Statistical Methods for Health

Care Research
Chapter 4
Hypothesis Testing with Inferential
Statistics

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Statistical Inference
Answers two types of questions
Parameter Estimation
Estimating a populations characteristics from
sample data
Hypothesis Testing
Testing statements of relationships between two or
more variables

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Parameter Testing
Point Estimate
A single number
Confidence Interval
A range into which the estimated value is estimated
to fall within

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Parameter Testing (cont.)

Example:
What is the prevalence of sexually transmitted
diseases (STDs) in young women in the United
States?
Point estimate: 24.1% of women age 14 to 19
have at least one STD.
Confidence interval: between 18.4% and 30.9% of
women age 14 to 19 have at least one STD.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hypotheses
Hypotheses articulate the expected relationships between
variables.
Stem directly from the research questions
Grounded in theory or conceptual models
Tested using data and inferential statistics
Testable hypotheses define
The groups that are being compared
The variables on which the groups are being
compared
The expected relationship
Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hypotheses (cont.)
Types of relationships
Association
No causal effect is presumed.
Causal
The independent variable is said to cause changes
in the dependent variable.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Hypotheses
Null hypothesis (H0) states that there will be no
relationship between the two variables.
Alternative hypothesis (Ha) states that there will be a
relationship between the two variables.
Directional
Nondirectional

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Hypotheses: Example

Null hypothesis (H0)
There will be no relationship between height and
weight in adolescent boys.
Alternative hypothesis (Ha)
Directional: Height will be positively related to weight
in adolescent boys (e.g., taller boys will weigh more).
Nondirectional: There will be a relationship between
height and weight in adolescent boys.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hypothesis Testing
Hypotheses are tested with inferential statistics.
The null hypothesis (H0) is always the hypothesis that is
being tested.
Rejecting the null: This means that the researchers
believe the variables are statistically associated with
one another.
Accepting the null hypothesis (failing to reject the
null): This means that the researchers do not believe
that the variables are statistically associated with one
another.
Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hypothesis Testing (cont.)

The decision to reject or accept the null hypothesis is
based upon two things:
The p-value (probability value): This is the probability
that the results of the statistical test were obtained by
chance alone. This is computed from the data and is
not known until the statistical test is completed.
The -level (alpha-level): This is p-value that is
defined by the researcher as statistically significant.
This is defined before any statistical tests are
conducted. Common -levels are 0.10, 0.05, and
0.01.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Which type of hypothesis is the following statement?
People who are immunized against the flu will be less
likely to contract the flu than those who are not
immunized.
A.Null hypothesis
B.Directional hypothesis
C.Nondirectional hypothesis
D.An alpha-level hypothesis

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B. Directional hypothesis
Rationale: This hypothesis states that a relationship
between immunization and contracting the flu is
expected and also states the direction of that
hypothesis.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Outcome of Testing Hypotheses

When we test hypotheses with statistics, one of the four
things can happen:

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Errors

Type I Error
Reject the null when it is true
In other words, we say that there is a relationship
between the variables when one really does not exist.
Type II Error
Accept the null when it is false
In other words, we say that there is no relationship
between the variables when one really does exist.
In any given study, we will never know if we have
committed either one of these errors.
Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Errors
Type I Error: reject the null when it is true
The probability of making a type I error is defined by
the -level of the study.
Given an -level of 0.10, we will make a type I
error 10% of the time.
Type II Error: not rejecting the null when it is false.
This is referred to as (beta).

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Power of a Test
The power of a test is its ability to detect statistically
significant differences.
Mathematically, this is defined as 1-.
Power is a function of the -level, the sample size, and
the population effect size.
There are numerous statistical packages that will
compute the power of a study.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
If there is, in fact, a relationship between immunization
and contracting the flu and the researcher concludes
there is no relationship, what type of error have they
committed?
A. Insufficient power in the study
B. Logical error
C. Type I
D. Type II

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
D. Type II Error
Rationale: A type II error is when we say that there is no
relationship between the variables, but one really does
exist.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Six-Steps for Hypothesis Testing

1. State the hypothesis (in both the null and the alternative
form).
2. Define the -level and choose the appropriate statistic.
3. Make sure the data meet the assumptions of the statistic
that you are using.
4. Compute the parameters (e.g., means, percents) that are
being compared.
5. Compute the test statistic and obtain the p-value of the
statistic.
6. Compare the p-value to the -level and state a conclusion.
Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Example of Six-Step Process

We will use the six-step process to conduct a onesample z-test. A one-sample z-test is used to compare
a sample mean to a population mean.

In this example, we will ask the question: do women

who attend a local church health fair have a
significantly different mean BMI than women in the
general U.S. population?

Our data come from a sample of women attending a

health fair at a local church.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

State the Hypothesis

Step 1: State the hypothesis

H0: The mean BMI of the women attending the health

fair will not be significantly different than that of the
U.S. population.

Ha (nondirectional): The mean BMI of the women

attending the church health fair will be significantly
different than that of the U.S. population.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Define the -Level and Choose the

Appropriate Statistic
Step 2: Define the -level

The -level for this study is 0.05.

This means that if the value of the computed statistic

occurs by chance 5% of the time or less, the null
hypothesis will be rejected.

We will use a one-sample z-test.

This is the appropriate test to use when comparing a

sample mean to a population mean.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Rejection Region

This following figure shows the rejection region for the

one-sample z-test with a nondirectional hypothesis. This
is also referred to as a two-tailed test.

Those test results that fall in the bottom or top 2.5%

(e.g., the outer 5%) are considered statistically
significant. This is our rejection region; if the value of
the computed one-sample z-test falls in this region, we
reject the null hypothesis.

Note: The current standard is to use two-tailed tests

even with directional hypotheses, although it is more
technically correct to use a one-tailed test with these.
Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Rejection Region (cont.)

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assumptions
Step 3: Make sure the data meet the assumptions of the
statistic that you are using

The one-sample z-test assumes that

The data are normally distributed (the BMI data
meet this assumption).
The population mean and standard deviation are
known (the population mean BMI is 27.9 [sd=5.4]).

The assumptions are met so we can proceed with the

test.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Compute the Parameters

Step 4: Compute the Parameters (e.g., means, percents)
that are being compared

The mean BMI of the 48 women in the sample was

29.2, with a standard deviation of 3.4.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Compute the Test Statistic

Step 5: Compute the test statistic, and obtain the p-value of
the statistic

The equation for the one-sample z-test is

The computed statistic is

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

State a Conclusion
Step 6: Compare the p-value to the -level and state a
conclusion

The computed statistic is 1.67. Since it does not fall

into the rejection region (it would need to be either
less than 1.96 or greater than +1.96), the associated
p-value is greater than 0.05.

We conclude that there is no statistically significant

difference in the mean BMI between the women in our
sample and the U.S. population mean.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question

True or False

If the difference between two groups is large, we can

say that it is statistically significant even if our
computed p-value is not less than the -level that we
set for the study.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer

False

Rationale: Statistical significance is defined by our

computed p-value and our preset -level.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins