Sample Questions

Question 1

The epidemiologic triangle (triad) describes the occurrence of disease as an interaction between what three factors?

1) Person, place and time
2) Host, agent and environment
3) Person, environment and immunity
4) Host, agent and exposur

Answer 1

Host, agent and environment

Question 2

Which of the following estimates of an odds ratio most strongly suggests a computational error?

1) 7.8
2) 1.2
3) -0.9
4) 20.9

Answer 2

-0.9

Question 3

The sensitivity of a particular screening test for a disease is 95%, and the specificity is 90%. Which of the following statements is correct?

1) Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease
2) Of 100 people sampled from a population with the disease, the test will correctly detect 90 individuals as positive for the disease
3) If a person tests positive, the probability of having the disease is 0.95
4) If a person tests positive, the probability of having the disease is 0.90

Answer 3

Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease

Question 4

Which measure of mortality would you calculate to determine the proportion of all deaths that is caused by heart disease?

1) Case fatality ratio
2) Cause-specific mortality rate
3) Crude mortality rate
4) Proportionate mortality ratio

Answer 4

Proportionate mortality ratio

Question 5

Which of the following best describes a study where exposure histories is collected from a group of persons with a specific disease and from a comparison group to determine the relative frequency of an exposure?

1) Clinical trial
2) Randomized controlled trial
3) Case-control
4) Cohort

Answer 5

Case-control

Question 6

The four P’s of public health marketing services include:

1) Product, promotion, prestige, and planning
2) Product, place, promotion, and pragmatism
3) Product, price, place, and promotion
4) Product, price, precision, and promotion

Answer 6

Product, price, place, and promotion

Question 7

An appropriately tailored intervention message most importantly should:

1) Take into account characteristics of the target population
2) Be designed through community organizational strategies
3) Meet the criteria established by the funding agency
4) Be designed and tested by colleagues and experts in the field

Answer 7

Take into account characteristics of the target population

Question 8

The best use of clinical practice guidelines is as an:

1) indication of the best diagnostic and treatment practices based on the best available evidence.
2) inforceable standard of care against which deviations should be detected and corrected.
3) ideal therapy plan that should be supported in public health regulation and patient education.
4) information pamphlet for distribution in public health patient education programs.

Answer 8

indication of the best diagnostic and treatment practices based on the best available evidence.

Question 9

Public health agencies should be aware of how to communicate the role of public health with external stakeholders. What is the role of public health agencies when communicating with external stakeholders?

1) To promote the agency and engage in advocacy
2) To promote favorable legislation
3) To provide STI tests and keep the public safe
4) To provide vaccinations

Answer 9

To promote the agency and engage continin advocacy

Question 10

5. For the first time scientists in the United States conducted a longitudinal study that followed children with Zika for one year. They found that even children who appeared with no deformities at birth developed specific developmental delays. Which communication criteria do Zika scientists meet when they share their research findings with their communities and global constituencies? Select the BEST answer.
   1) They practice transparency in advancing Zika research
   2) They demonstrate beneficence, a core public health ethical principle
   3) They provide strategic leadership in leading local and international solutions
   4) They demonstrate their competence in Zika researc

Answer 10

They provide strategic leadership in leading local and international solutions

Question 11

For the governance of an organization, which of the following should be measurable?

1) Vision and values
2) Mission and vision
3) Goals and objectives
4) Mission and goals

Answer 11

Goals and objectives

Question 12

In an effort to improve a research center’s public image, the director commits to securing additional funding for faculty whose research has significant measurable community impact. This leadership style can be described as:

1) Transactional
2) Transformational
3) Passive-avoidant
4) Autocratic

Answer 12

Transactional

Question 13

Succession planning involves a defined plan to:

1) cultivate a new group of leaders
2) outline new ideas for research studies
3) amend the mission and operations of an organization
4) update current programs and services to incorporate policy and regulatory changes

Answer 13

cultivate a new group of leaders

Question 14

In the design and implementation of public health data systems, installing security features should be:

1) inherent in privacy by design at all stages.
2) a task separately done by an expert cybersecurity team.
3) limited to firewalls and administrative control.
4) the final step before release of software system

Answer 14

inherent in privacy by design at all stages.

Question 15

After identifying and appointing expert members to inter-professional teams for implementing health initiatives, the administration:

1) has shifted all responsibility to the team.
2) role should only consist of receiving periodic progress reports.
3) should plan to confirm the team norms and dynamics are productive.
4) can announce that the initiative was successfully launched.

Answer 15

should plan to confirm the team norms and dynamics are productive.

Question 16

Income, interpersonal stress, and education level are all examples of ____________, which determine the overall health, and quality of life of our communities.

1) Physical determinants
2) Spatial determinants
3) Environmental determinants
4) Social determinants

Answer 16

Social determinants

Question 17

When conducting a research study, which of the following is an unique requirement when the study involves human subjects?

1) Securing enough funding for the project
2) Reporting only the data that strengthens support of the hypothesis
3) Ensuring that all participants receive an incentive upon completion of data collection
4) Obtaining a waiver or an approval from an Institutional Review Board prior to the start of the study

Answer 17

Obtaining a waiver or an approval from an Institutional Review Board prior to the start of the study

Question 18

A public health department government employee manages that department’s non-infectious conditions epidemiology program. The program’s recent report on traffic accident deaths has attracted attention. Mothers Against Drunk Drivers, a non-profit incorporation, has asked that person to simultaneously take a leadership role in MADD’s program to oversee fund-raising activities and promote compliance with laws about drinking and driving. Would it be ethical for this person to accept MADD’s offer of simultaneous employment?

1) Yes, provided the outside activity is not operated within the government agency, and the employee does not incur conflicts of interest, divulge confidential information nor receive special privileges or benefits.
2) Yes, because this is a non-profit corporation it is not subject to the same restrictions that apply to for-profit businesses, so the employee is completely free to engage in activities complimentary to promoting state laws.
3) No, because there is potential to influence legislation this type of non-profit corporate engagement is contrary to the ethical requirement that government employees refrain from political activities.
4) No, for ethical reasons government employees generally are banned from simultaneously taking senior leadership positions in outside businesses during the course of their government employment.

Answer 18

Yes, provided the outside activity is not operated within the government agency, and the employee does not incur conflicts of interest, divulge confidential information nor receive special privileges or benefits.

Question 19

When making decisions, public health leaders face the ethical challenge of:

1) Ignoring the rights and liberties of those individuals affected by disease
2) Creating maximum benefit for all while minimizing individual harm
3) Maximizing resource expenditures
4) Demanding trust from health care providers serving patients

Answer 19

Creating maximum benefit for all while minimizing individual harm

Question 20

The U.S. Supreme Court interpreted the 10th amendment to the U.S. Constitution to give the states ‘police powers’ to pursue public health initiatives that protect general welfare, however differences in such initiatives persist across the states because:

1) Police powers prohibit states from defining standards of care and required the federal government to do so
2) Standards of care are implied by police powers but implementation is left to the states
3) Police powers permit each state the right to define and delegate authority and responsibility for public health services
4) States use police powers to fund public health services only through property taxes, and these vary from state to state

Answer 20

Police powers permit each state the right to define and delegate authority and responsibility for public health services

Question 21

Which of the following terms means that a tumor has spread to other locations within the body?

1) Malignant
2) Metastatic
3) Benign
4) Hyperplastic

Answer 21

Metastatic

Question 22

Which of the following can be considered a concern with live, attenuated vaccines?

1) They are very expensive to produce
2) They produce a weak response and require booster shots
3) They can cause disease in an immunocompromised individual
4) People can develop allergic reactions to them

Answer 22

They can cause disease in an immunocompromised individual

Question 23

Characteristics, attributes or exposures such as hypertension, unsafe sex, alcohol consumption, unsafe water that can increase the likelihood of developing disease or injury are known as

1) Risk factors
2) Environmental factors
3) Causal factors
4) Community factors

Answer 23

Risk factors

(A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Some examples of the more important risk factors are underweight, unsafe sex, high blood pressure, tobacco and alcohol consumption, and unsafe water, sanitation and hygiene.)

Question 24

Which of the following methods is the most accurate exposure assessment in workers?

1) Determination of the chemical in the air
2) Biomonitoring of chemicals or metabolites of the chemicals in blood and urine
3) Determination of the chemical on the skin
4) Estimation of the exposure by taking an occupational history

Answer 24

Biomonitoring of chemicals or metabolites of the chemicals in blood and urine

Question 25

Which of the following disinfection methods is most commonly used in US drinking water supply systems? 1) Ozonation 2) Bromination 3) Chlorination 4) Ultraviolet irradiation

Answer 25

Chlorination

Question 26

The nutrient-rich solids produced as a byproduct of municipal sewage treatment and often proposed for use as a soil amender in agriculture is termed: 1) Hazardous waste 2) Suspended Solids 3) Biochemical Oxygen Demand (BOD) 4) Sludge

Answer 26

Sludge

Question 27

High level of nitrates in groundwater are of particular concern in rural communities that rely on well water because: 1) Nitrates can cause "Blue-Baby Syndrome" in infants 2) Nitrates are potent carcinogens in adults 3) The well water will be undrinkable due to taste, odor, and color problems 4) The well water will form nitric acid and become corrosive to metal pipes in the water system

Answer 27

Nitrates can cause "Blue-Baby Syndrome" in infants

Question 28

Which of the following statements best characterizes research findings about trait-based approaches to leadership theory? 1) Intelligence, high energy, and initiative are necessary 2) Personality traits are irrelevant 3) No one set of traits has been established as necessary 4) Leaders are born, not made

Answer 28

No one set of traits has been established as necessary

Question 29

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with states to implement national environmental standards such as NAAQS? 1) By creating a memorandum of understanding focusing on cost-sharing of environmental burdens 2) By establishing air quality monitoring stations 3) By using a State Implementation Plan (SIP) approved by the EPA 4) By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

Answer 29

By using a State Implementation Plan (SIP) approved by the EPA

Question 30

Historically, which of the following had the greatest impact on average life expectancy? 1) Vaccinations for infectious diseases 2) Improvements in sanitation and hygiene 3) Advances in medical care technology 4) Increased application of health education

Answer 30

Improvements in sanitation and hygiene

Question 31

Public health actions frequently involve a balancing of individual rights vs. the good of the community. Where that balance is struck is based on: 1) Explicit direction found in the Nation's Constitution 2) Societal values 3) Science 4) Deontological principles

Answer 31

Societal values

Question 32

Which of these has been defined as a core function of public health? 1) Maintaining the census to define populations 2) Consulting stakeholders to decide what best serves public interest 3) Conducting research to solve all population health problems 4) Acting in an ethical manner

Answer 32

Consulting stakeholders to decide what best serves public interest

Question 33

Waiting until a program or intervention is complete to begin evaluation activities misses important and valuable opportunities for what type of evaluation? 1) Outcome and impact evaluation 2) Summative evaluation 3) Process evaluation 4) Participant evaluation

Answer 33

Process evaluation

Question 34

Which term below refers to the concept of confirming conclusions from qualitative data through multiple data sources, multiple methods, multiple theories, or multiple data collectors. 1) Triangulation 2) Systematic Review 3) Data Cleaning 4) Meta-analysis

Answer 34

Triangulation (Data triangulation is when a finding or piece of data is verified with several different data sources or research methods. Triangulation adds credibility to findings (K4Health, n.d.).)

Question 35

A public health professional is asked to conduct a needs assessment for a community. A needs assessment: 1) Introduces resources to fill community gaps 2 Ensures a competent public and personal health care workforce 3) Assists to identify and prioritize health problems 4) Provides health resources for medically underserved populations

Answer 35

Assists to identify and prioritize health problems (also known as a community health assessment, uses "systematic, comprehensive data collection and analysis" to identify and prioritize the key health needs of a community)

Question 36

To report on a program to local officials about the degree to which the program meets its ultimate goal and provides evidence for use in policy and funding decisions, what is needed? 1) Feasibility study 2) Cost analysis study 3) Process evaluation 4) Impact evaluation

Answer 36

Impact evaluation

Question 37

An anti-vaccine group is pressuring government to stop requiring vaccination of children because the disease incidence rate has become very low. The health department is defending the vaccination stance and looking for a way to explain this to legislators. In terms of systems theory, the relationship over time between required vaccination and decrease in incidence rate is a: 1) Positive feedback loop 2) Outflow effect 3) Negative feedback loop 4) Inflow effect

Answer 37

Negative feedback loop

Question 38

Generally, the largest single component in most public health budgets, and therefore the one with which managers must be most familiar is: 1) computer software and hardware 2) pharmaceuticals 3) personnel 4) shortfalls

Answer 38

Personnel

Question 39

In the planning process, the group being served is referred to as the: 1) Pilot population 2) Key informants 3) General population 4) Priority population

Answer 39

Priority Population (priority population is the people for whom the program is intended. In the past, this has also been called the target popluation.)

Question 40

The primary disadvantage of incremental program budgeting is: 1) It makes comparison from one year to the next difficult 2) It requires the justification of all dollars allocated 3 It requires far more time and effort than zero-based budgeting (ZBB) 4) It may not reflect the current programmatic priorities of the organization

Answer 40

It may not reflect the current programmatic priorities of the organization (Incremental budgeting does allow for easy year-to-year comparisons (A), does not require last-dollar justification (B), and requires a considerably lower investment than fully implemented zero-based budgeting (ZBB). The major deficiency of traditional incremental budgeting approaches is that they do not necessarily reflect program-based allocation of resources or organizational priorities among programs.)

Question 41

A supervisor asks three staff members to work together on developing and implementing a community health needs assessment. The supervisor has requested the final needs assessment to be completed in three weeks and after two and a half weeks, only two of the staff members have completed their sections. What would be the best way for the supervisor to give constructive feedback to the staff member who has not completed their assignment? 1) Point out all the issues they have had with this staff member’s performance to-date. 2) Prepare by developing a “feedback sandwich” approach with two reinforcing statements surrounding a corrective statement. 3) Give feedback to the staff member as the supervisor catches them on their way into the office. 4) Hold the entire team accountable in group meeting.

Answer 41

Prepare by developing a “feedback sandwich” approach with two reinforcing statements surrounding a corrective statement.

Question 42

In the funding applications that state public health departments typically submit every year, program and organizational budget requests: 1) are not included, only research project funding is described. 2) are justified by reasonable numbers on accounting spreadsheets. 3) need explanation in a budget narrative. 4) tend to always be funded.

Answer 42

need explanation in a budget narrative.

Question 43

The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is to: 1) Subject a proposed major project or action to a comprehensive environmental review study 2) Ensure that an important industrial project or action is constructed 3) Ensure that the environment is protected at all cost 4) Achieve sustainable development while relieving communities concerns

Answer 43

Subject a proposed major project or action to a comprehensive environmental review study (Before the National Environmental Policy Act, there was no requirement for a systematic study of the environmental effects of a proposed project. Thus, projects could be executed with little or no regard to the environmental effects. Poor environmental stewardship was apparent in many cases, for example, in disposal of hazardous waste and groundwater contamination. The significant environmental movement of the 1960s pressured Congress to pass the National Environmental Policy Act to promote developments that are in harmony with environmental protection. This approach is executed by ensuring that the environmental effects of a proposed major Federal action or project are studied, understood, and mitigated as much as possible and that better alternatives to a proposed project are preferred.)

Question 44

Can federal environmental laws allow States to make parallel environmental laws? 1) Yes, if more stringent than federal standards 2) Yes, if less stringent than federal standards 3) Yes, if no less stringent than federal standards 4) No, states may not make their own environmental laws where federal laws exist

Answer 44

Yes, if no less stringent than federal standards

Question 45

HACCP is a food safety system employed to: 1) Detect bacterial contamination in food after it happens 2) Identify and control problems that may cause foodborne illness before they happen 3) Isolate and identify bacterial pathogens from a foodborne illness outbreak 4) Set temperature limits for food containing eggs

Answer 45

Identify and control problems that may cause foodborne illness before they happen

Question 46

Which of the following pairs of values are most likely to conflict during a response to a public health emergency? 1) Truth-telling versus community welfare 2) Beneficence versus justice 3) Individual autonomy versus community welfare 4) Community welfare versus justice

Answer 46

Individual autonomy versus community welfare

Question 47

The first step in the policy process typically is: 1) Undertake Consultation 2) Problem definition 3) Policy analysis 4) develop options and proposals

Answer 47

Problem definition (Problem definition is typically the first step in the policy process. The second step is agenda setting. The next step is policy making. The fourth step is budgeting. The fifth step is implementation and the final step of the policy process is evaluation.)

Question 48

That individuals are motivated to satisfy or pursue food, drink, or shelter before focusing on esteem or self-actualization is an example of which model? 1) Hierarchy of needs (Maslow) 2) Expectancy theory (Vroom) 3) Two-factor theory (Herzberg) 4) Theory X/Theory Y (McGregor)

Answer 48

Hierarchy of needs (Maslow) (This model posits that needs must be met in the following order: physiological needs; safety-security; belongingness; esteem; then self-actualization.)

Question 49

Which of the following are the three ethical principles outlined in the Belmont Report? 1) Beneficence, liberty, and risk reduction 2) Justice, beneficence, and respect for people 3) Quality, respect for people, and ethical treatment 4) Justice, respect for people, and integrity

Answer 49

Justice, beneficence, and respect for people (They serve as the cornerstone of current guidelines for ethical treatment of human subjects in research. Created by the former U.S. Department of Health, Education, and Welfare (now the Department of Health and Human Services), the Belmont Report was entitled “Ethical Principles and Guidelines for the Protection of Human Subjects of Research” and is an important historical document in the field of medical ethics. Dated April 18, 1979, the document is named for the Belmont Conference Center, where it was drafted)

Question 50

Which term is used to characterize the movement addressing the social condition of unequal distribution of environmental hazards experienced by minority populations or groups with low income? 1) Environmental equity 2) Environmental justice 3) Environmental pollution 4) Environmental democracy

Answer 50

Environmental justice

Question 51

In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called: 1) Behavioral assessment 2) Needs assessment 3) Ecological assessment 4) Environmental assessment

Answer 51

Needs assessment

Question 52

An incremental approach to program planning in public health: 1. Uses multiple sources and methods to collect similar information 2. Provides an intensive, detailed description and analysis of a single project 3. Produces a plan where the specification of every step depends upon the results of previous steps 4. Results in plans that may be immediately necessary but may overlap or leave gaps

Answer 52

Results in plans that may be immediately necessary but may overlap or leave gaps

Question 53

An individual's capacity to obtain, process, and understand basic health information and services needed to make basic health decisions is called: 1. Medical informatics 2. Health literacy 3. Health education 4. Numeracy

