| Course | HEP 444 Epidemiology |
|---|---|
| Module | Module 2 |
| Paper type | Article review |
| Length | About 559 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | BS in Health Education and Health Promotion |
| Updated | October 2026 |
Free sample paper for HEP 444 Module 2
Fifty Years of British Doctors: A Review of a Landmark Cohort Study on Smoking and Mortality
Student Name
BS in Health Education and Health Promotion, Arizona State University
HEP 444: Epidemiology
Instructor Name
Month Day, Year
Fifty Years of British Doctors: A Review of a Landmark Cohort Study on Smoking and Mortality
Citation and Purpose
Doll et al. (2004) reported 50 years of follow-up of male British doctors to compare the hazards of smoking for men who formed their habits in different periods and to measure how much risk falls when smokers stop at different ages.
Methods
Design. A prospective cohort study. In 1951, doctors on the British medical register were sent a questionnaire about their smoking habits, and 34,439 men who replied formed the cohort. Smoking habits were updated by later questionnaires, and deaths and their causes were monitored for 50 years.
Exposure. Self-reported smoking status, type of tobacco, amount smoked and, for former smokers, age at stopping.
Outcome. Death from any cause and from specific causes, obtained through national death records.
Analysis. Death rates were compared between continuing smokers, former smokers and lifelong nonsmokers, separately for men born in different decades.
Results
Excess deaths among smokers were mainly from vascular, cancer and respiratory diseases that smoking can cause. Men born between 1900 and 1930 who smoked only cigarettes and continued to smoke died about 10 years younger, on average, than lifelong nonsmokers. Quitting bought back years of life expectancy, roughly three for men who stopped at 60 and close to ten for those who stopped by 30. For men born in the 1920s, the probability of dying between 35 and 69 was 43% among cigarette smokers and 15% among nonsmokers, roughly a threefold death rate ratio (Doll et al., 2004).
Strengths
The prospective design measured smoking before deaths occurred, which establishes the time order and avoids recall bias about exposure. Follow-up lasted 50 years with very little loss, because doctors are easy to trace through professional records. Repeated questionnaires captured changes in smoking, including quitting, and the large cohort allowed analysis by birth decade.
Weaknesses
Smoking was self-reported, so some misclassification is likely, although doctors were probably accurate reporters. The cohort included only male doctors, a group with higher income and better access to care than the general population, which may limit generalizability to women or to other occupations. As an observational study it could not randomize smoking, so confounding by other habits, such as alcohol use, remains possible.
Hill's Criteria Applied
Hill (1965) presented these viewpoints as aids to judgment rather than a checklist; here, eight of nine point toward a causal relationship.
| Criterion | Evidence in the study | Supported? |
|---|---|---|
| Strength | Death rates roughly tripled among men born in the 1920s who smoked cigarettes | Yes |
| Consistency | Findings agree with many other cohort and case-control studies, including the earlier case-control work by Doll and Hill (1950) | Yes |
| Specificity | Smoking was linked to many diseases, not one | Weak, as Hill noted this criterion often is |
| Temporality | Smoking was measured years before death | Yes |
| Biological gradient | Mortality tables rise with the number of cigarettes smoked | Yes |
| Plausibility | Tobacco smoke contains carcinogens and damages blood vessels and lungs | Yes |
| Coherence | Results fit what is known about lung cancer and heart disease | Yes |
| Experiment | Stopping smoking reduced the excess risk, a natural experiment | Yes |
| Analogy | Other inhaled toxins, such as asbestos, cause similar diseases | Partly |
Conclusion
The British Doctors Study is a model cohort study. Its design, length and evidence on quitting make a strong case that smoking causes premature death and that stopping at any age helps.
References
Doll, R., & Hill, A. B. (1950). Smoking and carcinoma of the lung: Preliminary report. BMJ, 2(4682), 739-748. https://doi.org/10.1136/bmj.2.4682.739
Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004). Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ, 328(7455), 1519. https://doi.org/10.1136/bmj.38142.554479.AE
Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295-300. https://doi.org/10.1177/003591576505800503
Reading the HEP 444 Module 2 assignment instructions
The cohort Article Review in HEP 444 is worth 30 points, one of two reviews in the course. Choose a published cohort study as your instructor directs, then summarize its methods, identify strengths and weaknesses and examine its tables and figures for evidence on each of Hill's criteria for causality. Cohort designs sort people by exposure first and then track what happens to each group, so pay attention to how exposure was measured, how long follow-up lasted and how many people were lost. Paraphrase rather than quote; the syllabus deducts a point for every quotation.
Inside the HEP 444 Module 2 example
The review begins by naming the article and what its authors set out to learn. The methods are summarized under design, exposure, outcome and analysis, and the results section reports the key figures in the authors' own measures. Strengths and weaknesses are explained in terms of cohort design: time order, recall, follow-up, generalizability and confounding. A table works through all nine of Hill's criteria with evidence from the study, followed by a sentence on how Hill intended them to be used and a short conclusion. Each weakness is followed by its likely effect on the findings, so the reader sees whether it would inflate or shrink the association. The criteria table includes a column judging support, which makes the student's reasoning visible at a glance.
Where the marks sit in the HEP 444 Module 2 rubric
The review is worth 30 points. Readers look for an accurate summary of the design and methods, strengths and weaknesses tied to the study's actual features rather than generic lists, and a thoughtful application of Hill's criteria that cites specific tables or results. Marks drop when the summary repeats the abstract, when weaknesses are listed without explaining their effect on the results, when Hill's criteria are named but not linked to evidence and when quotations replace paraphrase. Using the study's own figures, such as years of life lost and the effect of quitting at different ages, shows that the student read beyond the abstract. A review that names which criteria are weak, rather than marking all nine as met, reads as more careful.
HEP 444 Module 2 help with common mistakes
Read the methods section twice before you write. Draw a quick diagram of who was followed, from when and for what. For each Hill criterion, find a specific table, figure or result. Explain how each weakness could bias the result and in which direction. Keep the summary to the facts and save judgment for the strengths and weaknesses. If you are unsure whether your article is truly a cohort study, the desk can help check its design. Choose a cohort study with clear tables; landmark studies often have open full text. Note the follow-up rate and length. Remember that cohort studies can estimate incidence and relative risk directly, which case-control studies cannot.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HEP 444 Module 2 questions, answered
Where can I find a free HEP 444 Module 2 sample paper?
The full cohort review of the British Doctors Study on smoking and mortality is on this page.
What are Hill's criteria for causality?
Nine viewpoints: the strength of the association, consistency across studies, specificity, time order, dose-response, plausibility, coherence, experimental evidence and analogy.
What makes a cohort study strong?
Measuring exposure before the outcome, long and complete follow-up and a large sample.
How many years did smoking shorten life in the British Doctors Study?
About 10 years for men born 1900 to 1930 who kept smoking cigarettes.
How many article reviews are in HEP 444?
Two, one cohort study and one case-control study, at 30 points each.