Day 3

Prevalence

1
Continuing with Tools for Doing the Study

On an average school day, how many hours do you watch TV?

  ✔ From questions to answers
 
A. I do not watch TV on an average school day
✔ From answers to counts
 B. Less than 1 hour per day
 C. 1 hour per day

From counts to prevalence

 D. 2 hours per day
 E. 3 hours per day
 F. 4 hours per day
From prevalence to statements
G. 5 or more hours per day
 

2
Continuing with tools for doing a study
✔What are you curious about?
✔From curiosity to a hypothesis
✔From a hypothesis to questions
✔From questions to answers
✔From answers to counts
From counts to prevalence
From prevalence to statements

Interpretation – Conclusions - Communication

3
Three main tools

4
 Review - Tool # 1

1. Cross-sectional study design: a relatively

quick way to test a hypothesis

al le da
s c A sn
ti m e t u dy apsh
e s of w o
Som alence hat t
prev
is go
on ing

One poi
nt
in time
An observational study

5
 Review - Tool # 2

2. Contingency table: puts numbers in a table

so we can get from answers to counts

s u re
e xpo The
ow s o m e table simples
Sh d out c t
an is th
e 2x
table 2

Everyon
e i s in
the table
somewh
ere
Handy for calculations
6
 Tool # 3

3. Prevalence – calculations to quantify

outcomes in populations; prevalence ratios
(comparisons) provide a measure of
association between exposure and outcome
d as
late o r
a lcu tion Eve
C ra c ge
f
a cen ta ou t r y one
com with
per and e – th
lon rece e
g-te nt
rm

Especially used in cross-sectional studies 7

 From Epi Textbooks

The main outcome measure obtained from a

cross-sectional study is prevalence.

A cross-sectional study is sometimes called a

prevalence study.

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 Prevalence
The number of people with a
specified condition or event,
among a specified population
and at a specified time

The proportion of a population

found to have a condition
(typically a disease such as
diabetes or a health-related
behavior such as smoking or
seat-belt use)

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10
 Express it in numbers

The Numerator is the number of

people in the population or
sample who experienced the
outcome or effect, in this case,
wearing blue.

The Denominator is the total

number of people in the
population or sample, in this
case, total number of students
in the class.

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 Prevalence of wearing blue
Numerator
The number of students who
are wearing blue

Denominator
All the students in the class

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 Prevalence of wearing blue

# wearing blue
x 100 = % wearing blue
# in class

= Prevalence
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 Prevalence of wearing glasses

Numerator
The number of students
who are wearing glasses

Denominator
All the students in the class

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 Prevalence of wearing glasses

# wearing glasses
x 100 = % wearing glasses
# in class

= Prevalence
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 Numerator
The number of students who
had cereal for breakfast

Denominator
All the students in the class

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 Numerator
The number of students who
walked to school

Denominator
All the students in the class

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 Numerator
The number of students who . . . ?

Denominator
All the students in the class

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Prevalence Ratio

A comparison of two
prevalences

Calculated by dividing the

prevalence of the outcome
in the exposed by the
prevalence of the outcome
in the unexposed  

a/(a+b) divided by c/(c+d).

19
High school students who send more text messages/day are
more likely to binge drink compared to students who send fewer
text messages/day.

Binge Not a binge Prevalence

drinker drinker Total Prevalence Ratio

Hyper- 30
30 70 100 30 %
texter a b 100
c d
1.4
Not a
hyper- 88
88 312 400 22 %
texter 400

a c
a+b ÷
c+d

People who ____________________________________________

are ______ times as likely to _______________________________
compared to people who __________________________________ 20
High school students who send more text messages/day are
more likely to binge drink compared to students who send fewer
text messages/day.

Binge Not a binge Prevalence

drinker drinker Total Prevalence Ratio

Hyper- 30
30 70 100 30 %
texter a b 100
c d
1.4
Not a
hyper- 88
88 312 400 22 %
texter 400

Hyper-texters are 1.4 times as likely to binge drink than

those who are not hyper-texters.
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 Interpretation of Prevalence Ratios
Results Interpretation
Prevalence Ratio POSITIVE ASSOCIATION - the prevalence
Above 1.0 rate among the exposed group is greater than
the prevalence rate among the unexposed
group

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Teenagers who are not restricted from watching R-rated films
are more likely to try smoking compared to teenagers who have
restrictions on watching R-rated films.

Tried Did not try Prevalence

smoking smoking Total Prevalence Ratio

656
No 656 771 1427 46 %
restriction a b 1427
c d
3.5
Partial or 413
complete 413 2704 3117 13%
restriction 3117

a c
a+b ÷
c+d

People who ____________________________________________

are ______ times as likely to _______________________________
compared to people who __________________________________ 23
Teenagers who are not restricted from watching R-rated films
are more likely to try smoking compared to teenagers who have
restrictions on watching R-rated films.