Answer 53

``` Health literacy (Issel writes that though the incremental approach to program planning may address an immediate need (i.e.: closing bathhouses in the early days of HIV/AIDS epidemic) it may also leave gaps (i.e.: did not identify the virus). The incremental approach to program planning will address only part of the problem, may be the result of disjointed efforts and leave many factors unaccounted for.) ```

Question 54

An individual's capacity to obtain, process, and understand basic health information and services needed to make basic health decisions is called:

Answer 54

Health Literacy

Question 55

the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning

Answer 55

Medical Informatics

Question 56

is a social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death through education-driven voluntary behavior change activities

Answer 56

Health education

Question 57

is the ability to understand and work with numbers

Answer 57

Numeracy

Question 58

A primary technique for preventing food-borne disease in cafeteria-type food service establishments is: Why?

Answer 58

Maintaining warm foods at a sufficiently high holding temperature Microbial food contaminants such as Salmonella, Campylobacter, and E. coli may multiply rapidly at warm temperatures (between about 41-140F or 5-60C). Maintaining warm foods above 140F (60C) will kill actively growing bacteria.

Question 59

Which of the following pairs of values are most likely to conflict during a response to a public health emergency? 1. Truth-telling versus community welfare 2. Beneficence versus justice 3. Individual autonomy versus community welfare 4. Community welfare versus justice

Answer 59

Individual autonomy versus community welfare (Responses to public health crises are likely to entail some restriction of individual freedom as a trade-off to ensure the health, safety, and well-being of the broader community.)

Question 60

Which of the following principles of medical and public health ethics requires doing no harm while promoting the welfare of others? 1. Autonomy 2. Beneficence 3. Privacy 4. Justice

Answer 60

Beneficence (is defined as promoting the welfare of others while avoiding behavior that results in harm).

Question 61

Enrollment for a new public information session advertised exclusively through the agency’s website was much lower than expected. A small quick survey of the target audience found that very few remember seeing the ad. This suggests that: 1. an agency website redesign is indicated 2. the ad is not motivating those who read it. 3. websites are not the best way to reach this audience. 4. a formal review of communication strategy is indicated.

Answer 61

formal review of communication strategy is indicated (Effectiveness of communication strategies should be conducted, gaps identified and corrected. Google Analytics, for example, can be helpful to evaluate the frequency, duration, number of pages viewed, and domains from which a website has been visited. Surveys of target audiences, as well as focus groups, can help to understand linguistic and format preferences, as well as other influences on individual’s perceptions. Here, there is enough information to detect a problem but not enough to diagnose its root cause(s)).

Question 62

To report on a program to local officials about the degree to which the program meets its ultimate goal and provides evidence for use in policy and funding decisions, what is needed?

Answer 62

Impact evaluation

Question 63

defined as occurring during the operation of an existing program at appropriate Intervals such as at the end of a program. This evaluation will reveal information about the degree to which the program meets its ultimate goal and provides evidence for use in policy and funding decisions.

Answer 63

Impact evaluation

Question 64

The minimal effective dose of any environmental agent that evokes a stated all or none response is known as

Answer 64

A threshold dose (can be thought of as a dividing point above which health effects begin to be observed, but below which they are not).

Question 65

Which of these has been defined as a core function of public health? 1. Maintaining the census to define populations 2. Consulting stakeholders to decide what best serves public interest 3. Conducting research to solve all population health problems 4. Acting in an ethical manner

Answer 65

Consulting stakeholders to decide what best serves public interest

Question 66

A local public health department (LHD) must make significant budget cuts. Area managers are directed to review and compare current services, service utilization and cost to areas of need identified a recent community health needs assessment completed by the LHD. This approach, as a prelude to decision-making, is based on: 1. internal assessment and strategic goals 2. External assessment and department policy review 3. Internal assessment and external assessment 4. Strategic planning and maximizing program efficiency.

Answer 66

Internal assessment and external assessment (In the context of public health assessment is the beginning of the continuum of problem identification, priority setting, strategic planning, intervention and evaluation. Assessment can be either internal, addressing processes within an organization, or external, addressing processes within the community.)

Question 67

In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called: 1. Behavioral assessment 2. Needs assessment 3. Ecological assessment 4. Environmental assessment

Answer 67

Needs assessment (Needs assessment provides information about what is needed in the target community. In the PRECEDE-PROCEED model, a needs assessment is the general umbrella term and may involve a social assessment, epidemiological assessment, behavioral, environmental, educational, or ecological assessment. Using a needs assessment allows the planner to determine the degree to which the needs is are being met. Needs assessment help to identify the gap between what is and what should be)

Question 68

Which of the following makes community-based participatory research (CBPR) unique compared to other research methods? 1. Approval from the institutional review board (IRB) is needed 2. The methods are heavily survey based 3. The participants (target population) becomes a part of the research process 4. It is only used with specific populations

Answer 68

The participants (target population) becomes a part of the research process (CBPR is different from other research methods because the community is part of the process from planning to implementation and is seen as a researcher instead of a subjects.)

Question 69

Waiting until a program or intervention is complete to begin evaluation activities misses important and valuable opportunities for what type of evaluation? 1. Outcome and impact evaluation 2. Summative evaluation 3. Process evaluation 4. Participant evaluation

Answer 69

Process evaluation Process evaluation is concerned with how the program is delivered. It deals with issues such as when program activities occur, where they occur, and who delivers them. In other words, process evaluation asks whether the program is being delivered as intended. An effective program may not yield desired results if it is not delivered properly

Question 70

These types of evaluations typically occur after a program or intervention concludes and assess its impact on participants and the broader community, respectively

Answer 70

Outcome and Impact

Question 71

This type of evaluation assess the extent to which a program has achieved its goals

Answer 71

Summative

Question 72

Which of the following statements best characterizes research findings about trait-based approaches to leadership theory? 1. Intelligence, high energy, and initiative are necessary 2. Personality traits are irrelevant 3. No one set of traits has been established as necessary 4. Leaders are born, not made

Answer 72

No one set of traits has been established as necessary ( Later research on leadership emphasized behavior rather than traits. More recent literature focuses on a combination of traits and behaviors, but has not explicitly identified a set of traits, innate or otherwise, that constitute a leader.)

Question 73

The biggest change in competencies for public health career professionals circa 2019 is

Answer 73

more emphasis on 'soft' skills for leading teams and on integration across technical skills

Question 74

Generally, the largest single component in most public health budgets, and therefore the one with which managers must be most familiar is: 1. computer software and hardware 2. pharmaceuticals 3. personnel 4. shortfalls

Answer 74

Personnel. (From the perspective of hospitals, the No. 1 cost category in hospital budget is employees' wages and benefits. Cuts in personnel or staffing willleave public health departments unable to respond to crisis.)

Question 75

The U.S. Supreme Court interpreted the 10th amendment to the U.S. Constitution to give the states 'police powers' to pursue public health initiatives that protect general welfare, however differences in such initiatives persist across the states because: 1. Police powers prohibit states from defining standards of care and required the federal government to do so 2. Standards of care are implied by police powers but implementation is left to the states 3. Police powers permit each state the right to define and delegate authority and responsibility for public health services 4. States use police powers to fund public health services only through property taxes, and these vary from state to state

Answer 75

Police powers permit each state the right to define and delegate authority and responsibility for public health services (police powers may be used by states to promote laws in the interests of the general welfare and health of society. Public health examples include laws authorizing: (1) isolation and quarantine; (2) community vaccination; (3) licensure of medical professionals; and (4) response to public health emergencies, such as bioterrorism or infectious disease outbreaks. States retain discretion over the content and scope of such laws, provided they are not found to violate constitutional rights, and this leads to differences in how such policies are implemented at the state and local level.)

Question 76

An understaffed city health department submits an annual budget to it's city leadership; including a request for an additional 6.0 FTE positions. This budget includes the funding request but no accompanying narrative and was submitted despite the City Manager’s request for each department to avoid any funding increases in their requests. When asked about this, the department responds by: 1. Submitting another budget with no new positions. 2. Asking another department to decrease their budget by 6.0 FTE positions. 3. Provide information to justify the increased number of positions. 4. Reaching out to the media to gain citizen support for the new positions.

Answer 76

Provide information to justify the increased number of positions.

Question 77

The epidemiologic triangle (triad) describes the occurrence of disease as an interaction between what three factors? 1. Person, place and time 2. Host, agent and environment 3. Person, environment and immunity 4. Host, agent and exposure

Answer 77

Host, agent and environment (The epidemiologic triad refers to the interactions between the host, agent, and the environment to produce disease, particularly communicable disease. Using this model, the host is typically a human, the agent is typically a bacteria, virus or other pathogenic organism, and the environment is the setting in which the interactions take place. In some cases, a fourth variable, known as a vector, may be involved in the interaction.)

Question 78

Determining whether to continue or modify but not terminate a program is a reasonable objective of a: 1. formative evaluation 2. summative evaluation. 3. qualitative evaluation. 4. quantitative evaluation

Answer 78

Formative Evaluation

Question 79

assesses context in which a program is developed and can include a needs assessment or the development of program components-research that contributes to the design of a program

Answer 79

Formative

Question 80

Answer evaluations are conducted as a pass or fail examination that can lead to program termination (Qualitative, quantitative, or a mix of both methods can be used in either of these)

Answer 80

Summative

Question 81

What is an evaluation designed to present conclusions about whether a program should be sustained, changed, or eliminated? 1. Formative evaluation 2. Implementation evaluation 3. Process evaluation 4. Summative evaluation

Answer 81

Summative evaluation (Evaluation falls into one of two broad categories: formative and summative. Summative evaluations should be completed once your programs are well established and will tell you to what extent the program is achieving its goals.)

Question 82

In a box-and-whisker plot, if the median is displaced to near the left-edge of the box, the data distribution is best described as: 1. Symmetric. 2. Right skewed 3. Left skewed 4. Bimodal.

Answer 82

Right Skewed. For a right skewed distribution, the mean is typically greater than the median. The right hand side tail of the distribution will also be longer than the left

Question 83

Waterborne diseases can result from fecal contamination. Which of the following would be classified as a waterborne disease? 1. Cryptosporidium parvum 2. Flavivirus 3. Plasmodium spp. 4. Borrelia burgdorferi

Answer 83

Cryptosporidium parvum. (Cryptosporidium parvum, colloquially referred to as crypto, is a waterborne disease that is a major cause of gastroenteritis worldwide. It is a protozoan parasite that is resistant to chlorination, making its control difficult)

Question 84

Answer is a family of parasites that causes malaria, which, like flavivirus, is water-related

Answer 84

Plasmodium spp.

Question 85

Answer is a genus of viruses that includes mosquito-transmitted diseases such as Yellow Fever that are classified as water-related because part of disease's vector's lifestyle occurs in water

Answer 85

Flavivirus

Question 86

Answer is a bacterial species that causes Lyme disease, the vector for which is the deer tick.

Answer 86

Borrelia burgdorferi

Question 87

In the planning process, the group being served is referred to as the: 1. Pilot population 2. Key informants 3. General population 4. Priority population

Answer 87

Priority population (The priority population is the people for whom the program is intended. In the past, this has also been called the target popluation.)

Question 88

The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is to: 1. Subject a proposed major project or action to a comprehensive environmental review study 2. Ensure that an important industrial project or action is constructed 3. Ensure that the environment is protected at all cost 4. Achieve sustainable development while relieving communities concerns

Answer 88

Subject a proposed major project or action to a comprehensive environmental review study (Before the National Environmental Policy Act, there was no requirement for a systematic study of the environmental effects of a proposed project. Thus, projects could be executed with little or no regard to the environmental effects. Poor environmental stewardship was apparent in many cases, for example, in disposal of hazardous waste and groundwater contamination. The significant environmental movement of the 1960s pressured Congress to pass the National Environmental Policy Act to promote developments that are in harmony with environmental protection. This approach is executed by ensuring that the environmental effects of a proposed major Federal action or project are studied, understood, and mitigated as much as possible and that better alternatives to a proposed project are preferred.)

Question 89

Public Health law fundamentally attempts to balance the greater good of the community with... 1. the cost of implementation of the law 2. the acceptability of interventions 3. the autonomy of the individual 4. the ease of enforcement

Answer 89

the autonomy of the individual (Public health law is "the study of the legal powers and duties of the state, in collaboration with its partners (e.g., health care, business, the community, the media, and academe), to assure the conditions for people to be healthy (to identify, prevent, and ameliorate risks to health in the population) and the limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the common good" (Gostin, 2007).)

Question 90

A district health department is trying to decide whether to invest in interpretation services and translated materials to address local language barriers, address needs of limited English proficient (LEP) clients and meet Federal requirements. The Four Factor Analysis–to guide LHDs in meeting these mandates and to provide recommendations for providing translated materials and interpretation services- is part of a 1. National Standards for Culturally and Linguistically Appropriate Services (CLAS) Assessment 2. Language Needs Assessment 3. Health Resource Access Assessment 4. Community Literacy Assessment

Answer 90

Language Needs Assessment

Question 91

Four Factor Analysisfor lep

Answer 91

