TUGAS TUTORIAL EPIDEMIOLOGI

SESI TUTORIAL 6
Application of Attributable Risk

By:
NADIA CHALIDA NUR
NIM. 15/388169/PKU/15391
GIZI DAN KESEHATAN

PROGRAM STUDI MAGISTER ILMU KESEHATAN MASYARAKAT

FAKULTAS KEDOKTERAN
UNIVERSITAS GADJAH MADA
2015

Tutorial Epidemiologi 6
Application of Attributable Risk
Overview
In epidemiological research, the occurrence of disease in a group of people exposed to a risk
factor is compared to that observed in an unexposed group in order to establish causal
relationships, and to identify effective interventions. In this way we can quantify the association
between a risk (or protective) factor and a disease (or other outcome). An important application
of epidemiology is to estimate how much disease is caused by a certain modifiable risk factor.
The data on the impact of risk factors or interventions are essential to assess the effectiveness
and cost-effectiveness of interventions. In this chapter, you will learn about the value of knowing
risk that is attributable to a specific exposure and assess portion of the risk due to exposure and
predict impact on the disease incidence when a causal risk factor is removed;
Objective
1. Explain the value of knowing the risk that is attributable to a specific exposure
2. Introduce students to the methods for calculating and interpreting attributable risks
3. Calculate the attributable risks to assess the fraction and portion of the risk due to exposure

and predict the impact on the incidence of disease when a causal risk factor is removed
Activity 1 (Before Class Session)

Read assigned article: Effect of viewing smoking in movies on adolescent smoking

initiation: a cohort study

Activity 2
Answers questions below:
a. Why might viewing movies that depict smoking induce adolescents to start to smoke?
Karena remaja lebih banyak menonton film dengan adegan merokok dan bagian dari gaya
hidup. Bisa karena aktor atau aktris kesukaan mereka merokok dan menunjukkan
ketangguhan, keseksian sehingga mereka meniru untuk memulai merokok. Jika pemerintah
tidak melakukan sensor pada film tersebut maka dengan kondisi remaja yang masih labil
akan mudah terpengaruh pada lingkungan yang sering mereka amati. Sehingga remaja akan

menganggap merokok adalah hal yang biasa dan membuat mereka mudah bergaul dengan
yang lain.
b. What epidemiologic study design was used to test the hypothesis?
Cohort Study, dimulai pada tahun 1999 dan di follow up selama 26 bulan
c. How was the study implemented?
We assessed exposure to smoking shown in movies in 3547 adolescents, aged 1014 years,
who reported in a baseline survey that they had never tried smoking. Exposure to smoking in
movies was estimated for individual respondents on the basis of the number of smoking
occurrences viewed in unique samples of 50 movies, which were randomly selected from a
larger sample pool of popular contemporary movies. We successfully re-contacted 2603
(73%) students 1326 months later for a follow-up interview to determine whether they had
initiated smoking.
d. What were the results of the study?
Overall, 10% (n=259) of students initiated smoking during the follow-up period. In the
highest quartile of exposure to movie smoking, 17% (107) of students had initiated smoking,
compared with only 3% (22) in the lowest quartile. After controlling for baseline
characteristics, adolescents in the highest quartile of exposure to movie smoking were 271
(95% CI 173425) times more likely to initiate smoking compared with those in the lowest
quartile. The effect of exposure to movie smoking was stronger in adolescents with nonsmoking parents than in those whose parent smoked. In this cohort, 522% (300673) of
smoking initiation can be attributed to exposure to smoking in movies.
e. For what potential confounders did the investigators account?
Potential Counfounder :
child characteristics (sex, age, school, self-reported school performance, sensation

seeking, rebelliousness, and self-esteem),

social influences (parent, sibling, and friend smoking;
receptivity to tobacco promotions), and parenting characteristics (parent education,
two measures of authoritative parenting, and adolescents perception of parental
disapproval of smoking)

f. What does the relative risk of 2.25 mean for Either Parent SmokesYes in Table 1?
Remaja yang salah satu orang tuanya merokok memiliki 2,25 kali inisiatif merokok leboh
besar jika dibandingkan remaja yang orang tuanya tidak merokok
g. What does the relative risk of 0.55 mean for Maternal ResponsivenessFourth Quartile in
Table 1?
Remaja yang terpapar ibu yang memiliki respon ibu yang baik memiliki pengaruh yang baik

