PUBH6005 Epidemiology Assignment: Study Design, Sampling, Risk

This report analyzes various aspects of study design, sampling, and population risk, focusing on the Whitehall studies and their implications. It examines the sampling frames used in Whitehall I and II, disease risk assessment methods, and the generalizability of the study results to other populations, including the feasibility of conducting a similar study in Australia. The report also explores different study designs for assessing causal relationships between various factors and health outcomes, such as lung cancer and smoking, depression and binge eating, the effects of detention on asylum seekers, folate supplementation and autism, and drug testing for Alzheimer's disease. The report provides recommendations on the most effective study methods for each scenario, including randomized control trials, longitudinal studies, meta-analysis, and experimental designs, along with the rationale behind these choices. The assignment demonstrates an understanding of epidemiological principles and the application of various research methodologies to address public health issues.

Running head: STUDY DESIGN, SAMPLING AND POPULATION RISK
STUDY DESIGN, SAMPLING AND POPULATION RISK
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1STUDY DESIGN, SAMPLING AND POPULATION RISK
Part 1:
What is the sampling frame for each phase of the Whitehall study (Whitehall I and II)?
The sampling frame used for the Whitehall I study was the randomized control trail in
which the survey was conducted consisting of the civil servants, belong to the male gender,
and who lived in London for the duration between 1967 and 1969 (Marmot et al., 1978).
Whereas the sampling frame used for Whitehall II study was the method of
disproportionate randomized sampling. In this study, the sampling population was selected on
the basis of different age group which included both men as well as women serving in the
offices of London as civil servant with unequal intervals. The age groups for the study was
distributed in to each phase in a manner where (Breeze et al., 2001);
Phase 1 included people of age above 34 and below 56
Phase 2 included people of age above 36 and below 61
Phase 3 included people of age above 40 and below 65
Phase 4 included people of age above 41 and below 67
Phase 5 included people of age above 44 and below 70
Phase 6 included people of age above 47 and below 72
Phase 7 included people of age above 49 and below 75
Phase 8 included people of age above 52 and below 77
Phase 9 included people of age above 54 and below 81 (Chandola et al., 2008).

2STUDY DESIGN, SAMPLING AND POPULATION RISK
How was disease risk assessed (both in data collection and analysis) in each of the three
studies and why?
According to the study conducted by Marmot et al., (1978) on Whitehall I stated that
individual which includes both men and women with the lower job options witness increased
risk of suffering from coronary heart diseases. The researchers conducted the survey for three
years in two different type of occasions. The result statistic stated that the population with
low job control has an odd ratio of about 1.94 in comparison with the high job control
population and also that the risk factor for the disease in not dependent on the work support
and demand of the jobs (Marmot et al., 1978).
According to study conducted by Breeze et al., (2001) for the Whitehall II, the
population with poor health condition and socioeconomic status are more susceptible to
coronary heart diseases. The survey findings were similar to those of the Whitehall I study
which stated that age also plays a major factor in the condition (Breeze et al., 2001).
The study of Whitehall II conducted by Chandola et al., (2008), included both men
and women serving as civil servants and they all belonged to the age group above 34 and
below 80 years. These populations have witnessed work stress and other heath difficulties
leading to coronary heart disorders. The findings demonstrated that there is a link between
the stress achieved in the workplace with the coronary heart disorders (Chandola et al., 2008).
To what extent can the results of each of the three studies be generalised to other
populations
The Whitehall I study was conducted within the men civil servants of the London
offices and lived there between the years of 1967 and 1969 and the Whitehall II study was