1. The number or proportion of LEP residents within each district, 2. The frequency with which LEP individuals come into contact with VDH programs, 3.The nature and importance of the program, activity or service provided by the recipient to its beneficiaries, and, 4. The resources available to the grantee/recipient and the costs of interpretation/ translation services

Question 92

A management/leadership theory which posits that when staff are able to grow and develop staff performance results are better, is an example of: 1. Situational Leadership Theory 2. Douglas McGregor Theory Y 3. Contingency Leadership Theory (CLT) 4. Path-goal Theory

Answer 92

Douglas McGregor Theory Y

Question 93

This theory of leadership maintains that the leader can affect the performance, motivation, and satisfaction of followers

Answer 93

Path-goal Theory

Question 94

This theory involves the adoption of management style to meet the needs of all personne

Answer 94

Contingent Theory

Question 95

This theory employees are generally not satisfied with work and are motivated by salary alone

Answer 95

Douglas McGregor Theory X

Question 96

Societies have fostered discrimination against certain communities in various ways. Policy makers must address this to move toward health equity. One theory, which explains the reinforcing feedback loop of poor housing quality, lesser paying jobs, poor education and poor health outcomes, may be summarized as: 1. Social Epidemiology 2. Institutional racism 3. Structural racism 4. Causative factors

Answer 96

Institutional Racism (As a result of institutional racism, racial stratification and disparities have occurred in employment, housing, education, healthcare, government and other sectors. While many laws were passed in the mid-20th century to make discrimination illegal, major inequalities still exist. Institutional racism is distinguished from the bigotry or racial bias of individuals by the existence of systematic policies and practices within institutions that effectually disadvantage certain racial or ethnic groups.)

Question 97

Public Health professionals have to learn to work effectively with the media. Public health is potentially appealing for the popular press because: 1. its stories have urgency, drama and novelty. 2. it is a source rich in detail, facts and figures. 3. scientists and journalists have a long history of mutual trust. 4. public information officers issue press releases.

Answer 97

its stories have urgency, drama and novelty.

Question 98

Measure of evaluation for a cohort study

Answer 98

Relative Risk

Question 99

Measure of evaluation for a case control

Answer 99

Odds Ratio

Question 100

May government employees use the government room rate offered by hotels if they are on a personal rather than a business trip? 1. Yes, being a government employee one always is eligible to accept hotels’ government rates regardless. 2. Yes, hotels and government agencies generally maintain a “don’t ask, don’t tell” position on this question. 3. Yes, if the hotel offers this rate to all government officials traveling on official business or not. 4. Yes, if the hotel offers it to you specifically by name.

Answer 100

Yes, if the hotel offers this rate to all government officials traveling on official business or not.

Question 101

Which of the following approaches recognize that health of people is interconnected with health of animals and environment; and collaborate with physicians, veterinarians, ecologists, epidemiologists, and other related healthcare providers to monitor and control public health threats and to learn about how diseases spread among people, animals, and the environment? 1. Veterinary Public Health 2. Environmental Health 3. One Health 4. Population Health

Answer 101

One Health (One Health focuses on the interface of humans, the environment, and animals)

Question 102

has been defined as "the health outcome of a group of individuals, including the distribution of such outcomes within the group”

Answer 102

Population Health

Question 103

the relationships between people and their environment; promotes human health and well-being; and fosters healthy and safe communities

Answer 103

Environmental Health

Question 104

Which of the following is not a disease that can be contracted by the food-borne route? 1. Salmonellosis 2. Giardiasis 3. West Nile virus neuro-invasive disease 4. Hepatitis A

Answer 104

West Nile virus neuro-invasive disease (Infected mosquitoes transmit West Nile virus by biting humans. Infection with the virus can lead to West Nile virus neuro-invasive disease (WNVND), which can include encephalitis, meningitis, and other presentations. WNVND is seasonal, with the highest rates in the warmer months when mosquito populations are highest. Only about 1 in 150 infected persons will become seriously ill, but about 1 in 5 may have milder symptoms.)

Question 105

Safe Harbor provisions are intended to protect patient privacy by defining: 1. the covered entities with which patient data may be shared. 2. which data elements to remove to create de-identified data sets. 3. encryption protocols and Internet routes for transmitting data. 4. data use agreement provisions for sharing confidential data sets.

Answer 105

which data elements to remove to create de-identified data sets. (Safe Harbor has been in place for decades, and more recently has proven inadequate. Other legislation, like HIPAA in the United States, not Safe Harbor, defines the covered entities with which personal health data may be shared directly.)

Question 106

In the design and implementation of public health data systems, installing security features should be: 1. inherent in privacy by design at all stages. 2. a task separately done by an expert cybersecurity team. 3. limited to firewalls and administrative control. 4. the final step before release of software systems.

Answer 106

inherent in privacy by design at all stages. | Privacy by design is not a new principle, but under GDPR became a legal requirement.

Question 107

Public health agencies should be aware of how to communicate the role of public health with external stakeholders. What is the role of public health agencies when communicating with external stakeholders? 1. To promote the agency and engage in advocacy 2. To promote favorable legislation 3. To provide STI tests and keep the public safe 4. To provide vaccinations

Answer 107

To promote the agency and engage in advocacy (Longest & Rohrer (2005) recommend that public health agencies can systematically acquire information from other agencies by engaging in three of the commonest features. These involve promoting the agency, advocacy and social marketing.)

Question 108

In order to effectively evaluate organizational performance, performance indicators must be: 1. approved by all organizational staff 2. publicly reported 3. benchmarked against previously agreed upon standards 4. clear in the organizational mission statement

Answer 108

benchmarked against previously agreed upon

Question 109

The principal difference between other industrialized countries and the United States in terms of providing universal health care coverage is that: 1. This is recognized as a basic human right in the other countries' founding document but not in the United States Constitution 2. All hospitals are owned by and all physicians are employees of the other governments while the United States takes a free market approach 3. The other countries spend more per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population. 4. The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population

Answer 109

The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population (Legislation long after other industrialized countries were founded added universal health care as a right, with variations from country to country in the way this is funded and organized. The United States has been unique among these nations in not providing coverage for all its citizens, in paying much more per capita for healthcare, and in ranking at the lowest levels on the metrics that usually are monitored to reflect a nation's health. Comparative data from the Organization for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) are published in annual reports on the performance of healthcare systems.)

Question 110

Which of the following is not a construct from the Health Belief Model? 1. Susceptibility 2. Cues to action 3. Decisional balance 4. Barriers

Answer 110

Decisional balance | decisional balance is often employed within stages of change theory, particularly in SOC’s Strong and Weak Principles.

Question 111

An outbreak of pneumonia has occurred at a resort and it is determined that Legionella is the organism that is responsible. To find the source of the bacteria, one of the highest priorities would be to check: 1. food handlers for infected cuts and sores 2. for dead animals on the property 3. resort water supply and storage 4. employees who have come to work with influenza

Answer 111

resort water supply and storage | Legionella is transmitted via the air when contaminated water from these and other sources is vaporized and inhaled.

Question 112

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with states to implement national environmental standards such as NAAQS? 1. By creating a memorandum of understanding focusing on cost-sharing of environmental burdens 2. By establishing air quality monitoring stations 3. By using a State Implementation Plan (SIP) approved by the EPA 4. By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

Answer 112

By using a State Implementation Plan (SIP) approved by the EPA (To avoid or minimize contradictory measures and standards among States, the Federal government provides the umbrella (uniform) guidance and standards for ambient air quality and requires States to participate in the implementation by developing a plan that meets Federal requirements. That plan is known as the SIP and contains a number of air quality control measures.)

Question 113

A short narrative or statement that describes the general focus and purpose of a program is called: 1. A mission statement 2. A long-term goal 3. A long-range plan 4. An objective

Answer 113

A mission statement

Question 114

Policy analysis when designing public health programs is: 1. involves a straightforward statistical analysis of health and public polling data. 2. a subjective political task accomplished by legislative debate and trade-offs. 3. complex, involving data collection and clarification of objectives. 4. impossible to define because different policy areas require different approaches.

Answer 114

complex, involving data collection and clarification of objectives. (The modified Bridgman and Davis framework for policy development shows policy analysis to consist of three elements: collect relevant data and information, clarify objectives and resolve key questions, then develop options and proposals. It identifies policy analysis as a step between identifying issues and undertaking consultation before moving on to making decisions)

Question 115

Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities are commonly referred to as: 1. Health behavior factors 2. Risk markers 3. Needs assessment 4. Determinants of health

Answer 115

Determinants of health

Question 116

Select the qualitative method that collects data through a simultaneous conversation with a group of people. 1. key informant interviews 2. discourse analysis 3. surveys 4. focus groups

Answer 116

Focus Groups

Question 117

is the study of social life, understood through analysis of languages in its widest senses (including face-to-face talk, non-verbal interaction, images, symbols and documents)

Answer 117

Discourse Analysis

Question 118

is the collection of information from a sample of individuals through their response to questions

Answer 118

Surveys

Question 119

are in-depth interviews with people who have informed perspectives about the topic or community you're working with

Answer 119

Key Informant Interview

Question 120

Assume systolic blood pressure (SBP) is modeled using linear regression analysis with LDL cholesterol as a single predictor. The coefficient of LDL cholesterol is positive and statistically significant at alpha = 0.05. The slope of the regression line: 1. can be interpreted as the average increase in LDL cholesterol for every one unit increase in SBP. 2. can only be interpreted if its value is greater than 1. 3. cannot be interpreted without knowing the value of the correlation coefficient. 4. can be interpreted as the average increase in SBP for every one unit increase in LDL cholesterol

Answer 120

can be interpreted as the average increase in SBP for every one unit increase in LDL cholesterol (This is the standard interpretation of the slope for a continuous independent variable.)

Question 121

Which term is used to characterize the movement addressing the social condition of unequal distribution of environmental hazards experienced by minority populations or groups with low income? 1. Environmental equity 2. Environmental justice 3. Environmental pollution 4. Environmental democracy

Answer 121

Environmental justice

Question 122

Under which circumstance would there be no ethical violation for an officer or employee of a governmental regulatory agency to accept food or beverage paid for by others? 1. Any meal, at any time, can be accepted from anyone except when an actual regulatory transaction is taking place. 2. Breakfast or dinner alone at his or her hotel provided in lieu of an honorarium for speaking at an industry-sponsored event. 3. Lunch provided on-site by an organization to everyone involved during day-long inspections of their operational facilities. 4. Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event

Answer 122

Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event

Question 123

Which of the following is the best example of a process evaluation for a program designed to decrease mortality from drinking and driving among high school youth? 1. Document change in mortality associated with drinking and driving 2. Document change in numbers of youth riding with impaired drivers 3. Document risks of riding with impaired drivers 4. Document number of students who attend a drinking and driving education program

Answer 123

Document number of students who attend a drinking and driving education program (Process evaluation is concerned with how the program is delivered. It deals with issues such as when program activities occur, where they occur, and who delivers them and how many people participate in those activities.)

Question 124

The Dartmouth Atlas of Healthcare demonstrates that small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in: 1. Physician practice styles 2. Consumer preferences for high-cost services 3. Age of the population served 4. Health status of the population served

Answer 124

Physician practice styles (The Dartmouth Atlas of Healthcare found wide variations in the frequency that various medical care treatments occurred in different areas of the United States. Additional research has shown that these variations are likely not associated with differences in health status, patient age, or consumer preferences, but rather with the practice styles noted and with the supply of physicians in different areas. Research on small area variations has supported the development of clinical practice guidelines.)

Question 125

Which leadership theory advances the notion that one’s task-relationship orientation can only be modified within certain limits and that structural and power factors will dictate whether you have a good leadership “fit?” 1. Contingency 2. Path-Goal 3. Transactional 4. Transformational

Answer 125

Contingency (Contingency Theory views effective leadership as contingent on matching a leader’s style to the right setting. After the nature of a situation is determined, the fit between leader’s style and the situation can be evaluated. Situational factors include leader member relations, task structure (degree to which tasks are clearly defined) and position power within the organization.)

Question 126

Which of the following would be the best source of information on adult and infant mortality? 1. Disease registries 2. Vital statistics 3. National Health Interview Survey 4. Hospital clinic statistics

Answer 126

Vital statistics (Vital statistics are the best source of information on adult and infant mortality. Data are routinely collected on all deaths that occur in the U.S. through death certificates. Death certificates record the age at death and are reported through the vital statistics registration system.)

Question 127

The linear relationship between two continuous variables is often described by: 1. Odds ratio 2. Relative risk 3. Correlation coefficient 4. F-test

Answer 127

Correlation Coefficient ( In probability theory and statistics, correlation (also called the correlation coefficient) indicates the strength and direction of a linear relationship between two random variables. In general statistical usage, correlation refers to the departure of two variables from independence. There are several coefficients that measure the strength and direction of correlation, with the appropriate correlation coefficient depending on the nature of data. The best known is the Pearson product-moment correlation coefficient, which is obtained by dividing the covariance of two continuous variables by the product of their standard deviations. The odds ratio and McNemar’s test are both used for categorical data, and the F-test is used for continuous measurements on more than two groups.)

