PUBH6005 Epidemiology Assessment 2: Study Design and Analysis Report

This report analyzes epidemiological study designs, focusing on the Whitehall studies and their implications for public health. Part 1 examines the Whitehall I and II studies, comparing mortality rates across different employment grades and exploring the impact of socioeconomic factors on cardiovascular disease. It also discusses the generalizability of these studies and compares them to other relevant research, such as the UP Study and the Australian Longitudinal Study on Women’s Health. Part 2 delves into the suitability of various study designs—cohort, case-control, cross-sectional, longitudinal, and randomized controlled trials—for addressing specific research questions related to lung cancer and smoking, depression and binge eating, mental complications in detention centers, autism development, and Alzheimer's disease treatment. The report emphasizes ethical considerations for each study design, providing a comprehensive overview of epidemiological research methods and their applications.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Part 1
Answer 1
Whitehall I study compared the mortality of the people under highly stratified
environment of the British Civil service. The study showed that the among the civil servants
of the British Government, the rate of mortality was higher among the lower grade in
comparison to the higher grade civilians. The people, who reside on the higher order of the
hierarchy levels, are expected to live longer in comparison to the person who resides under
the low order of the employment hierarchy. Thus the Whitehall I study concluded that higher
mortality rates are higher among the men of lower employment grade. The study also showed
that higher order mortality rate is due to the higher occurrence of coronary heart disease
among the men with lower employment grade in comparison to the higher grades employee
(Marmot et al., 1991).
The Whitehall II study was conducted with longitudinal perspective over the British
Civil Servant. The prospective cohort study was designed to show the impact of the social
gradient in the process of development of the cardiovascular disease and other associated
lifestyle disease. The results of the study showed that the people who are in the lower
position of the social hierarchy, higher is the mortality rate occurring from the cardiovascular
disease. The social gradient in the Whitehall II study was determined by the grade of
employment, income and education (Marmot et al., 1991).
Answer 2
The study conducted by Breeze et al. (2001), the assessment of the disease risk in the sample
selection was conducted based on the parameters defined by the Whitehall study. The
parameters include personal and family medical history, job profile and smoking habits,

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physical activity. In the resurvey, age, smoking habits, employment grade and baseline
evidence of cardiovascular and respiratory symptoms were take into consideration. Chandola
et al. (2008) also recruited the sample in the study based on the inclusion parameters used by
Whitehall in his second study. In order to measure the overall outcome of the study, the
behavioral risk factors, metabolic syndrome, increase in the concentration of cortisol during
the morning time and variability of the heart rate were taken under consideration. An et al.
(2016) stated that the cortisol marker in the blood and rate of the heart helps to determine the
condition of the cardiovascular system. In order to access the risk of the disease, Marmot et
al. (1978) used self-reported questionnaire. The questionnaire used to access the grade of
employment as one of the important parameters for the assessment of the cardiovascular risk.
Apart from this. London School of Hygiene Cardiovascular Questionnaire was used to access
the smoking history, medical treatments, respiratory symptoms and other leisure time
activities. The outcome was measure based on the cardio-vascular health-related quality of
life patients.
Answer 3
The results of all the three studies can be generalized over other population because,
very common factors that are markers for the cardiovascular health complications are used
for the selection of the population under the study. the physical parameters used include the
past medical history, family medical history and other respiratory problems or smoking
problems. In the domain of the socio-economic factors, the socio-economic status was
selected. Both the people from higher and the lower socio-economic status were selected for
the conduction of the study. McShane and Böckenholt (2017) stated that when generalized
parameters were used for the selection of the population for the study, then the replicability of
the study increases.

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Answer 4
Yes.
Up Study Collaborators (2007) is a large-scale Australian cohort study over the
individuals who are over 45 years of age. Among them are 250,000 men and women selected
from the New South Wales, Australia. Bhupathiraju and Hu (2016) are of the opinion that the
people who are above 45 years of age are more prone towards getting affected cardiovascular
complications in comparison to the younger adults. On the other hand, Australian
Longitudinal Study on Women’s Health (2019) conducted a longitudinal survey over 57,000
women under three different cohort who are aged between 18 to 23, 45 to 50 and 70 to 75.
This study selected a wide array of women between different age group. Skinner et al. (2015)
are of the opinion that the younger adults who lead an unhealthy lifestyle or sedentary life
under present day population are vulnerable to develop cardiac-complications. However, this
cohort study only selected and opted out male thus application of this study over the general
population of Australia will only be limited to women and not men and thus restricting to
obtain generalized results.
Part 2
Answer 1
Cohort study will be suitable for this approach. Cohort studies are conducted over a
period in order to see the process of disease development between the exposed and non-
exposed group. Thus, it will be helpful to study the relationships between lung cancer and
smoking. One of the advantage of cross-sectional study is he incidence can be calculated
directly however, measurement of the effect is associated with relative risks and they are
prone to selection bias. The main ethical considerations that must be followed include

