Once persons who have a certain disease have been identified, how do we characterize the natural

history of their disease in

quantitative terms? Such characterization is essential if we are to identify any changes that take place
over time in survival

and severity, or changes that result from preventive or therapeutic interventions ( Chapter 6 ). Because
our ultimate objective

is to improve human health by modifying the natural history of disease, the next step is to select an
appropriate and effective

intervention—a selection that ideally is made using the results of randomized trials of prevention and
treatment (Chapters 7

and 8 [Chapter 7] [Chapter 8] ).

Section II deals with the use of epidemiology to identify the causes of disease. Chapter 9 discusses the
design of cohort

studies and Chapter 10 introduces case-control, nested case-control, case-cohort, case-crossover, and
cross-sectional

studies. Chapters 11 and 12 [Chapter 11] [Chapter 12] discuss how the results of these studies are used
to estimate risk. We

do so by determining whether there is an association of an exposure and a disease as reflected by an

increase in risk in

exposed persons. After a brief review ( Chapter 13 ), Chapter 14 discusses how we move from such
evidence of an

association to answering the important question: Does the association reflect a causal relationship? In
so doing, it is critical to

take into account issues of bias, confounding, and interaction, which are discussed in Chapter 15 .
Chapter 16 describes the

use of epidemiology, often in conjunction with molecular biology, to assess the relative contributions of
genetic and

environmental factors to disease causation.

Section III discusses several important applications of epidemiology to major health issues. Chapter 17
address