Question 128

A supervisor of a small community health clinic serving a largely multi-national immigrant community assigns their project manager the responsibility of developing a new process to ensure complaints and conflicts are addressed promptly and respectfully for each patient. This is prompted by a recent complaint that a staff member was rudely addressing a limited English-speaking patient and her family when trying to communicate a diagnosis. In order to create a new process that takes into account the cultural and communication needs of the patients, the program manager must: 1. Create a new conflict process based solely on examples from other clinics. 2. Select a group of patients to provide input on how complaints should be resolved. 3. Wait until a new complaint occurs to observe the existing process. 4. Ask their coworkers how they personally deal with complaints and conflicts in the office.

Answer 128

Select a group of patients to provide input on how complaints should be resolved. (The other answers are partly correct, as observation and assessment are part of developing a new process or policy, however, they do not take into account the culture of the organization and its patients or its existing policies. The correct answer is consistent with the National Culturally and Linguistically Appropriate Services (CLAS) Standards which are designed to advance health equity and eliminate health disparities through governance, communication, and engagement.)

Question 129

Which of the following statements is not associated with the current paradigm of quality management? 1. Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care 2. The appropriate locus for ensuring quality is at the system level 3. Process improvement is essential to ensuring quality of care 4. Employee satisfaction and patient satisfaction are closely linked

Answer 129

Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care (This is the only correct response because the current quality management paradigm considers the primary source of errors, waste, and other indicators of poor quality to be poor system design and ineffective processes rather than individual incompetence or carelessness. Deming and others regard the sanctioning of individuals for poor quality to be misplaced and likely to aggravate the problem.)

Question 130

All written intervention messages (whether printed, computer-delivered, or Internet-based) must: 1. Start with the most important information first 2. Include graphics, pictures, and the like to attract people's attention 3. Be at a reading level suitable to the target population 4. Be no longer than four sentences long

Answer 130

Be at a reading level suitable to the target population

Question 131

A population of rural women experiences a high rate of mortality related to breast cancer. A local university hospital implements a breast cancer screening intervention. This intervention is an example of: 1. Routine prevention 2. Primary prevention 3. Secondary prevention 4. Tertiary prevention

Answer 131

Secondary Prevention

Question 132

This type of prevention is about detection and treatment to halt or slow the progressions of diseases, and it involves screening and early disease detection methods. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Examples include: regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes suitably modified work so injured or ill workers can return safely to their jobs.

Answer 132

Secondary Prevention

Question 133

aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include: legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases.

Answer 133

Primary Prevention

Question 134

This prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

Answer 134

Tertiary Prevention

Question 135

A researcher is working with local barber shops to plan a health promotion intervention. The intervention activities will include health education training workshops and educational print materials for the customers. The intervention activities are hypothesized to lead to changes in customers' fruit/vegetable intake, physical activity, and screening adherence. Which of the following statements describes how the researcher might start a formative evaluation plan? 1. Document which participating barbers attended each of the training workshops 2. Document the barbers' change in fruit/vegetable intake 3. Document the customers' change in physical activity 4. Convene focus groups in two barber shops to discuss print materials

Answer 135

Convene focus groups in two barber shops to discuss print materials (Formative evaluation assesses the feasibility and appropriateness of a program before full-scale implementation.)

Question 136

In a state with a state-directed public health organization, the State Commissioner of Health has notified health districts to close health department dental programs in response to a state legislature vote to defund and discontinue health department dental services. The district health department has identified dental services as a leading community health need. To help assure continued access to services, the best first step is to: 1. develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner's office. 2. develop agreements with local providers or organizations for the provision of dental services. 3. Continue the dental program in-house at the local health department, since it was already financially sustainable and heavily utilized. 4. ensure implementation of contracts and other agreements with community partners to provide community dental services.

Answer 136

develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner's office.

Question 137

Which of the following components of a strategic planning process in a public health agency has logical priority over the others? 1. Preparing an action plan for eradicating giardiasis in the municipal water system 2. Developing the operating budget and staffing plan for the agency 3. Reviewing (and revising) the vision and mission statements for the agency 4. Setting strategic goals for a three-year cycl

Answer 137

Reviewing (and revising) the vision and mission statements for the agency (The initial activity in the prevailing strategic planning paradigm is the review and (as needed) revision of the organization’s mission and vision statements and its core values. This provides a philosophical foundation for subsequent steps in the strategic planning process)

Question 138

When beginning work with a coalition of community groups to improve health outcomes in the community, a key first step would be to: 1. Develop a shared vision 2. Develop an evaluation plan 3. Develop a data collection plan 4. Develop a logic model

Answer 138

Develop a shared vision (Developing a shared vision is important in make sure the coalition of community groups is on the same page. A shared vision allows the different coalition groups to come to a consensus on the definition of the health need or issue they are working on.)

Question 139

As a first step in public health emergency preparedness, jurisdictions should: 1. Ask a local government leader what will be expected of them. 2. Outsource public health emergency preparedness responsibilities. 3. Self-assess their ability to address resource elements for each preparedness capability and then assess their ability to demonstrate the functions associated with each capability. 4. Design and conduct at least one table-top exerci

Answer 139

Self-assess their ability to address resource elements for each preparedness capability and then assess their ability to demonstrate the functions associated with each capability. (State and local public health departments are key responders in emergency situations that impact the public's health. To assist public health departments with emergency preparedness, the Centers for Disease Control and Prevention has articulated 15 public health preparedness capabilities. Each capability has several associated functions and performing each function requires specific resource elements. The resource elements fall into three categories: Planning, Skills and Training, or Equipment and Technology As a first step, jurisdictions are encouraged to self-assess their ability to address the prioritized planning resource elements of each capability and then to assess their ability to demonstrate the functions and tasks within each capability. CDC has defined successful accomplishment of prioritized resource elements as the following: a public health agency has either the ability to have (within their own existing plans or other written documents) or has access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element.)

Question 140

Effective policy dialogue facilitators: 1. value the policy dialogue process over its outcome. 2. value an outcome over the policy dialogue process. 3. rarely engage in preparatory stages before panels meet. 4. moderate rather than interpose with questions.

Answer 140

value the policy dialogue process over its outcome

Question 141

To evaluate public health performance, we consider capacity, process, and outcomes. Which of the following represents an example of an “outcome?” 1. An increase in the types of vaccines offered to protect against common childhood diseases 2. Decrease in number of children age 0-2 with vaccine preventable disease 3. Routine health care 4. Increase in number of patients seen in the mobile immunization van

Answer 141

Decrease in number of children age 0-2 with vaccine preventable disease (Outcomes in program management and performance respond to the question of what impact will the planned program activity have? Or what change may we expect due to the program? The outcome may be short term/ mid term/ or long term. The increase in vaccination meets this criteria. Answer A and D are examples of program activities or OUTPUTS.)

Question 142

What is the “reservoir host” for West Nile Virus? 1. Birds 2. Mosquitoes 3. Humans 4. Cattle

Answer 142

Birds (Surveillance programs for West Nile Virus include the reporting of dead birds in affected areas. A reservoir of an infectious agent, such as a virus, is any animal, person, plant, soil, substance—or combination of any of these — in which the infectious agent normally lives. In addition, the infectious agent must primarily depend on the reservoir for its survival, and must be able to multiply there. It is from the reservoir that the infectious substance is transmitted to a human or other susceptible host. The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may not be the source from which an agent is transferred to a host. For example, the reservoir of Clostridium botulinum is soil, but the source of most botulism infections is improperly canned food containing C. botulinum spores.)

Question 143

The best example of community engagement and empowerment refers to which of the following? 1. Teaching community members how to best communicate with providers 2. Conducting health needs and assets assessment with communities and sharing the information 3. Teaching self-determination to community members 4. Reciprocal transfer of knowledge and skills among all collaborators and community partners

Answer 143

Reciprocal transfer of knowledge and skills among all collaborators and community partners

Question 144

Informed consent should avoid inclusion of: 1. risks and benefits 2. technical jargon 3. contact information 4. purpose

Answer 144

technical jargon

Question 145

Which of the following is defined as a community's ability to survive, adapt and thrive? 1. Community capital 2. Community development 3. Community organization 4. Community capacity

Answer 145

Community capacity

Question 146

Generalizing certain characteristics of the population based on the sample data is referred to as: 1. Random sample 2. Statistical inference 3. Descriptive statistics 4. Histograms and bar charts

Answer 146

Statistical inference (By definition, statistical inference is the use of statistics to make inferences concerning some unknown aspect of a population based on data from a sample of that population.)

Question 147

After reviewing evidence demonstrating increased survival of narcotic self-overdose after immediate naloxone administration, the State Commissioner of Health issues the following standing order: "This order authorizes pharmacists who maintain a current active license practicing in a pharmacy located in Virginia that maintains a current active pharmacy permit to dispense one of the following naloxone formulations (notes intranasal or autoinject kits options), in accordance the current Board of Pharmacy-approved protocol." "The State Good Samaritan Act states in part that any person who, in good faith prescribes, dispenses, or administers naloxone or other opioid antagonist used for overdose reversal in an emergency to an individual who is believed to be experiencing or about to experience a life-threatening opiate overdose shall not be liable for any civil damages for ordinary negligence in acts or omissions resulting from the rendering of such treatment if acting in accordance with the Good Samaritan Act or in his role as a member of an emergency medical services agency." This order demonstrates: 1. Secondary Prevention and Harm Prevention Strategy 2. Secondary Prevention and Harm Reduction Strategy 3. Tertiary Prevention and Harm Reduction Strategy 4. Tertiary Prevention and Harm Prevention Strategy

Answer 147

Tertiary Prevention and Harm Reduction Strategy

Question 148

The following test would be used to compare the frequency of diabetes between groups: 1. Chi-square goodness of fit test 2. Chi-square test of independence 3. Two independent samples t test 4. Analysis of variance

Answer 148

A chi-square test of independence is appropriate because it can compare the proportions of participants in each category. The outcome of interest is diabetes status, a dichotomous variable, and interest lies in comparing diabetes between groups.

Question 149

A distinctive foundation of the Comprehensive Unit-based Safety Program (CUSP) developed at Johns Hopkins and promoted by the Agency for Healthcare Research and Quality creates a culture of safety by focusing on: 1. detecting and reporting sentinel events 2. open attitudes and mutual respect 3. using standardized checklists 4. assuring professional expertise

Answer 149

open attitudes and mutual respect (CUSP tools support change at the unit level to create a culture of safety (AHRQ, 2018). This is more fundamental than checklists alone, although empowering all staff to participate in use of checklists also has been part of CUSP’s success in reducing the incidence of preventable adverse patient outcomes. Studies have found that working in an environment where open and mutual communication is present enhances clinical proficiency and job satisfaction (O'Daniel and Rosenstein, 2008). Sentinel events are events so egregious that a single occurrence is prima facie evidence of medical error (e.g. wrong-site surgery); however, few such events have proven to be reliable indicators because many low-probability adverse outcomes are not entirely preventable despite all aspects of care being correctly done.)

Question 150

Healthcare facilities share patient data through Health Information Exchange networks. Which of the following pairs address the definition of a covered entity among data recipients, and procedures for creating public use data sets de-identified of personal health information? 1. Health Insurance Portability and Accountability Act (HIPAA) and Safe Harbor conventions 2. Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA) 3. Safe Harbor conventions and the Consolidated Omnibus Budget Reconciliation Act (COBRA) 4. Health Information Technology for Economic and Clinical Health Act (HITECH) and Affordable Care Act (ACA)

Answer 150

Health Insurance Portability and Accountability Act (HIPAA) and Safe Harbor conventions (Healthcare facilities are legally required to report certain patient-identified data to regional and national public health agencies. National agencies, in turn, share certain data internationally with their counterparts. As this communication becomes more automated, various laws, regulations, and conventions were implemented to safeguard patient’s personal health information. Choice A is correct in this example from the United States of America. HIPAA, and its regulatory interpretation through related Privacy and Security rules (see https://www.hhs.gov/hipaa/for-professionals/index.html for more information), define as "covered entities" the data recipients subject to privacy protection provisions specified in the Act, including requiring patient permission. HIPAA includes an exemption for public health reporting of limited data sets, which eliminates the requirement that patients grant permission on data sharing of certain information. Patient permission is also not required for sharing identifiable personal health information with public health agencies for certain essential public health activities such as investigations of child abuse or a person at risk of contracting or spreading a disease. Safe Harbor conventions have defined which data elements to delete to create de-identified patient data sets. The other federal Acts deal with other issues of access to healthcare insurance (ACA, COBRA) and promotion of electronic reporting systems (HITECH). Safe Harbor is international in its roots; ACA, COBRA, HIPAA and HITECH are unique to the United States. It is important to understand related laws and regulations in different countries because data travelling through the internet crosses jurisdictions where different approaches to privacy protection and national security can create conflicts. For example, federal and provincial Information and Privacy Commissioners in Canada required that health information of Canadians be stored in Canadian archives due to concerns about the U.S. Patriot Act.)