45% kali lebih besar untuk tidak berinisiatif merokok dibanding remaja yang terpapar 0-531
kejadian
atau
Remaja yang terpapar ibu yang memiliki respon ibu yang kurang baik memiliki resiko 55%
kali lebih besar untuk berinisiatif merokok disbanding remaja yang terpapar 0-531 kejadian
h. What characteristic shown in Table 1 had the strongest association with smoking initiation?
Quartile 4
i. What does the relative risk of 4.31 mean for Movie Smoking ExposureFourth Quartile in
Table 1?
Remaja yang menonton film dengan paparan 1666-5308 kejadian merokok memiliki
inisyatof untuk merokok 4,31% lebih besar jika dibandingkan remaja yang menonton film
dengan paparan 0-531 kejadian.
j. What does the following statement mean? Although the relative risks were attenuated, the
relation between exposure to movie smoking and smoking initiation remained significant
after adjustment for all baseline covariates.
Setelah faktor perancu dikontrol, hubungan natara paparan (menonton flm dengan kejadian
merokok) tidak inisiatif untuk merokok tapi signifikan, meskipun nilai RR menurun
Activity 3
1.Complete table below:
Movie Smoking

Tried Smoking

Didnt Try

Total

Exposure
Smoking
Exposed
237
1715
1952
Unexposed
22
629
651
Total
259
2344
2603
2. Based on above table, what is the probability that these adolescents, regardless of their
movie viewing status, would start to smoke during the study?
Tried Smoking
259
Total Population = 2603 = 0,0998
Probabilitas remaja merokok setelah menonton film yang mengandung adegan merokok
adalah 9,9%
3.Calculate the risk of smoking among adolescents exposed to movies with 532 or more
occurrences of smoking?
a
237
a+b = 1952 = 0,121 (12,1%)
Risiko remaja merokok pada kelompok terpapar adalah 12,1%
4.Calculate the risk of smoking among adolescents unexposed to movies with 5325,308

occurrences of smoking?
c
22
c+ d = 652 = 0,0331 (3,31%)
Resiko remaja merokok pada kelompok tidak terpapar adalah 3,31%
5.How much of the total incidence of starting to smoke among adolescents who view 532 or
more smoking occurrences in movies is due to viewing such movies?
237
1952 = 0,121 (12,1 per 1000 remaja)
6.How much of the risk of starting to smoke among adolescents who viewed 532 or more
smoking occurrences in movies is due to viewing those movies? What does it mean?
Attribute Risk = Risk Exp Risk Unexp
= 12,1% - 3,4% = 8,7%
Dari total 121 dari 1000 remaja yang mulai merokok, 87 diantaranya benar benar
merokok karena menonton
Akan ada 87 dari 1000 remaja yang akan mulai merokok karena terpapar dengan film
adegan merokok
7.What percent of the incidence of starting to smoke among adolescents who view 532 or
more smoking occurrences in movies is due to viewing such movies?, What does it
mean?
12,1 3,4
12,1

8,7
12,1 = 0,719 (72%)

Kejadian merokok pada kelompok remaja yang menonton film yang ada adegan merokok
adalah sebesar 72%
8.How much of the total incidence of starting to smoke among all adolescents is due to
viewing 532 or more smoking occurrences in movies?
259
22

CI expCI unexp
2603 651
PRD
=
=
CI pops
259
2603
PRD = 0,06
66 per 1000 remaja