# Principles of Epidemiology in Public Health Practice, Third EditionAn Introduction to Applied Epidemiology and Biostatistics

This is an online version of a printed textbook. It is not intended to be an online course.

Refer to the book or to the electronic PDF versionCdc-pdf (511 pages) for printable versions of text, figures, and tables.

Book originally published: October 2006
Book updated: November 2011

# Introduction

This course [book] was developed by the Centers for Disease Control and Prevention (CDC) as a self-study course. Continuing Education for this course is no longer available.

# Objectives

Students who successfully complete this course should be able to correctly:

• Describe key features and applications of descriptive and analytic epidemiology.
• Calculate and interpret ratios, proportions, incidence rates, mortality rates, prevalence, and years of potential life lost.
• Calculate and interpret mean, median, mode, ranges, variance, standard deviation, and confidence interval.
• Prepare and apply tables, graphs, and charts such as arithmetic-scale line, scatter diagram, pie chart, and box plot.
• Describe the processes, uses, and evaluation of public health surveillance.
• Describe the steps of an outbreak investigation.

# Course Design

This course covers basic epidemiology principles, concepts, and procedures useful in the surveillance and investigation of health-related states or events. It is designed for federal, state, and local government health professionals and private sector health professionals who are responsible for disease surveillance or investigation. A basic understanding of the practices of public health and biostatistics is recommended.

## Course Materials

The course materials consist of six lessons. Each lesson presents instructional text interspersed with relevant exercises that apply and test knowledge and skills gained.

### Lesson One: Introduction to Epidemiology

Key features and applications of descriptive and analytic epidemiology

### Lesson Two: Summarizing Data

Calculation and interpretation of mean, median, mode, ranges, variance, standard deviation, and confidence interval

### Lesson Three: Measures of Risk

Calculation and interpretation of ratios, proportions, incidence rates, mortality rates, prevalence, and years of potential life lost

### Lesson Four: Displaying Public Health Data

Preparation and application of tables, graphs, and charts such as arithmetic-scale line, histograms, pie chart, and box plot

### Lesson Five: Public Health Surveillance

Processes, uses, and evaluation of public health surveillance in the United States

### Lesson Six: Investigating an Outbreak

Steps of an outbreak investigation

### Glossary

A Glossary that defines the major terms used in the course is also provided at the end of Lesson Six.

# Supplementary Materials

In addition to the course materials, students may want to use the following:

• A calculator with square root and logarithmic functions for some of the exercises.
• A copy of Heymann, DL, ed. Control of Communicable Diseases Manual, 18th edition, 2004, for reference. Available from the American Public Health Association (202) 777-2742.

# General Instructions

Self-study courses are “self-paced.” We recommend that a lesson be completed within two weeks. To get the most out of this course, establish a regular time and method of study. Research has shown that these factors greatly influence learning ability.

Each lesson in the course consists of reading, exercises, and a self-assessment quiz.

Complete the assigned reading before attempting to answer the self-assessment questions. Read thoroughly and re-read for understanding as necessary. A casual reading may result in missing useful information which supports main themes. Assignments are designed to cover one or two major subject areas. However, as you progress, it is often necessary to combine previous learning to accomplish new skills. A review of previous lessons may be necessary. Frequent visits to the Glossary may also be useful.

## Exercises

Exercises are included within each lesson to help you apply the lesson content. Some exercises may be more applicable to your workplace and background than others. You should review the answers to all exercises since the answers are very detailed. Answers to the exercises can be found at the end of each lesson. Your answers to these exercises are valuable study guides for the final examination.

## Self-Assessment Quizzes

After completing the reading assignment, answer the self-assessment quizzes before continuing to the next lesson. Answers to the quizzes can be found at the end of the lesson. After passing all six lesson quizzes, you should be prepared for the final examination.

• Self-assessment quizzes are open book.
• Unless otherwise noted, choose ALL CORRECT answers.
• Do not guess at the answer.
• You should score at least 70% correct before continuing to the next lesson.

Note that it may ask, “Which is CORRECT?” as well as “Which is NOT CORRECT?” or “Which is the EXCEPTION?”
• Read all the choices given.
One choice may be a correct statement, but another choice may be more nearly correct or complete for the question that is asked.

## Final Examination and Course Evaluation

We recommend that you thoroughly review the questions included with each lesson. There is no final exam.

## Course Evaluation

To do this, go to https://www.cdc.gov/TCEOnline/ and register as a participant. You will then need to register for the course (SS1978) and complete the course evaluation online. Your comments are valuable to us and will help to revise the self-study course in the future.

# Ordering Information

A hard-copy of the text can be obtained from the Public Health Foundation. Specify Item No. SS1978 or SS1000 when ordering.