Tried Did not try Prevalence

smoking smoking Total Prevalence Ratio

656
No 656 771 1427 46 %
restriction a b 1427
c d
3.5
Partial or 413
complete 413 2704 3117 13%
restriction 3117

Teenagers who have no restrictions on watching R-rated

films are 3.5 times as likely to try smoking as those who
have restrictions. 24
 Interpretation of Prevalence Ratios
Results Interpretation
Prevalence Ratio POSITIVE ASSOCIATION - the prevalence
Above 1.0 rate among the exposed group is greater than
the prevalence rate among the unexposed
group

25
Students living in urban areas engage in more experimenting
with prescription drugs than students living in rural areas.

Did Did not Prevalence

Experiment experiment Total Prevalence Ratio

95
Urban 95 905 1000 9.5 %
a b 1000
c d
0.73
Rural 130
130 870 1000 13.0 %
1000

a c
a+b ÷
c+d

People who ____________________________________________

are ______ times as likely to _______________________________
compared to people who __________________________________ 26
Students living in urban areas engage in more experimenting
with prescription drugs than students living in rural areas.

Did not Prevalence

Experiment experiment Total Prevalence Ratio

95
Urban 95 905 1000 9.5 %
a b 1000
c d
0.73
Rural 130
130 870 1000 13.0 %
1000

Students in urban areas are 0.73 times as likely to experiment

with prescription drugs than students in rural areas. 27
 Interpretation of Prevalence Ratios
Results Interpretation
Prevalence Ratio POSITIVE ASSOCIATION - the prevalence
Above 1.0 rate among the exposed group is greater than
the prevalence rate among the unexposed
group

28
 Interpretation of Prevalence Ratios
Results Interpretation
Prevalence Ratio POSITIVE ASSOCIATION - the prevalence
Above 1.0 rate among the exposed group is greater than
the prevalence rate among the unexposed
group
Prevalence Ratio NEGATIVE ASSOCIATION the prevalence rate
Below 1.0 among the exposed group is lower than the
prevalence rate among the unexposed group

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 Interpretation of Prevalence Ratios
Results Interpretation
Prevalence Ratio POSITIVE ASSOCIATION - the prevalence
Above 1.0 rate among the exposed group is greater than
the prevalence rate among the unexposed
group
Prevalence Ratio NEGATIVE ASSOCIATION the prevalence rate
Below 1.0 among the exposed group is lower than the
prevalence rate among the unexposed group
Prevalence Ratio NO ASSOCIATION – the prevalence rate
At or among the exposed group is similar or the
Near 1.0 same as the prevalence rate among the
unexposed group

• A prevalence ratio of 1.1 is a weak positive association, while a prevalence

ratio of 3.1 is a strong positive association
• A prevalence ratio of 0.95 is a weak negative association, while a ratio of
0.45 is a strong negative association
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 Results from some Epi Teams in Paterson NJ

Epi Stars - Drinking at least 2 cans or a 20-ounce bottle of

non-diet soda every day leads to a crash (feeling tired) - PR = 2.5

Pop Science – A healthy breakfast is associated with playing

in an organized sport - PR = 0.96

Hypertensions – Receiving a daily, weekly, or monthly

allowance is related to eating junk food/unhealthy food more
than twice a day - PR = 1.6

Dr. Observation – Healthy eating (at least 2 servings of fruit

and vegetables a day) results in better grades (“doing well
in school”) - PR = 1.0

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 Quick Summary of Cross-Sectional Study Calculations

• Questions about exposure and outcome are answered

simultaneously.
• Answers on exposure and outcome can be put into a 2x2
table.
o A “yes/no” answer will fit
o If using a multiple choice question, a predetermined “cut point” is
needed to define a “higher/lower” range to fit into a 2x2 table.
• Counts in the 2x2 table allow calculations of prevalence

• Comparisons of prevalences (prevalence ratio) allows a

statement about the association between exposure and
outcome.
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 Measure of Risk
The prevalence ratio (PR) is a measure of risk used in cross-sectional
studies. It compares prevalence in the exposed to prevalence in the
unexposed. A ratio of 1.0 denotes no difference between the two groups.

Interpreting
Interpreting PR SMR
and and Confidence
Confidence Intervals
Intervals

High, Statistically Significant

Examples

High, Not Statistically Significant

As Expected

Low, Statistically Significant

0 1 2 3 4 5 6 7
NoBaseline
difference SMR
Mortality Prevalence Ratio
between
exposed
in Generaland
unexposed
Population
Breakout Assignment

Prevalence

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Perform a few practice calculations as needed

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Deck Worksheet – page 2

Calculate the prevalence of the

outcome – for the exposed group
and for the unexposed group.

Calculate the prevalence ratio.

Populate the 2x2 table on page 1

with the above information.

Make a statement that uses the

prevalence ratio to describe size
of the association.

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Study Proposal: Section 6

6. Data Analysis Plan

6a. Contingency Table

6b. Prevalence among exposed

6c. Prevalence among unexposed

6d. Prevalence Ratio

6e. Statement of results

6f. How prevalence ratio will be used

in your study

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