Question 151

The incidence of bacteria that are resistant to antibiotics is: 1. Increasing 2. Decreasing 3. Staying the same 4. Difficult to measure

Answer 151

Increasing

Question 152

To inform a policy decision so that an intervention will result in the largest possible number of persons benefitted, which of the following statistics provides the most useful indication of the magnitude of exposure to a factor and subsequent development of disease? 1. Likelihood ratio 2. Absolute risk difference 3. Relative risk ratio 4. Prevalence rate

Answer 152

Absolute risk difference (Absolute risk difference is simply the difference in outcome rates, subtracting one group’s rate from the other. It is a more useful indicator of caseload for managers and policy-makers) ( Studies have shown that people have more difficulty making accurate decisions when presented with ratios rather than risk differences)

Question 153

______ is the ratio of the probability of an event occurring in an exposed group to the probability of that event occurring in a comparison, non-exposed group. Dividing one group’s rate by another in this manner is useful for identifying risk factors, but the ratio can be large whether the number of persons in each group is big or small, so _______is not a good estimator of caseload

Answer 153

Relative RIsk

Question 154

more commonly used in relation to interpreting diagnostic tests.

Answer 154

Likelihood Ratio

Question 155

__________ alone can be more cumbersome and are not as informative as incidence rates for diseases that are not chronic

Answer 155

Prevalence rates

Question 156

Which of the following water-borne disease organisms is very difficult to kill by chemical disinfection of drinking and/or recreational water supply systems and has caused major US disease outbreaks? 1. Vibrio cholerae (causes cholera) 2. Cryptosporidium (causes Cryptosporidiosis) 3. Giardia lamblia (causes Giardiasis) 4. Escherichia coli (causes acute gastroenteritis)

Answer 156

Cryptosporidium (causes Cryptosporidiosis) (Protozoa of the genus Cryptosporidium are highly resistant to chlorine disinfection, and are responsible for numerous and increasing waterborne disease outbreaks. The largest waterborne disease outbreak in US history, which occurred in Milwaukee, Wisconsin in 1993, was caused by contamination of the city's drinking water with this organism; over 400,000 residents became ill. Contact with contaminated recreational waters, such as in swimming pools, is a particularly common source of exposure. Giardia is another chlorine-resistant parasite, but it has not been associated with large-scale outbreaks)

Question 157

The most important reason for reduced mortality during the initial stage of a demographic/epidemiologic transition in a population is: 1. Increased use of antibiotics 2. Improved sanitation 3. Increased immunization 4. Screening for common infectious diseases

Answer 157

Improved sanitation

Question 158

When a new treatment is developed that prevents death, but does not produce recovery from disease, the following will occur: 1. Prevalence of the disease will increase 2. Incidence of the disease will increase 3. Prevalence of the disease will decrease 4. Incidence of the disease will decrease

Answer 158

Prevalence of the disease will increase

Question 159

Which of the following statements regarding disease measures is correct? 1. Incidence equals duration times prevalence 2. Prevalence is a rate 3. Cumulative incidence is a proportion 4. Incidence density is a proportion

Answer 159

Cumulative incidence is a proportion (Cumulative incidence is a proportion because it expresses the number of people who develop a condition as the numerator and the number of people at risk for the condition in the denominator, thus fulfilling the requirements of a proportion. Proportions are a type of ratio in which the numerator is included the denominator A rate, conversely, expresses the number of cases of a disease as a numerator and the total units of time as the denominator. Prevalence is expressed as incidence times duration, thus it is also a proportion. The numerator for incidence density is “number of cases” and the denominator is “person-time,” thus representing a rate and not a proportion.)

Question 160

Prevalence is expressed as incidence times duration, thus it is also a ______

Answer 160

Proportion

Question 161

In the construction of Box-plots, the upper and lower fences are used to detect which of the following? 1. Outliers 2. Maximum and minimum values 3. Median and range 4. Quartiles

Answer 161

Outliers (The lower fence is defined as: Q1 – 1.5(IQR). The upper fence is defined as: Q3 + 1.5(IQR) where Q1 and Q3 are the lower and upper quartiles and IQR is the interquartile range. The upper and lower fences are boundaries. Any measures that falls outside those boundaries can be considered outliers.)

Question 162

Which of the following best characterizes the contingency theory of leadership? 1. The leader’s authority is contingent upon subordinates 2. The leader’s effectiveness depends upon factors in the leadership context 3. The leader’s effectiveness depends upon the technical competency of staff 4. The leader’s authority is contingent upon formal rules and sanctions

Answer 162

The leader’s effectiveness depends upon factors in the leadership context (Contingency theory has broadened the scope of leadership understanding from a focus on a single, best type of leadership to emphasizing the importance of a leader’s style and the demands of different situations.)

Question 163

Which of the following is an expected benefit of consolidating independent hospitals and provider groups into an integrated health care system? 1. Economies of scale in production 2. Lower costs of integration 3. Ease of accommodating diverse organizational cultures 4. Immediate gains in administrative efficiency

Answer 163

Economies of scale in production (Growth through mergers and acquisitions are typically justified on the basis of economic efficiencies achieved through enhanced economies of scale, an increase share of the relevant market by the integrated system, and greater revenues. However, the demands of implementation and maintaining a larger integrated system increase the administrative burden (and associated overhead costs). Accommodating different organizational cultures is a challenge faced by management in most corporate mergers and often is recognized as a root cause of failed mergers and acquisitions.)

Question 164

As identified in the seminal 1988 Institute of Medicine report on the future of public health, which of the following is not one of the three core functions of the roles and responsibilities of public health agencies? 1. Assessment 2. Financial performance management 3. Policy development 4. Assurance

Answer 164

Financial performance management

Question 165

Drug therapy for individuals who have screened positive for tuberculosis (TB) infection, but do not have any TB symptoms, is considered which type of prevention for TB disease? 1. Primary 2. Secondary 3. Tertiary 4. Quaternary

Answer 165

Secondary | Secondary prevention includes early detection and treatment.

Question 166

From a political perspective, which type of analysis provides the weakest identification of social and economic impact? 1. Cost-benefit analysis 2. Cost-effectiveness analysis 3. cost-minimization analysis 4. cost-utility analysis

Answer 166

cost-minimization analysis (Selecting a policy, program or initiative that has the least direct cost without doing any estimation of possible benefit(s) might satisfy those who only believe in small government, but answer (C) is weak justification. Cost-benefit at least considers whether fiscal value of benefits could outweigh costs; cost-effectiveness identifies which of several options produces the most benefit for the least expenditure; and cost-utility analysis adds weighting of financial benefit in terms of perceived desirability of such benefits to recipients.)

Question 167

The logic model that has been the dominant paradigm representing types of information that may be collected to draw inferences about quality of care provided by a healthcare system has been: 1. Donabedian's model 2. Shewart's PDCA 3. Theory of Change 4. Web of Causation

Answer 167

Donabedian's model ( Other frameworks have been developed, but the three-category model first proposed by Avedis Donabedian in 1966 has predominated. Some have modified this linear model to include four categories: input (also sometimes called structure), process (also sometimes called throughput), output and outcome. Other models have been proposed to address the criticism that a linear model may not capture all the complexities of interactions.)

Question 168

In an effort to improve a research center's public image, the director commits to securing additional funding for faculty whose research has significant measurable community impact. This leadership style can be described as: 1. Transactional 2. Transformational 3. Passive-avoidant 4. Autocratic

Answer 168

Transactional (Transactional Leadership occurs where a leader influences another through a reciprocal relationship or an exchange of things of value to advance both of their agendas. It could be through contingent reward where the worker performs a task and both benefit from the outcome or through punishment. It is more closely aligned with management functions, getting a job done and achieving expected outcomes.)

Question 169

Ethical standards apply to government officers and employees. For such individuals, these standards apply: 1. only during their normal working hours. 2. just when performing official duties regardless of time. 3. when they identify themselves with their official title. 4. at all times, whether they are on or off duty.

Answer 169

at all times, whether they are on or off duty.

Question 170

Which of the following terms means that a tumor has spread to other locations within the body? 1. Malignant 2. Metastatic 3. Benign 4. Hyperplastic

Answer 170

Metastatic (A metastatic tumor is one that has begun to shed cells into the bloodstream that can then spread to other locations throughout the body. A malignant tumor is one that has begun to invade surrounding tissues, but has not yet necessarily metastasized. A benign tumor is not malignant and so does not grow in an uncontrolled manner or invade nearby tissues. A hyperplasia is a growth of cells in excess of what is normally observed, but it does not necessarily become malignant.)

Question 171

The use of sun protection like sun screen and/or wearing a hat are examples of which type of prevention strategy? 1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention 4. Quaternary Prevention

Answer 171

Primary Prevention (Primary Prevention measures include health promotion and disease prevention activities, before there is any evidence of disease.)

Question 172

The local health jurisdiction is seeking governmental funding to address breast cancer which has a lower incidence rate in group X than in group Y, though group X has a higher mortality rate. This is an example of: 1. Health disparity 2. Harm reduction 3. Modifiable risk factors 4. Life expectancy

Answer 172

Health Disparity (Health Disparity is defined as the difference in health status between two groups).

Question 173

Which of the following practices enhances equity across populations when making health policy decisions in a community? 1. Requiring randomized control evidence of effectiveness 2. Allocating resources based on population size 3. Collecting health-related data about the individuals in the community 4. Including diverse constituencies in the decision-making groups

Answer 173

Including diverse constituencies in the decision-making groups (Allocating resources based simply on population size may not target resources to the most needy populations or issues in a community, nor will it guarantee an improvement in equity. Collecting data is important and can be useful in the policy process. However, collecting data alone without interpreting the data and having a diversity of stakeholders weigh in on how the results will be used to make health policy decisions that impact the community will not enhance equity. Finally, it is important to frame questions that need evidence and then select the most appropriate type of evidence rather than accept only randomized controlled trials. Having diverse constituencies at the table during decision-making is the correct answer as acknowledging and incorporating different viewpoints will enhance equity in health policy decisions.)

Question 174

Which of the following strategic planning tools is in the form of a 2x2 table? 1. Gantt chart 2. Network diagram 3. Precede Proceed model 4. SWOT chart

Answer 174

SWOT chart (There are two planning tools that take the form of a 2x2 table: the Johari Window and the SWOT chart (also called SWOT matrix or SWOT analysis). SWOT stands for Strengths, Weaknesses, Opportunities and Threats. They are useful at the initial planning stage. The Precede Proceed model is a more complex model for cost-benefit evaluation, developed by Lawrence Green in 1974. Network diagrams and Gantt charts take the form of a railroad-type map and a matrix; they are used in program management to ensure a project stays on schedule.)

Question 175

To conduct an individual interview with an unemancipated adolescent aged 14 - 15 for a study on diabetes in high school students, from whom must the researcher gain consent, assent, and/or permission according to the ethical practices outlined by the Office of Human Research Protections ? 1. A parent/guardian 2. Teenager 3. Teenager and school official 4. Teenager and parent/guardian

Answer 175

Teenager and parent/guardian

Question 176

The goal of an ANOVA statistical analysis is to determine whether or not: 1. The means of two samples are different 2. The means of more than two samples are different 3. The means of two or more populations are different 4. The means of two populations are different

Answer 176

The means of two or more populations are different (One of the simplest experimental designs is the completely randomized design in which random samples are selected independently from each of g populations. An analysis of variance is used to test if the g population means are the same, or is at least one mean different from the others.)

Question 177

To determine whether to expand a component of a current intervention, which type of evaluation is needed? 1. Formative evaluation 2. Process evaluation 3. Outcome evaluation 4. Impact evaluation

Answer 177

Formative evaluation (a Formative evaluation ensures that a program or program activity is feasible, appropriate, and acceptable before it is fully implemented. It is usually conducted when a new program or activity is being developed or when an existing one is being adapted or modified.)

Question 178

A collaborative approach to research that equitably involves all partners in the research process and recognizes the strengths that each brings. For example, these partners could include community members, organizational representatives, and researchers. Please identify which of the following options best describes this type of research. 1. Ecological Study 2. Community Based Participatory Research 3. Theory of Reasoned Action 4. Randomized Community Trial

Answer 178

Community Based Participatory Research (Community Based Participatory Research recognizes the strength of equitably including members of a study population as active participants though all phases of the research)

Question 179

______ study where at least one variable, which can be the exposure or the outcome, is measured at the group level and not the individual level

Answer 179

Ecological Study

Question 180

is a theory that "explores the relationship between behavior and beliefs, attitudes, and intentions"

Answer 180

Theory of Reasoned action

Question 181

is a type of experimental study where the intervention is allocated to entire communities. This type of trial can be randomized or nonrandomized.

Answer 181

(Randomized) Community Trial

Question 182

If two copies of a mutant allele are necessary to cause symptoms of a disease to appear in the phenotype, what type of genetic disease is this? 1. Recessive 2. Sex-linked 3. Autosomal 4. Dominant

Answer 182

Recessive | A recessive condition is one in which an individual needs to be homozygous for a mutation in order to show symptoms.

Question 183

When comparing dichotomous variables with less than five expected observations per cell, the correct statistical test would be a: 1. t-test 2. rank sum test 3. Fisher's Exact test 4. Chi-square test

Answer 183

