HLTH2110: Analyse Data Using Stata and Interpret Research Report

Assessment Task 2

Purpose

The purpose of this assessment is to consolidate knowledge and skills acquired on work completed to date. Specifically, students will apply their knowledge and skills to analyse, appraise, and interpret evidence from observational research to understand back pain.

Outcomes Addressed: This assessment addresses the unit outcome/s ULO1 to ULO6.

Skills Assessed

This task allows you to develop and/or demonstrate the following:

• Statistical analyses using STATA software.
• Interpretation of epidemiological and statistical evidence.
• Critical appraisal of scientific research.
• Evidence-based health care.

Task overview

In this task, you will analyse data using STATA and interpret findings, writing a research report based on a series of epidemiological and statistical questions. Where indicated, report estimates to 1 decimal place, and present tables and figures with titles and appropriate labels.

Task Details

Background: 

Spinal pain is the leading cause of disability worldwide, with significant consequences for individuals’ health, social participation, and economic wellbeing. Observational epidemiological studies consistently show that spinal pain often emerges during adolescence, a critical developmental period marked by rapid physical, psychological, and social changes.

Recent research has highlighted the role of psychosocial factors, such as experiencing bullying, in shaping adolescent health outcomes, including musculoskeletal pain. Experiences of bullying and feeling unsafe at school can contribute to stress, which may influence pain perception and coping mechanisms.

In 2024, a cross-sectional study was conducted among adolescents attending four elite private secondary schools in Sydney’s North. These schools cater to families within the top 1% of income earners in Australia, providing a unique context for understanding spinal pain and associated psychosocial factors in a high socioeconomic environment. Data were collected via a self-reported survey, and the resulting dataset (n = 1,085) includes measures of low back pain, bullying experiences, perceived school safety, and school type (co-educational or single-sex).

Questions

1. Characteristing a sample of private school students 

a) Generate an appropriate frequency table to describe the sample by biological sex and school type. Include cell counts and column proportions, and ensure the table has a clear, informative title, and properly labeled variables. In addition, comment in one sentence on the proportion of female participants who attend a co-educational school.

b) Generate a histogram to display the percentage distribution of age in the sample. Ensure the figure includes an informative title and clearly labeled axes. In addition, comment in one sentence on the shape of the age distribution.

c) Generate a table that summarises the age of the sample. In the table, report the n, mean, sd, median, iqr, min, and max.

d) In one sentence, interpret the tables generated in Question 1 and describe the most appropriate overall characteristics as they relate to the number, sex, age, and school type of participants in the sample.

2. Analysing low back pain and bullying in private school students

a) Conduct an appropriate analysis to report the prevalence of low back pain in the past week with 95% Confidence Intervals. Report and interpret the estimates as proportions to 1 decimal place (1dp) [For example, 30.3%].

b) Report the prevalence (95%CI) of low back pain in male and female adolescents separately.

c) Bullying refers to repeated and intentional aggressive behaviour by an individual or group toward another person, where there is an actual or perceived power imbalance. Recode the bullying variable to align with this definition. Bullied: Students who reported being bullied about once a week or more often (responses 3, 4, or 5). Not Bullied: Students who reported never or only once or twice (responses 1 or 2). Report the prevalence of being bullied including 95%CI (1dp).

d) Report the prevalence (95%CI) of being bullied in male and female adolescents separately. 

3. Association between bullying and low back pain in private school students

In Question 3, you will conduct appropriate statistical analyses to evaluate the association between bullying and low back pain in private school students.

a) Generate an appropriate table to report the association between bullying and low back pain in private school students. In addition, report the proportion of bullied students that report low back pain

b) In one paragraph, state the null hypothesis, interpret the test statistic, and the p-value for the association.

c) Report and interpret the odds ratio (95%CI) (1dp) for the association between bullying and low back pain in adolescents.

d) Report and interpret the risk difference (attributable risk) (1dp) of being bullied vs. not bullied for reporting low back pain.

4. Exploration of a potential confounder 

Perceived School Safety refers to how safe students feel in their school environment, considering both physical safety (e.g., protection from harm, safe facilities) and psychological safety (e.g., feeling respected, supported, and free from bullying). A colleague suggests that Perceived School Safety might explain the association between bullying and low back pain in adolescents. This is plausible because:

• Students who feel unsafe are more likely to experience bullying.
• Feeling unsafe can increase stress and reduce physical activity, both of which are linked to musculoskeletal pain.
• Unsafe environments may also limit movement opportunities or involve poor physical conditions (e.g., inadequate seating, restricted play areas), which can directly contribute to back pain.

Your colleague doubts the meaningfulness of the association between bullying and low back pain in private school students. They suggest other factors such as Perceived School Safety likely explains the association and recommend you explore it for potential confounding.

a) In your own words describe what is meant by confounding.

b) Generate a scatter plot for ‘schsafe’ and ‘bullying’. Ensure the figure and axes are appropriately labelled. Using the correlation coefficient, interpret the figure in one sentence.

c) Conduct an appropriate T-Test to evaluate the association between Perceived School Safety and Low Back Pain. Report and interpret the mean value(s), 95%CI(s) and p-value(s) for the comparison(s). 

d) In one sentence, report whether Perceived School Safety could potentially confound the association between Bullying and Low Back Pain in private school students.

