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A clinical pediatric nurse has noticed a rise in childhood asthma diagnoses among the Hispanic population served by the local clinic. The nurse is concerned about this increase in asthma incidence in the patient population and turns to the literature to explore current research on this topic. The nurse finds, through the reading, that there appears to be an association between parental smoking and childhood asthma and wonders if this could be the cause of the rise in cases.
This type of suspected association between a risk factor (exposure) and a particular outcome (childhood asthma) can be evaluated using an observational study design. A relevant case-control study would match a group of controls (no asthma) with the case group (asthma diagnosis). Both groups would then be assessed on certain historical exposures like (a) family history; (b) early childhood respiratory infections; (c) secondhand smoke exposure; (d) urban residence (ozone); and (e) obesity. Measures might include interviews, surveys, and medical records. If results show the case group has a higher rate of exposure to a given risk factor, the researcher may conclude that exposure results in greater odds of asthma.
In any epidemiological study, the design and methodology used should be appropriate for that study and for the research question. It is important for researchers to understand the strengths and limitations of each of the study designs and methods. This gives them a better chance of correctly interpreting results and synthesizing them for use in developing and implementing evidence-based population health programs. For this Discussion, you will explore the strengths and limitations of various types of observational study designs and critique their appropriateness for specific studies.
This type of suspected association between a risk factor (exposure) and a particular outcome (childhood asthma) can be evaluated using an observational study design. A relevant case-control study would match a group of controls (no asthma) with the case group (asthma diagnosis). Both groups would then be assessed on certain historical exposures like (a) family history; (b) early childhood respiratory infections; (c) secondhand smoke exposure; (d) urban residence (ozone); and (e) obesity. Measures might include interviews, surveys, and medical records. If results show the case group has a higher rate of exposure to a given risk factor, the researcher may conclude that exposure results in greater odds of asthma.
In any epidemiological study, the design and methodology used should be appropriate for that study and for the research question. It is important for researchers to understand the strengths and limitations of each of the study designs and methods. This gives them a better chance of correctly interpreting results and synthesizing them for use in developing and implementing evidence-based population health programs. For this Discussion, you will explore the strengths and limitations of various types of observational study designs and critique their appropriateness for specific studies.
Resources

• Review the different types of observational study designs presented in the Learning Resources: ecologic, cross-sectional, case-control, and cohort.
• Carefully examine the characteristics, strengths, and limitations of each design.
• Consider when it is appropriate to use each of the observational study designs.
• Consider how using observational study designs can lead to improvements in population health.
• By Day 1 of this week, you should have received a communication from your Instructor assigning you to a small group to review two specific articles. Review the two articles your group was assigned, with a critical eye toward the researchers’ use of study design and their selected methods. Although several students will be assigned the same articles, this is NOT a group project; please submit your Discussion posts individually. You will then have the opportunity to discuss and share your thoughts with your colleagues.

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Observational Study Designs: Strengths and Limitations

  1. Ecologic Studies:
    • Description: Examines the relationship between exposure and disease at the population level, rather than the individual level.
    • Strengths:
      • Useful for generating hypotheses.
      • Relatively quick and inexpensive.
      • Can examine large populations.
    • Limitations:
      • Ecologic fallacy: Associations at the population level may not reflect individual-level associations.
      • Confounding variables can be difficult to control.
      • Cannot establish causality.
    • Appropriateness:
      • Useful for initial investigations of potential associations, especially when individual-level data is unavailable.
      • Useful to examine the effects of public policy.

Full Answer Section

 

 

 

 

  1. Cross-Sectional Studies:
    • Description: Examines exposure and disease at a single point in time.
    • Strengths:
      • Relatively quick and inexpensive.
      • Can assess prevalence of diseases and exposures.
      • Useful for generating hypotheses.
    • Limitations:
      • Cannot establish temporal relationships (causality).
      • Susceptible to recall bias.
      • Prevalent cases may not be representative of incident cases.
    • Appropriateness:
      • Useful for assessing the prevalence of diseases and risk factors in a population.
      • Useful for generating hypotheses about potential associations.
  2. Case-Control Studies:
    • Description: Compares individuals with a disease (cases) to individuals without the disease (controls) to assess past exposures.
    • Strengths:
      • Efficient for studying rare diseases.
      • Relatively quick and inexpensive.
      • Can examine multiple exposures.
    • Limitations:
      • Susceptible to recall bias.
      • Difficult to select appropriate controls.
      • Cannot directly calculate incidence or prevalence.
      • Can only calculate odds ratios.
    • Appropriateness:
      • Useful for studying rare diseases or diseases with long latency periods.
      • Useful for generating hypotheses about potential risk factors.
  3. Cohort Studies:
    • Description: Follows a group of individuals (cohort) over time to assess the development of disease in relation to exposures.
    • Strengths:
      • Can establish temporal relationships (causality).
      • Can directly calculate incidence.
      • Can examine multiple outcomes.
      • Minimizes recall bias.
    • Limitations:
      • Can be time-consuming and expensive.
      • Susceptible to loss to follow-up.
      • Not efficient for studying rare diseases.
    • Appropriateness:
      • Useful for studying common diseases and exposures.
      • Useful for establishing causality.

Application to the Pediatric Asthma Scenario

  • Case-Control Study:
    • As described in the scenario, a case-control study is a suitable design for investigating the association between parental smoking and childhood asthma.
    • It is efficient for examining multiple exposures, such as family history, respiratory infections, and secondhand smoke.
    • However, researchers must be mindful of potential recall bias, as parents may have difficulty accurately recalling past exposures.
    • Control selection is also very important, to have a control group that is as similar to the test group as possible, besides the presence of asthma.
  • Cohort Study:
    • A cohort study would also be useful. Researchers could follow a group of children from birth, assessing their exposure to parental smoking and other risk factors, and then track the development of asthma over time.
    • This design would provide stronger evidence of causality, but it would be more time-consuming and expensive.
  • Cross Sectional study:
    • A cross sectional study could give a snapshot of current asthma rates, and current smoking habits, within the population. It would not show causality, but could show correlation.
  • Ecological Study:
    • An ecological study could examine asthma rates and smoking rates at the population level, but it would be susceptible to the ecological fallacy.

Improving Population Health

  • Observational studies provide valuable insights into the causes and risk factors of diseases.
  • These insights can be used to develop and implement evidence-based public health programs.
  • For example, if a case-control study finds a strong association between parental smoking and childhood asthma, public health campaigns can be developed to educate parents about the risks of secondhand smoke exposure.
  • Cohort studies can help identify high-risk groups and develop targeted interventions.

By understanding the strengths and limitations of observational study designs, researchers can conduct more rigorous studies and generate more reliable evidence to improve population health.

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