Introduction to Epidemiology

A. Criteria to identify a case and controls-

Cases- Men and women who are drinkers and have a positive bladder cancer state. Cancer of non-invasive nature will be selected for the study purpose. Patients having a diagnosed stage of bladder cancer, having a TNM staging of TaNxMo will be taken into consideration for the study purpose. Patient having noninvasive papillary carcinoma of bladder will be taken for the study, as per the diagnosis defined by the TNM staging of cancer post screening.

Controls- Men and women between the age group of 50-70 years, selected on the basis of underlying risk factors and on the basis of existing literature review.

  1. Demographics including age, occupation, ethnicity, race.
  2. Drinkers, positive bladder cancer status, attributing risk factors.
  3. Family history of binge drinking, family history of smoking, family history of bladder cancer.
  4. Other life style related risk factors, such as high BMI, stress and anxiety, nutritional status, physical activity and so on.
  5. Including all kinds of alcoholic beverages such as on beer, red wine, white wine, sherry, other fortified wines, liqueur, and liquor. 
  6. Bladder cancer to be identified on the basis of TNM staging of cancer.
  7. Methods of recruitments of cases and controls-

As many of the subjects and participants might not be willing to give their consent for the study, with a fear of their identity getting revealed, three optimal methods for recruitment of the study can be taken. There are multiple methods that can be opted for recruiting participants for this study, irrespective of its limitations. These methods can be as follow:

  • Through the means of previous study- The study can be based on a previously conducted cohort study. This previous study might not fulfill all criteria for the study, but might be able to cover on the basic aspects. For example, certain studies are there which have been able to directly link the development of bladder cancer with binge drinking. However, there is a limited data proving the same effect of mild of moderate drinking in contributing to the person developing bladder cancer. The previous studies conducted have also not been able to establish a string connection for the incidence of drinking and development of bladder cancer in women. As this study will be considering both males and females, a larger group of population can be catered to.
  • Through the means of post- A particular region can be selected for the study purpose. The local database of the region can be searched for communities’ settings where individuals are more social and prefer going to bars and restaurants quite often. The database search will also be able to provide good demographics details of the targeted population, thus, minimizing few steps in the data collection method (Maheshwari, 2020). Local clinics and community centers can also be approached for recruiting potential candidates for conducting this study. Local general practioners and clinics will also be able to provide details on personal history and other parameters. This can also be an effective method to recruit people who are already diagnosed with bladder cancer and may be having an ongoing treatment for the same.
  • Through the means of support groups- People suffering from cancer often tend to attend certain support groups. People might also be enrolled in deaddiction groups to get treated for alcohol misuse. These people can be directly recruited from these support groups and centers. As they will be approached through a channel, they are already aware of, it will be easier to gain their trust. This will also make it easy for the recruiter to compel them to take part in the study. The abstract data can also be collected from these support group, without the direct involvement of the candidates and by keeping their identity under covers (Chung, 2019). A larger sample size for the study can be covered by this means. It will reduce the selection time considerably and will also help in narrowing down the selection-bias, possible during voluntary recruitment of the participants. This method can also be considered as time as well as cost effective. A good compiled data can be obtained from a single valid information pool.

B. Measure of alcohol consumption-

In order to measure the alcohol consumption in the subjects considered for the study purpose, they can be divided into mild, moderate and severe of binge drinkers.

  • Mild drinkers can be considered as individuals having a drink of 1-2 per week or occasionally taking any drink.
  • Moderate drinkers can be classified into drinkers who have 5-6 drinks per week.
  • Severe drinkers can also be classified as the individuals consuming alcohol in a binge manner. This can include both heavy episodic drinking events or single occasion drinking which is risky in nature. Excessive intake of alcohol that too far beyond the prescribed limit (Zheng, 2020).

The further assessment can be done by some of the common assessment tools, that include self-reporting data. This can be in the form of self-administered computer or paper-based screening questionnaire that can be self-reported by the participants taking place in the study. Two of the most appropriate tools for this case study can be SMAST (Self-Administered Michigan Alcoholism screening Test) (Go, 2018) and ARPS (Alcohol-Related Problem Survey) (Grucza, 2018). Both of these scales are clinician certified and can be helpful in providing authentic data, as it is self-reported. It can also help in highlighting the underlying and attributing risk factors, acclimating in the habit of drinking in the participants.

References for Introduction to Epidemiology 

Chung, S. Y., Hacker, E. D., Rawl, S., Ellis, R., Bakas, T., Jones, J., & Welch, J. (2019). Using Facebook in recruiting kidney transplant recipients for a REDCap study. Western Journal of Nursing Research41(12), 1790-1812. DOI

Go, H. Y., & Lee, J. H. (2018). A Study on the Lifestyle of Korean Medical Students: Drinking Patterns and Eating Attitudes. Journal of Society of Preventive Korean Medicine22(3), 21-29. DOI

Grucza, R. A., Sher, K. J., Kerr, W. C., Krauss, M. J., Lui, C. K., McDowell, Y. E., ... & Bierut, L. J. (2018). Trends in adult alcohol use and binge drinking in the early 21st‐century United States: a meta‐analysis of 6 National Survey Series. Alcoholism: Clinical and Experimental Research42(10), 1939-1950. DOI

Maheshwari, N., & Haque, M. M. (2020). A role of competency-based recruitment screening: a case study on Indian manufacturing unit. International Journal of Indian Culture and Business Management20(4), 467-487. DOI

Zheng, Q., Tscharke, B. J., Krapp, C., O’Brien, J. W., Mackie, R. S., Connor, J., ... & Thai, P. K. (2020). New approach for the measurement of long-term alcohol consumption trends: Application of wastewater-based epidemiology in an Australian regional city. Drug and Alcohol Dependence207, 107-195. DOI

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