3STUDY DESIGN, SAMPLING AND POPULATION RISK
conducted involving both the men and the women civil servants living and working in
London, they belonged to different age groups with unequal intervals (Marmot et al., 1978).
The three studies stated the same issues and findings, which provided the information
that occurrence of the coronary diseases occurs more often to individuals with minor socio-
economic status as well as low job control (Breeze et al., 2001). The findings of the three
studies stated that the individuals of working class with the decreased job security witness
stunted growth, overweight, increased blood pressure, high blood sugar level and habit
substance abuse, increasing the risk of coronary heart disease. Thus the findings of the three
studies stated that the lower the job and socio-economic condition, higher us the risk of
coronary heart disease (Chandola et al., 2008).
Would it be feasible to conduct a similar study in Australia using an existing cohort such
as the 45 and up study cohort or the Australian Women’s longitudinal study cohort? Why
or why not?
Regions of Australia has been witnessing various difficulties and issues of increases
in the ageing individuals. As Australia has developed in their field of medical practice, the
rate of mortality has decreased and thus leading to an increase in the ageing population
belonging to the age group of 65 and above. The growing ageing population provides the
Australian health care organizations with the idea to focus on the growing issues related to
the ageing population, their treatment and accommodation as well as financial support. The
three consecutive studies provide them with the better understanding of the need to
incorporate their attention in developing treatment approaches, old age accommodations and
insurances for the elderly populations (Chandola et al., 2008). Thus, it makes it reasonable to
perform the similar study in Australia with the help of the existing cohort such as the 45 and
above study cohort.

4STUDY DESIGN, SAMPLING AND POPULATION RISK
These studies will help the understand the issues and factors that has been effecting
the aging population in Australia, which includes, the habit of substance abuse, nutrition
uptake, socio-economic condition, culture and availability and access to health care facilities
(Marmot et al., 1978). In order to provide better health to these ageing populations, it will be
necessary to address their quality of life, eating habits, risk factors for diseases, medical
assistance and treatment. hence, it is known that the cohort study will help in understanding
the disease, the severity of the infections and the reason behind the generation of the health
condition as well as the health care strategies and treatment outcomes. The research should be
conducted for long duration in order to better assess the effectiveness of the study and its
better outcomes on the ageing population.
Part 2:
Causal relationship between lung cancer and smoking
In order assess the association between lung cancer and smoking habit, it will be
effective to use randomized control trial as the study method, as it permits the selection of
control and test group on randomized manner. It is helpful in maintaining then decreased
level of risk factors and benefits during the trail. It is effective in cases of assessing lung
cancer treatment and association of the condition with smoking habit, as it permits
comparison of treatments with the other variations found in the treatment process. The study
method permits smoking to the trial population here as the control are not permitted to smoke
and the different outcomes from both the trail and control group are assessed (Fehrenbacher
et al., 2016). As the study is based on random selection of the population, it decreases the
chances of being biased while selecting population and test methods, permitting accurate test
findings. The study population needs to be huge and the research should be conducted for
longer duration in order to better asses the outcomes of the study (Goldberg et al., 2016).

5STUDY DESIGN, SAMPLING AND POPULATION RISK
Association between depression and binge eating in a population of obese adolescents and
adults
In order to assess the association in between the depression state and binge eating
within the obese population of adolescents and adults, it will be effective to use longitudinal
study method (Fichter & Quadflieg, 2016). It is one of the methods that have the ability to
best assess the different patterns of variables in the provided time duration for any condition
and also ensures appropriate results than that of other methods. The study method also
requires longer time duration with huge sample population to conduct the study. The cohort
study conducted on the adults and adolescent with the condition of obsess showed that it is
more likely to occur in females than the male groups. The findings also provided the
information that, the binge eating habit is not associated with substance abuse practise but, it
is due to the level of stress in their lives and it might later lead to substance abuse (Hazzard et
al., 2018).
Long term effects of detention on the mental and physical health of asylum seekers
In this condition, the use of meta-analysis as the study or research design will be
helpful. It ensures qualitative analysis of the study findings and also requires linear regression
to assess the physical and mental effects of admission to the asylum (Turrini et al., 2019).
The research design uses statistical analysis with combing the various evidences to better
interpret the condition and oitcomes.it is one of the simplest methods to operate and easy to
analyse the results. The study model is also found to be sensitive because of the data
anomalies, resulting in providing false interpretations in some conditions. The study design
helps in better assessment of the mental and physical condition of an individual staying in
asylum for longer duration and analyse data with the information of the individual before