5. Comparison and critial appraisal of evidence

The following questions require comparison and reflection on the following observational study “Phillips N, Brown BT, Lin H, Swain MS. Association Between Pain and Bullying in Australian Adolescents: A Secondary Analysis of Cross-Sectional Data From the Australian Child Wellbeing Project.

a) Consider the study design of this research. When interpreting an association, what is one limitation inherent in this study design?

b) Consider the participants in the current study of private school students. Are they representative of the population? Is the participant sample in the study by Phillips et al., directly comparable to the study sample in Question 1 (HLTH2110 2025_Assignment Data.xlsx)? If not, what is one key difference?

c) What confounders were considered in the study by Phillips et al? How did the researchers control for the effect of the confounders in this study?

d) Using Table 2 reported by Phillips et al., explain any similarities or differences in the reported odds ratio for the association between bullying and back pain in Australian adolescents vs. private school students from Sydney’s north.

e) In your own words, write a short summary of the interpretation of Table 2 reported by Phillips et al.

f) Consider the findings of both observational studies of adolescents. Based on your current knowledge of chiropractic care, how could the research findings be integrated into practice to ensure evidence-based practice?

Brief Summary of Assessment Requirements

Assessment Task 2 – HLTH2110 focuses on the application of epidemiological and statistical knowledge to understand spinal (low back) pain in adolescents using observational data. Students are required to:

Key Pointers to be Covered:

1. Sample Characterisation: Generate frequency tables, histograms, and summary statistics for demographic variables such as sex, age, and school type.
2. Prevalence Analysis: Compute the prevalence of low back pain and bullying overall and stratified by sex, including confidence intervals.
3. Association Assessment: Evaluate the relationship between bullying and low back pain using contingency tables, odds ratios, risk differences, hypothesis testing, and interpretation of p-values.
4. Confounder Exploration: Investigate potential confounders (Perceived School Safety), including correlation analysis and T-tests, and interpret their influence on the main association.
5. Critical Appraisal: Compare findings with existing literature, assess study limitations, representativeness of the sample, confounder management, and implications for evidence-based practice.

Skills Assessed: STATA analysis, interpretation of statistical and epidemiological evidence, critical appraisal, and evidence-based healthcare application.

Approach Taken by the Academic Mentor

The Academic mentor guided the student in a step-by-step structured approach to ensure clarity and thoroughness:

Step 1: Understanding the Dataset

• Reviewed the dataset to identify key variables: age, sex, school type, low back pain, bullying, and perceived school safety.
• Explained the importance of correct variable coding and labeling for accurate STATA analysis.

Step 2: Sample Characterisation

• Frequency tables were generated to summarise sex and school type.
• Histograms were created to illustrate age distribution.
• Summary statistics tables calculated mean, median, standard deviation, IQR, min, and max.
• Mentor emphasized interpreting the sample distribution and drawing concise conclusions about participant demographics.

Step 3: Prevalence and Stratified Analysis

• Prevalence of low back pain and bullying was calculated using proportions and 95% confidence intervals.
• Stratified analysis by sex was conducted to identify differences in prevalence between male and female adolescents.
• Students were instructed to provide clear, one-sentence interpretations for each analysis.

Step 4: Association Between Bullying and Low Back Pain

• Contingency tables were created to quantify the association.
• Statistical tests were performed to assess significance (p-values).
• Odds ratios and risk differences were calculated and interpreted.
• Mentor guided the student on reporting results to one decimal place and explaining practical implications.

Step 5: Confounding Analysis

• Introduced the concept of confounding and its relevance to observational studies.
• Generated scatter plots and calculated correlation coefficients between perceived school safety and bullying.
• Conducted T-tests to assess the association between perceived school safety and low back pain.
• Interpreted whether perceived school safety could confound the bullying-back pain relationship.

Step 6: Critical Appraisal of Evidence

• Compared findings with the Phillips et al. study.
• Assessed study design, sample representativeness, confounder control, and limitations.
• Integrated findings into evidence-based practice recommendations for adolescent chiropractic care.

Outcome Achieved

• Comprehensive Analysis: Student successfully characterised the sample, calculated prevalence, assessed associations, and explored potential confounders.
• Evidence-Based Interpretation: Findings were critically appraised in the context of the Phillips et al. study.
• Practical Application: Student was able to translate research evidence into actionable insights for clinical practice in adolescent musculoskeletal health.

• Learning Objectives Covered:

  • ULO1–ULO6, including STATA proficiency, statistical interpretation, critical appraisal, and application to evidence-based practice.

  • Enhanced understanding of epidemiological methods, data presentation, and health outcomes interpretation.

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