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Apr 3, 2024

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1. What information from the newspaper articles did you use to identify the original article? Was one of the articles more helpful than the other for this purpose? This article was published in 2015. Had this article just been released in the last week, what specific search strategy would you begin with? I personally thought the New York Times was more helpful than the Sacramento Bee. I used the graph and the small text at the bottom of the article that said another version was printed in 2015. When I searched that Article, they mentioned it came up in the PNAS (Proceeding of National Academy of Sciences). I then researched same article and included PubMed and found it. I think if it was released this week the only thing, I would do different is look up Anne Case and Angus Deaton studies and hope that I find it that way. 2. Now, if you have not done so already, carefully read the research article. When we critically read research reports we should identify any methodological limitations of the articles, then judge whether these limitations should influence our conclusions. Some methodological limitations I thought could influence my conclusion in this article was regrading the sample of white non-Hispanics selected if education was missing, they based those individuals’ education on cause specific mortality based on sex, year and cause of death. However, that could result in individuals being assigned to the wrong educational level and ultimately affect they hypothesis finding. 3. Focus for the moment on the sub-section on “Mortality Data.” Notice that the investigators used data that had been collected in national and international efforts. Assume that all data that they used were of high quality. Now consider that the international data were not separated by race and ethnicity. What constraints does this place on our ability to interpret the results? In light of these constraints do you believe that that authors’ conclusions are justified? Why or why not? I think limitations that come with not separating race and ethnicity is not being able to determine or justify that a specific race or ethnic group died from specific cause/disease. If I were basing the authors conclusion solely on his international data not separated by race and ethnicity, then I’d say no their conclusion is not justified because they did not separate race from ethnicity so how could they determine midlife white non-Hispanic men had a higher mortality rate. You could not solely on the international data they would just be able to determine which disease had a higher mortality rate. 4. Now consider the “Methods” text, noting that mortality rates (expressed as deaths per 100,000 person-years) are not age-adjusted within the 10 year 45-54 year age group. Is it reasonable to compare these rates between populations, for example between non- Hispanic whites (USW) and Hispanics (USH) in the United States, or between USW and residents of other countries? Why or why not? I think its reasonable compare rates between population because we’re looking at a specified age group. If each populations had the same specified age group. However, I also think its not reasonable if each population and residents of other countries were categorized in different age

groups. I think it could cause outliers and skew the results compared to the USW age group, making the finding unreliable. 5. Return to the results described in the section entitled “Midlife Mortality." Based on cause-specific mortality (figure 2), the authors focus on a particular reason that the trend in all cause mortality for the USW group is notably different from that in all others (figure 1). Do you concur? What would you add to their interpretation? I agree with the author when looking at figure 2 and table 1 that reasons that trend in all cause mortality was notable different for USW when looking at suicides, alcohol poisoning and chronic liver disease. However, suicides accidental or intentionally were undetermined that can create some issues if other countries took this confounding into consideration. Perhaps not doing so causes bias or misclassification for notable all-cause mortality in USW 6. Identify additional specific causes for which mortality increased between 2000 and 2015 in middle-aged non-Hispanic whites in the United States. Comment on how these may (or may not) be related to the “fifth phase of the epidemiologic transition." Specific causes of mortality between 2000 and 2015 in middle-aged non-Hispanic whites in the United States was shown in Fig. 2 within the article, presenting that there was an additional upward mortality from lung cancer and diabetes. This is related to the “fifth phase of epidemiology” because it was marked by the increase in overweight and obesity epidemic. I do think they are related because the figure shows that there was a continued increase, and the fifth house may have used those finding to determine when the obesity epidemic occurred. The obesity epidemic has made diabetes a major concern for midlife Americans due to a continued decrease in physical activity and unhealthy lifestyle the probability from dying of diabetes increases. 7. Hypothesize an explanation for the decline in lung cancer–specific mortality experienced by this group between 2000 and 2015. State a prediction of your hypothesis; how could you attempt to refute it using data collected from humans? I think the decline of smoking in 2000-2015 may have resulted in the population receiving proper education on the harms of smoking through the many scare tactics that were in campaigns, flyers, posters, and commercials. There were many cancer and death commercials involving smoking and therefore there was a dip. I would hypothesis that population exposed to such commercials constantly are less likely to smoke. I could refute this looking at a population exposed to anti-smoking commercials compared to one who does not and see if it truly affects smoking rates within populations.

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