6STUDY DESIGN, SAMPLING AND POPULATION RISK
admission to the asylum (Nosè et al., 2017). It compares the finding before detention to the
asylum and after getting out of the asylum after a long duration of stay.
Relationship between folate supplementation during pregnancy and development of autism
in offspring
The experimental study design will be effective in order to assess the association of
the condition of pregnancy and use of the prenatal folic acid supplement, also the increase in
risk of the occurrence of autistic syndrome in the child. the prenatal folic acid is used as
supplement during the phases of pregnancy, as it has an effective role in decreasing the risk
of any deficiency in the child’s neural tube (Harrison et al., 2019). Though, there are still
researches that needs to be conducted in order to ensure that these supplements have their
effectiveness in restoring other neuro-development difficulties in the children. These
experimental study design functions in a controlled population with flied experiments and has
the ability to clearly interpret the outcomes and also assess the effects and activities if
different drugs and their level in the plasma (Malek et al., 2019).
Testing of a drug for use in elderly people diagnosed with Alzheimer’s disease
In order to study the outcomes of any drug administration in the elderly individual
witnessing Alzheimer’s, it will be effective to use clinical trial and experimental study
methodology, as these methods are better effective in conditions for monitoring the
effectiveness of any drug. Elderly population often suffer due to the condition of fall due to
their impaired health condition. it has been stated in various researches that, several
medications provided to the elderly population for their condition of fall and Alzheimer’s
may have deleterious effects on the health of these individuals (Nasica-Labouze et al., 2015).
Thus it will be necessary to experiment of the effects and outcomes of the drugs administered

7STUDY DESIGN, SAMPLING AND POPULATION RISK
for the condition of Alzheimer’s in the elderly population and it will be better performed
using clinical trial and experimental study methodology. The study design helps in
understanding the availability of the products, various studies, and the accumulation of drug.
It also helps in comparing the effectiveness and other factors of various other drugs that are
available for the condition of Alzheimer’s.

8STUDY DESIGN, SAMPLING AND POPULATION RISK
Reference:
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. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446548/
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.
https://doi.org/10.1093/eurheartj/ehm584
Fehrenbacher, L., Spira, A., Ballinger, M., Kowanetz, M., Vansteenkiste, J., Mazieres, J., ...
& Braiteh, F. (2016). Atezolizumab versus docetaxel for patients with previously
treated non-small-cell lung cancer (POPLAR): a multicentre, open-label, phase 2
randomised controlled trial. The Lancet, 387(10030), 1837-1846.
https://doi.org/10.1016/S0140-6736(16)00587-0
Fichter, M. M., & Quadflieg, N. (2016). Mortality in eating disorders‐results of a large
prospective clinical longitudinal study. International Journal of Eating Disorders,
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Goldberg, S. B., Gettinger, S. N., Mahajan, A., Chiang, A. C., Herbst, R. S., Sznol, M., ... &
Yu, J. (2016). Pembrolizumab for patients with melanoma or non-small-cell lung
cancer and untreated brain metastases: early analysis of a non-randomised, open-label,
phase 2 trial. The lancet oncology, 17(7), 976-983. https://doi.org/10.1016/S1470-
2045(16)30053-5

9STUDY DESIGN, SAMPLING AND POPULATION RISK
Harrison, A., Pentieva, K., Ozaki, M., McNulty, H., & Parle‐McDermott, A. (2019).
Assessment of candidate folate sensitive‐differentially methylated regions in a
randomised controlled trial of continued folic acid supplementation during the second
and third trimesters of pregnancy. Annals of human genetics, 83(1), 23-33.
https://doi.org/10.1111/ahg.12281
Hazzard, V. M., Hahn, S. L., Bauer, K. W., & Sonneville, K. R. (2019). Binge eating-related
concerns and depressive symptoms in young adulthood: Seven-year longitudinal
associations and differences by race/ethnicity. Eating behaviors, 32, 90-94.
https://doi.org/10.1016/j.eatbeh.2019.01.004
Malek, L., Umberger, W. J., Zhou, S. J., Makrides, M., & Huynh, E. (2019). Understanding
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10STUDY DESIGN, SAMPLING AND POPULATION RISK
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