJones and& Bartlett solutions Learning,to to- to LLC determine the following7: © Jones & Bartlett Learning, LLC day’s nutrition-related healthNOT conditions.FOR SALE Community OR DISTRIBUTION ■ e population that is aectedNOT by a FORdisease SALE or disorder OR DISTRIBUTION nutrition research is dened as the “organized study ■ e incidence or prevalence of a health problem of a trend at both the basic and more applied levels that in the community focuses on social, structural, and physical environmental ■ e likelihood the causes and risk factors contrib- inequities© Jones through & active Bartlett involvement Learning, of community LLC uting to the© Jones health problem& Bartlett may Learning, or may not LLCbe members,NOT organizational FOR SALE representatives, OR DISTRIBUTION and researchers determinedNOT FOR SALE OR DISTRIBUTION in all aspects of the research process with the specic topics varying between investigators and the public.”1 One example of epidemiological research in the Learning to conduct successful research and epidemi- community is that of the Racial and Ethnic Approaches ological studies is crucial to community nutrition. to Community Health Across the United States (REACH © Jones & EpidemiologyBartlett Learning, is the study LLC of the determinants, © JonesU.S.) Program. & Bartlett e Centers Learning, for Disease LLC Control and NOT FORoccurrence, SALE OR and distributionDISTRIBUTION of health and disease in a NOTPrevention FOR SALE (CDC) OR created DISTRIBUTION REACH U.S. to address the dened population.2,3 It studies scientically the factors problem of health disparities among dierent racial that aect the health of individuals in the community. It and ethnic groups and to show that the health status also serves as the foundation for intervention programs of groups most aected by health inequities can be improved. REACH U.S. supports strategies that ad- that use evidence-based information to address the pre- 8 © Jones2-4 & Bartlett Learning,dress LLC health disparities throughout© Jones the life & span. Bartlett One Learning, LLC vention of health conditions.NOT FOR Today, SALE epidemiologists OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION employ a range of study designs, from observational to of the success stories of the REACH U.S. program was experimental, with the purpose of revealing unbiased conducted at the Genesee County (Michigan) Health relationships between exposures (e.g., nutrition, bio- Department. e department coordinated a multifac- logical agents, stress, or chemicals) and outcomes (e.g., eted community eort to reduce the high death rates diseases,© wellness, Jones and & Bartletthealth indicators). Learning, Epidemiological LLC among African© AmericanJones & infants Bartlett born Learning, in and around LLC studiesNOT are usually FOR categorized SALE OR as DISTRIBUTION follows3,5: Flint, Michigan.NOT e FOR program’s SALE activities OR DISTRIBUTION included the following8: ■ Descriptive (organizing data by time, place, and ■ person) Case-management services designed to reach ■ Analytic (aiming to examine associations or pregnant women and new mothers in high-risk areas of the county © Jones & commonlyBartlett Learning,hypothesized LLC causal relationships, and © Jones & Bartlett Learning, LLC ■ Community dialogue sessions designed to educate NOT FOR SALEincorporating OR DISTRIBUTION a case-control or cohort study) NOT FOR SALE OR DISTRIBUTION ■ Experimental (clinical or community trials of residents about infant death rates and available treatments and other interventions) resources ■ Workshops conducted to help participants understand is chapter discusses the basic research process the connections between racism and health care and epidemiological studies© Jones in dietetic & practice.Bartlett A Learning, more LLC © Jones & Bartlett Learning, LLC advanced research process is presented in Appendix F. Social marketing eorts were used to communicate NOT FOR SALE OR DISTRIBUTIONimportant health messages aboutNOT how FOR to reduce SALE infant OR DISTRIBUTION deaths, and a medical services committee was formed to identify and promote best clinical practices. ▸ Epidemiology in Community Results showed that the death rate for African Health© Jones & Bartlett Learning, LLC American infants© Jones in Genesee & Bartlett County Learning, dropped from LLC NOT FOR SALE OR DISTRIBUTION a high of 23.5NOT deaths FOR per SALE1,000 live OR births DISTRIBUTION in 1999 to Epidemiological and demographic measures and research a low of 15.2 in 2005. In comparison, the rate among methods are used to study health-related conditions. Caucasian American infants in 2005 was 6.3 deaths per For example, they are used to investigate outbreaks 1,000 live births. e disparity ratio between African of food poisoning, chickenpox, measles, and acquired Americans and Caucasian Americans also dropped © Jonesimmunodeciency & Bartlett Learning, syndrome LLC (AIDS). ey are also © Jonesfrom a high & Bartlett of 3.6 African Learning, American LLC infant deaths for NOT FORused SALE to investigate OR DISTRIBUTION environmental conditions, lifestyles, NOTevery FOR 1 Caucasian SALE OR American DISTRIBUTION infant death in 2001 to health-promotion strategies, and other factors that aect 2.4:1 in 2005.8 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284348286_CH03_083_104.indd 84 08/06/17 7:36 PM Nutritional Epidemiology 85 © Jones & Bartlett▸ Learning, LLC © Jonesbecause & Bartlett they may Learning, consume hundreds,LLC even thousands Nutritional Epidemiology of dierent foods during that period. In addition, the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9 Nutritional epidemiology is the study of dietary intake diculty may be due to the following : and the occurrence of disease in human populations.9 ■ Other people preparing the meals (e.g., restaurant, In nutritional epidemiology, accurate quantication friends, spouse, prepackaged foods) so that the of nutritional exposure is critical. Exposure is the client does not know what, or how much, he or characteristics or© agents Jones (e.g., & food, Bartlett medications, Learning, time LLC © Jones & Bartlett Learning, LLC she has consumed in the sun) that aNOT person FOR comes SALE in contact OR DISTRIBUTION with that NOT FOR SALE OR DISTRIBUTION ■ may be related to disease risk (see TABLE 31).10 It is Seasonal variations in food intake ■ complicated and challenging to evaluate and associate Life events (e.g., weekends, holidays, vacations, dietary intake with disease risk. For instance, cigarette birthdays) smoking© Jones can & be Bartlett accurately Learning, assessed as anLLC activity with Indeed,© Jones the daily &