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selection, none of the participants can be forced to take part in the stud and participants can
leave the study at any point of time (Glymour & Bibbins-Domingo, 2019).
Answer 2
Case control study will be best suited in order to the association between depression
and binge eating over obese population including adolescents and adults. This is because,
case control studies are useful for determining the overall degree of associations between the
risk factors and the disease development between different population group. Due to
retrospective study design, case control studies are subjected to recall bias. However, the case
control studies require less time and are inexpensive. The main ethical consideration includes
informed consent that is notifying the selected population about the reason for the recruitment
in the study (DiCenso, Guyatt & Ciliska, 2014).
Answer 3
Cross-sectional study, an observational study format will be best suited to study the
physical and mental complications among the people who are in detention centre for a
prolong period of time. This single time observation helps to reduce the chance of decrease in
sample population arising from the follow-up like the cross-sectionals studies. However, this
study fails to establish the cause and effect relationships and this can be considered as one of
the drawback. The ethical consideration that must be followed in this study is taking consent
from the population before initiation of the study (DiCenso, Guyatt & Ciliska, 2014).
Answer 4
Longitudinal study will be suitable for this purpose. This longitudinal involves
repeated observations over the same variables either during a short and long period of time
(DiCenso, Guyatt & Ciliska, 2014). Thus, a long-term observation will help to ensure the
process of development of autism if any over new born whose mothers are supplemented

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with folate. The disadvantage of this approach is, during the follow-up session the sample
size might get reduce. The advantage of this process is it helps to show patterns of disease
development during the course of time. One ethical dilemma includes harm of the
participants’ health due to long term observation (DiCenso, Guyatt & Ciliska, 2014).
Answer: 5
For testing of the drug over the elderly suffering from Alzheimer’s disease
randomized control trial (RCT) will be suitable. This study is considered as gold standard for
the study design. It will help to avoid the chances of selection bias and confounding bias.
However, during the prospective follow-up the sample size might be reduced. Blinding is an
important perspective RCT but blinding at times hampers the ethical consideration of
autonomy of research (Bothwell et al., 2017).

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References
An, K., Salyer, J., Brown, R. E., Kao, H. F. S., Starkweather, A., & Shim, I. (2016). Salivary
biomarkers of chronic psychosocial stress and CVD risks: a systematic
review. Biological research for nursing, 18(3), 241-263.
Australian Longitudinal Study on Women’s Health. (2019). Study Overview. Access date:
19th July 2019. Retrieved from: https://www.alswh.org.au/
Bhupathiraju, S. N., & Hu, F. B. (2016). Epidemiology of obesity and diabetes and their
cardiovascular complications. Circulation research, 118(11), 1723-1735.
Bothwell, L. E., Greene, J. A., Podolsky, S. H., & Jones, D. S. (2016). Assessing the gold
standard—lessons from the history of RCTs.
Breeze, E., Fletcher, A. E., Leon, D. A., Marmot, M. G., Clarke, R. J., & Shipley, M. J.
(2001). Do socioeconomic disadvantages persist into old age? Self-reported morbidity
in a 29-year follow-up of the Whitehall Study. American journal of public
health, 91(2), 277.
Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., ... &
Marmot, M. (2008). Work stress and coronary heart disease: what are the
mechanisms?. European heart journal, 29(5), 640-648.
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Glymour, M. M., & Bibbins-Domingo, K. (2019). The future of observational epidemiology:
improving data and design to align with population health. American journal of
epidemiology, 188(5), 836-839.

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Marmot, M. G., Rose, G., Shipley, M., & Hamilton, P. J. (1978). Employment grade and
coronary heart disease in British civil servants. Journal of Epidemiology &
Community Health, 32(4), 244-249.
Marmot, M. G., Stansfeld, S., Patel, C., North, F., Head, J., White, I., ... & Smith, G. D.
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McShane, B. B., & Böckenholt, U. (2017). Single-paper meta-analysis: Benefits for study
summary, theory testing, and replicability. Journal of Consumer Research, 43(6),
1048-1063.
Skinner, A. C., Perrin, E. M., Moss, L. A., & Skelton, J. A. (2015). Cardiometabolic risks and
severity of obesity in children and young adults. New England Journal of
Medicine, 373(14), 1307-1317.
Up Study Collaborators. (2007). Cohort profile: the 45 and up study. International journal of
epidemiology, 37(5), 941-947.