Fisher's Exact test (When analyzing dichotomous variables with small cell sizes, the Fisher's Exact test should be used because it produces the exact p value, rather than an approximation from a Chi-square test. Rank tests are used for skewed distributions or ranked data and a t-test is used for continuous data.)

Question 184

used for continuous data

Answer 184

T-test

Question 185

To learn more about the “natural course” of syphilis, from 1932-1972, the US Public Health Service left infected study participants (comprised of poor black men) untreated. This resulted in pain, blindness, infertility, and death, as well as transmission of the disease to partners and children. The Tuskegee Syphilis Study, is a sentinel public health event because of these ethical violations and resulted in: 1. The Nuremberg Code 2. The Belmont Report 3. Rose-Welch Report 4. The Legal Epidemiology Competency Model

Answer 185

The Belmont Report (The US PHS were found to be in violation of various ethical considerations: the participants were deceived about the rationale and process of the study; there was no informed consent; treatment was withheld. The study went on for 40 years, when these egregious actions were brought to light. In response to this, the National Research Act of 1974 and the Belmont Report which identifies basic ethical principles that should underlie human subjects research)

Question 186

The difference between primary and secondary prevention of disease is: 1. Primary prevention focuses on control of causal factors, while secondary prevention focuses on control of symptoms 2. Primary prevention focuses on control of acute disease, while secondary prevention focuses on control of chronic disease 3. Primary prevention focuses on control of causal factors, while secondary prevention focuses on early detection and treatment of disease 4. Primary prevention focuses on increasing resistance to disease, while secondary prevention focuses on decreasing exposure to disease

Answer 186

Primary prevention focuses on control of causal factors, while secondary prevention focuses on early detection and treatment of disease (Primary prevention is directed towards preventing the “incidence” of disease. This means that primary prevention aims to decrease the prevalence of risk factors or increase the prevalence of preventive factors, thus changing the incidence of disease. In secondary prevention, disease has already occurred and the prevention program aims to detect disease early so that treatment can be started early)

Question 187

To help lay, professional and policy audiences understand the rationale for a program proposal, it is best to: 1. provide everyone with the same report, written in plain language aimed for a Grade 10 reading level. 2. recognize that policy or professional audiences prefer to see benefit or risk projections as ratios, lay audiences prefer them expressed as number-needed-to-treat or harm. 3. present a comprehensive literature review, summarize all the numbers in one table and let the facts speak for themselves. 4. tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience.

Answer 187

tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience.

Question 188

Using a qualitative evaluation method would be most useful in which of the following scenarios? The researcher is: 1. primarily concerned with the generalizability of the results. 2. interested in capturing the context of program participation and the participants' stories. 3. concerned with ease of analysis and interpretation of data 4. comparing outcomes for a group participating in a program to the outcomes for a similar group not receiving the program

Answer 188

interested in capturing the context of program participation and the participants' stories. (Qualitative methods place emphasis on lived experiences and are especially useful for capturing context and complexity.)

Question 189

Activists criticized America's public health policy response during initial years of its AIDS epidemic on the grounds that: 1. Absence of universal health care insurance prevented victims from accessing expensive treatment 2. Government indifference and political infighting resulted in apathy toward a suffering gay community. 3. Too much money was being spent on treatment, not enough on prevention to stop the epidemic. 4. Too much resource was being spent on urging people to change risk behaviors, not enough on medication.

Answer 189

Government indifference and political infighting resulted in apathy toward a suffering gay community.

Question 190

The primary purpose of strategic planning is to: 1. assign tasks and responsibilities to individuals based on expertise 2. determine the organization's annual budget allocation 3. maximize return on investment for programming 4. determine the direction an organization will pursue

Answer 190

determine the direction an organization will pursue (Strategic planning is an organizational management activity that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholders are working toward common goals, establish agreement around intended outcomes/results, and assess and adjust the organization's direction in response to a changing environment.)

Question 191

The leadership in a public health organization has decided to conduct a training needs assessment of its staff, identify training needs, and to invest in training and other resources to ensure that the organization is able to carry out its essential functions and its mission, now and into the future. This is an example of (a/an): 1. Capacity building 2. Efficiency Study 3. Continuous Quality Improvement 4. Feasibility Study

Answer 191

Capacity building (Capacity building in an organization are categorized by efforts of the organization to enhance its ability to competently achieve its (operational, programmatic, financial) goals now and into the future)

Question 192

Social marketing is the use of marketing principles to influence human behavior in order to improve health. Which one below is NOT one of the 4 P's of social marketing? 1. Price 2. Promotion 3. Place 4. Process

Answer 192

Process | The four P's of social marketing is Price, Promotion, Place, and Product.

Question 193

What term reflects the meaning of external validity of study findings as used in an evidence-based critical appraisal? 1. Generalizability 2. Bias 3. Confounding 4. Surrogate end points

Answer 193

Generalizability (Generalizability describes the extent to which the effects in a study truly reflect what can be expected in a target population beyond the people included in the study.)

Question 194

A systematic error where something else other than the predictor variable influences the response variable.

Answer 194

Bias

Question 195

Presence of a factor that influences both the intervention and the outcome of research.

Answer 195

Confounding

Question 196

An outcome that substitutes for a direct measurement of a clinical outcome. This may correlate with the real clinical outcome.

Answer 196

Surrogate end points

Question 197

Data for which personally identifiable information was not collected, or has been encrypted or removed are known as: 1. Confidential 2. Secure 3. Anonymous 4. Coded

Answer 197

Anonymous (In public health surveillance, data anonymization ensure all personally identifiable information is not collected, or has been encrypted or removed so as to not compromise individual privacy)

Question 198

The “Greenhouse Gas” of primary concern in global warming is: 1. Chlorofluorocarbons 2. Carbon monoxide 3. Sulfur dioxide 4. Carbon dioxide

Answer 198

Carbon dioxide (Carbon dioxide in the atmosphere absorbs and re-emits infrared radiation emitted from the earth's surface, acting as an insulating blanket that helps moderate the earth's temperature. This is termed the "Greenhouse Effect." Atmospheric carbon dioxide concentration has increased substantially in recent decades due to fossil fuel combustion, causing great concern about the potential adverse effects of excessive global warming.)

Question 199

Which statement best describes the p-value? 1. The probability that the null hypothesis is true 2. The probability of rejecting the null hypothesis when it is true 3. The probability that a replicating experiment would not yield the same conclusion 4. The probability of rejecting the null hypothesis when it is false

Answer 199

The probability that a replicating experiment would not yield the same conclusion (The definition of a p-value is the probability that a test statistic would be as extreme as, or more extreme than, observed if the null hypothesis were true. P-value is a statement of the probability that the difference was observed by chance if the groups were really alike, as stated under the null hypothesis.)

Question 200

Public health departments can use health profession students (eg. medicine, nursing, other allied health specialties) in projects to assess community health needs: 1. if those students are formally employed by that health department under a national fellowship program that puts selected applicants into mentorship placements. 2. provided the students interview but do not take clinical measurements or samples from individuals. 3. when supervised by their clinical instructors in actions within the scope of that profession’s practice. 4. but this is not often done because the health department would be responsible for all supervision and liability.

Answer 200

when supervised by their clinical instructors in actions within the scope of that profession’s practice.

Question 201

Exposure assessment attempts to answer all of the following questions except: 1. Toxicity of the exposure 2. Frequency and duration of exposure 3. Population exposed 4. Route of exposure

Answer 201

Toxicity of the exposure

Question 202

It can be helpful to make sure you are setting goals and objectives that are SMART. The R in SMART stands for: 1. Reliable 2. Resistant 3. Realistic 4. Rapid

Answer 202

Realistic. A "SMART" goal or objective is one that is Specific, Measurable, Achievable, Realistic, and Time-bound.

Question 203

In low resource countries during an outbreak, what simple, low-tech sanitation measure can dramatically reduce the spread of enteric bacteria and viruses? 1. Disposing of stagnant water 2. Sleeping under an insecticide-soaked bednet 3. Vaccination of those individuals who work on the water supply 4. Add chlorine to water storage containers

Answer 203

Add chlorine to water storage containers In addressing an outbreak of bacteria and viruses in a low resource country, disinfection is considered a primary mechanism for inactivating/destroying pathogenic organisms and preventing the spread of waterborne diseases to downstream users and the environment. Some of the most commonly used disinfectants for decentralized applications include chlorine, iodine, and ultraviolet (UV) radiation. Chlorine is one of the most practical and widely used disinfectants.

Question 204

May a state officer or employee of a regulatory agency concurrently conduct an outside (private) business or accept outside employment? 1. Yes, provided the outside business activity is unrelated to the area that he or she regulates. 2. No, any outside business engagement gives the appearance of unacceptable conflict of interest. 3. Perhaps, but only if the outside business engagement is approved by the agency’s head. 4. There is no clear ethical standard – this is more a question of ability to manage both schedules.

Answer 204

Yes, provided the outside business activity is unrelated to the area that he or she regulates.

Question 205

What level of government typically provides the oversight and guidance to prioritize public health needs and resources that focuses program planning and evaluation? 1. Public Health Department Program Management 2. Public Health Department chief executive officer 3. Board of Health 4. Legislature

Answer 205

Board of Health

Question 206

In cohort studies, which of the following is correct about the role of a suspected factor in the etiology of a disease? 1. There are equal numbers of people in both study groups. 2. At the beginning of the study, those with the disease and those without the disease have equal risks of having the factor. 3. The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders. 4. The incidence of the disease is low.

Answer 206

The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders. (Ensuring that exposed and unexposed groups enrolled in a study are as similar as possible in regard to potential confounders helps ensure that the two groups will be comparable. This increases the internal validity of the findings.)

Question 207

In this era of personalized medicine, a growing number of biomarkers are becoming readily available to individuals. Which of the following presents the greatest ethical concerns? 1. Cancer biomarkers (e.g. specific gene mutations or elevated expression levels) 2. Direct to consumer family heritage genomic analysis services 3. Blood typing 4. Newborn Cystic Fibrosis screening

Answer 207

Direct to consumer family heritage genomic analysis services (The other types of markers are used within the context of medical diagnosis or prognosis testing, so covered by patient privacy conventions. Unlike licensed medical service providers and clinical laboratories, direct-to-consumer commercial genomic services do not operate under the same legal constraints on ownership and privacy, which has raised concerns)

Question 208

Out of a population of 500,000 people, 500 were observed for two years. Five developed disease. What is the incidence density rate? 1. 5/500 2. 5/1000 3. 5/500,000 4. 500/500,000

Answer 208

5/1000 Incidence rates measure the number of new cases of a disease that emerge in an at-risk population within a window of time. When expressed as a fraction, the numerator is the number of new cases that emerge. The denominator is the number of people in the at-risk population during that same window of time. Mortality rates measure the number of deaths in a population within a specific window of time. The numerator is the number of deaths that occur and the denominator is the number of people in the population during that window of time. Highly fatal diseases, such as liver cancer, have a short duration because as new cases are added to a population, they are quickly resolved through death. Thus, the numerator for both measures of incidence and mortality will be roughly the same if the window of time is the same.

Question 209

The last category in a cumulative relative frequency distribution will have a cumulative relative frequency equal to? 1. 0 2. 1 3. The total number of individuals in the given data set 4. The total number of categories in the given data se

Answer 209

1 A cumulative relative frequency distribution is a tabular summary of a set of data showing the relative frequency of items less than or equal to the upper class limit of each class. The relative frequency is defined as the fraction or proportion of the total number of items. To find the cumulative relative frequencies, add all the previous relative frequencies to the relative frequency for the current row. Thus the last entry of the cumulative relative frequency column is one, indicating that one hundred percent of the data has been accumulated.

Question 210

Which of the following characteristics is true for a prospective (or concurrent) cohort study, but not true for a retrospective (or historical) cohort study? 1. They are good for rare exposures 2. Exposed and unexposed groups are followed over time 3. he disease outcome has not yet occurred when the study begins 4. Incidence rates can be calculated for exposure groups

Answer 210

he disease outcome has not yet occurred when the study begins In a prospective or concurrent cohort study, the outcome of interest is not known at the beginning of the study, while in a retrospective or historical cohort study, some or all of the study activity, including disease outcome, may have already occurred.

Question 211

estimates the probability or risk that a person will develop disease DURING A SPECIFIED TIME. Number of new cases of disease = numerator • Number in candidate population over a specified period of time = denominator

Answer 211

Cumulative Incidence

Question 212

new cases of disease in candidate population divided by person-time of observation #new cases of disease person time of observation

Answer 212

Incidence Rate

Question 213

Which of the following is calculated by dividing the number of new cases of disease by the total population at risk?

Answer 213

Cumulative Incidence

Question 214

Relative Risk Formula

Answer 214

RR= a/(a+b) or Rate in exposed over | c/(c+d) or Rate in unexposed

Question 215

Explain how relative risk works: ie what do the various numbers mean?

Answer 215

RR=1.0 - no association between exposure and disease • RR=2.0 - two times the risk of disease in the exposed compared to the unexposed • RR=1.6 - 1.6 times the risk of disease in the exposed compared to the unexposed or 60% increased risk of disease in the exposed (1.6 - 1.0 = .60 = 60%) • RR = 0.5 - 0.5 times or ½ the risk of disease in exposed compared to unexposed.

Question 216

Odds Ratio are most commonly used in what studies?

Answer 216

casecontrol studies; however they can also be used in | cross-sectional and cohort study designs as well.

Question 217

Define Odds Ratio

Answer 217

represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

Question 218

Odds Ratio Formula

Answer 218

OR = (a/b) / (c/d) | or ad/bc

Question 219