# Acknowledgments

## Developed by

• U.S. Department of Health and Human Services
• Centers for Disease Control and Prevention (CDC)
• Office of Workforce and Career Development (OWCD)
• Career Development Division (CDD)
• Atlanta, Georgia 30333

### Technical Content

• Richard C. Dicker, MD, MSc, Lead Author, CDC/OWCD/CDD (retired)
• Fátima Coronado, MD, MPH, CDC/OWCD/CDD
• Denise Koo, MD, MPH, CDC/OWCD/CDD
• Roy Gibson Parrish, II, MD

### Development Team

• Sonya D. Arundar, MS, CDC (contractor)
• Ron Teske, MS, CDC (contractor)
• Susan Baker Toal, MPH, Public Health Consultant
• Nancy M. Hunt, MPH, CDC (ORISE Fellow)
• Susan D. Welch, MEd, Georgia Poison Center
• Cassie Edwards, CDC (contractor)

### Planning Committee

• Christopher K. Allen, RPh, MPH, CDC
• W. Randolph Daley, DVM, MPH, CDC
• Patricia Drehobl, RN, MPH
• Sharon Hall, RN, PhD, CDC
• Dennis Jarvis, MPH, CHES, CDC
• Denise Koo, MD, MPH, CDC

### Graphics/Illustrations

• Sonya D. Arundar, MS, CDC (contractor)
• Lee Oakley, CDC (retired)
• Jim Walters, CDC

### Technical Reviewers

• Tomas Aragon, MD, DrPH, San Francisco Department of Public Health
• Diane Bennett, MD, MPH, CDC
• Danae Bixler, MD, MPH, West Virginia Bureau for Public Health
• R. Elliot Churchill, MS, MA, CDC (retired)
• Roxanne Ereth, MPH, Arizona Department of Health Services
• Stephen Everett, MPH, Yavapai County Community Health Services, Arizona
• Michael Fraser, PhD, National Association of County and City Health Officials
• Nancy C. Gathany, MEd, CDC
• Marjorie A.Getz, MPHIL, Bradley University, Illinois
• John Mosely Hayes, DrPH, MBA, MSPH, Tribal Epidemiology Center United South and Eastern Tribes, Inc., Tennessee
• Richard Hopkins, MD, MSPH, Florida Department of Health
• John M. Horan, MD, MPH, Georgia Division of Public Health
• Christina M. Bruton Kwon, MSPH, Science Applications International Corporation, Atlanta
• Edmond F. Maes, PhD, CDC
• Sharon McDonnell, MD, MPH, Darmouth Medical School
• William S. Paul, MD, MPH, Chicago Department of Public Health
• James Ransom, MPH, National Association of County and City Health Officials
• Lynn Steele, MS, CDC
• Donna Stroup, PhD, MSc, American Cancer Society
• Douglas A. Thoroughman, PhD, MS CDC
• Kirsten T. Weiser, MD, Darmouth Hitchcock Medical School
• Celia Woodfill, PhD, California Department of Health Services

## Field Test Participants

• Sean Altekruse, DVM, MPH, PhD, U.S. Public Health Service
• Gwen A. Barnett, MPH, CHES, CDC
• Jason Bell, MD, MPH
• Lisa Benaise, MD, Med Immune, Inc., Maryland
• Amy Binggeli, DrPH, RD, CHES, CLE, Imperial County Public Health Department, California
• Kim M. Blindauer, DVM, MPH, Agency for Toxic Substances and Disease Registry
• R. Bong, RN, BSN, Federal Bureau of Prisons
• Johnna L. Burton, BS, CHES, Tennessee Department of Health
• Catherine C. Chow, MD, MPH, Hawaii Department of Health
• Janet Cliatt, MT, CLS(NCA), National Institutes of Health
• Catherine Dentinger, FNP, MS, New York City Department of Health and Mental Hygiene
• Veronica Gordon, BSN, MS, Indian Health Service, New Mexico
• Susan E. Gorman, PharmD, DABAT, CDC
• Deborah Gould, PhD, CDC
• Juliana Grant, MD, MPH, CDC
• Lori Evans Hall, PharmD, CDC
• Nazmul Hassan, MS, Food and Drug Administration
• Daniel L. Holcomb, BS, Agency for Toxic Substances and Disease Registry
• Asim A. Jani, MD, MPH FACP, CDC
• Charletta L. Lewis, BSN, Wellpinit Indian Health Service, Washington
• Sheila F. Mahoney, CNM, MPH, National Institutes of Health
• Cassandra Martin, MPH, CHES, Georgia Department of Human Resources
• Joan Marie McFarland, AS, BSN, MS, Winslow Indian Health Care Center, Arizona
• Rosemarie McIntyre, RN, MS, CHES, CDC
• Gayle L. Miller, DVM, Jefferson County Department of Health and Environment, Colorado
• Long S. Nguyen, MPH, CHES, NIH
• Paras M. Patel, RPh, Food and Drug Administration
• Rossanne M. Philen, MD, MS, CDC
• Alyson Richmond, MPH, CHES, CDC (contractor)
• Glenna A. Schindler, MPH, RN, CHES, Healthcare Services Group, Missouri
• Sandra K. Schumacher, MD, MPH, CDC
• Julie R. Sinclair, MA, DVM, MPH, CDC
• Nita Sood, RPh, PharmD, U.S. Public Health Service
• P. Lynne Stockton, VMD, MS, ELS(D), CDC
• Jill B. Surrency, MPH, CHES, CDC (contractor)
• Joyce K. Witt, RN, CDC

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Page last reviewed: May 18, 2012