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Apr 3, 2024

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EPID 410 Spring 2024 Lab 8 - Cohort Studies Learning Objec-ves: • Differen-ate between a prospec-ve and a retrospec-ve cohort study • Calculate and interpret a risk ra-o • Calculate and interpret a>ributable risk • Determine sta-s-cal significance using 95% confidence intervals • Evaluate an epidemiologic abstract for key study elements Part 1. Use the following abstract to answer the ques-ons below. NOTE: The content of this abstract has been modified from its original format. Crouch E., Radcliff E., Benne> K.J., et. al.: Examining the rela-onship between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr 2021; 21: pp. 1388-1394. OBJECTIVE: Although prior research has examined the prevalence of adverse childhood experiences (ACEs) among children with a>en-on deficit-hyperac-vity disorder (ADHD), li>le is known about the household and family se‘ngs of children with ADHD. Our study examined the associa-on between ACEs and ADHD diagnosis. METHODS: We recruited a random sample of 4600 children three years of age or older. At baseline, 400 of the children were determined to have ADHD and were excluded from further study. We collected baseline informa-on on the number of ACEs including parental separa-on/divorce, parental death, witnessing household violence, witnessing neighborhood violence, household mental illness, household incarcera-on, household substance abuse, racial/ethnic mistreatment, and economic hardship on the r emaining 4200 ADHD-free children . We then followed these children over 10 years for a diagnosis of ADHD. RESULTS: Some results from the study are provided in Table 1. Table 1. Number of ACEs and ADHD incidence 1. What is the study design? Cohort study 2. Is this a prospec-ve or retrospec-ve study? ADHD No ADHD Total ≥4 ACEs 50 200 250 <4 ACEs 370 3580 3950 Total 420 3780 4200

Prospec@ve 3. What is the exposure of interest? Number of ACES 4. What is the outcome of interest? Having ADHD or not 5. What is the baseline prevalence of ADHD in the popula-on ini-ally recruited for the study? Express as a percentage and round to the nearest whole number. 400 6. What is the overall cumula-ve incidence of ADHD in the study popula-on? Express per 100 and round to the nearest whole number. 10 7. Calculate the risk ra-o. Round to the nearest hundredth. Interpret your answer in words. 2.22 8. If the 95% confidence interval for your risk ra-o es-mate were 1.72 to 2.71, what would you conclude about the effect of experiencing ≥4 ACEs on the risk of ADHD? Yes 9. Suppose you are the co-author charged with wri-ng the final sentence of the abstract. The final sentence states the conclusions or the “take-home message” of the study results. Given the exposure, outcome, and study results, write a conclusion sentence for the abstract. NOTE: Due to publica2on space limita2ons, you are limited to one sentence. The risk of developing adhd among those who have 4 or more ACES is 2 ;mes the risk of having adhd for those who had less than 4 ACEs 10. Calculate the a>ributable risk of ≥4 ACEs on ADHD, express per 100 popula-on, and round to the nearest whole number. Interpret your answer in words. Among the individuals who had ADHD, 11 deaths per 100 popula-on can be a>riputed to the fact that those people had at least 4 ACEs Part 2 . Table 2 below was taken from a retrospec-ve cohort study looking at weight gain during pregnancy and having a low birth weight infant. Use the table to answer the ques-ons that follow. The table was modified from Putu Riza Kurnia Indriana, Luh Putu Suariyani, Ni Ketut Su-ari. Weight gain during pregnancy and low birth weight babies: a retrospec-ve cohort study in Gianyar District, Bali. Table 2. Incidence of low birth weight and the risk ra-o of several variables V Variables Risk Ra@o 95% CI Weight gain during pregnancy Not in accordance with standards 7.22 3.95, 13.19

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