``` Which condition must be met in order for the Odds Ratio to approximate the Relative Risk? • The disease must be common • The disease must be rare • The exposure must be common • The exposure must be rare ```

Answer 219

The disease must be rare

Question 220

making assumptions about the individual based on finding at the level of the population

Answer 220

Ecological Fallacy

Question 221

Identify the Study Type Unit of analysis: Population or groups • Exposure status: Based on the population • Time can vary

Answer 221

Ecological/Correlational

Question 222

``` Identify the Study Type Time: Snap-shot in time – If a particular point in time=point prevalence • Population: individual level • Population: selected without regard to exposure or disease status • Measure: Prevalence of disease • Measure of association: OR • Cannot determine cause and effect ```

Answer 222

Cross-sectional

Question 223

``` Identify the Study type Disease is rare • Disease has a long induction and latent period • Little is known about the disease • Selection of the cases • Selection of controls ```

Answer 223

Case - control

Question 224

the observational equivalent of experimental studies but the researcher cannot allocate exposure

Answer 224

Cohort Studies

Question 225

A study in which two or more groups of people that are free of disease and that differ according to the extent of exposure (e.g. exposed and unexposed) are compared with respect to disease incidence

Answer 225

Cohort Study

Question 226

Threats to internal validity can be lumped into | three (3) categories

Answer 226

Bias, chance, confounding

Question 227

systematic error in the design or conduct of a study. • The systematic error arises from flaws either in the method of selection of study participants or • Procedures for gathering exposure/disease information

Answer 227

Bias

Question 228

Effect of BIas

Answer 228

Erroneous results leading to | misleading conclusions

Question 229

A distortion in the measure of the association between exposure and outcome • A mixing of effects – The association between exposure and disease is distorted because it is mixed with the effect of another factor that is associated with the disease. • s a problem of comparison, a problem that arises when important extraneous factors are differentially distributed across groups being compared

Answer 229

Confounding

Question 230

(TP + FN) / Total

Answer 230

Prevalence

Question 231

TP / (TP + FN)

Answer 231

Sensitivity

Question 232

TN / (TN + FP)

Answer 232

Specficity

Question 233

TP / (TP + FP)

Answer 233

Positive Predictive Value

Question 234

TN / (TN + FN)

Answer 234

Negative Predictive Value

Question 235

should be increased when the penalty associated with missing a case is high (e.g. minimize false negatives) – when the disease can be spread – when subsequent diagnostic evaluations are associated with minimal cost and risk

Answer 235

Sensitivity

Question 236

should be increased when the costs or risks associated with further diagnostic techniques are substantial (minimize false positives – e.g. positive screen requires that a biopsy be performed).

Answer 236

Specficity

Question 237

Healthy People 2020 Goals:

Answer 237

Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. • Achieve health equity, eliminate disparities, and improve the health of all groups. • Create social and physical environments that promote good health for all. • Promote quality of life, healthy development, and healthy behaviors across all life stages

Question 238

``` The study of the distribution and determinants of death, disease, and disability in human populations, and the application of this study to control health problems ```

Answer 238

Epidemiology

Question 239

To improve health outcomes in Villa Miseria, which of the following principles would be helpful? a. Health determinism b. Social justice c. Epidemiologic studies d. The Transtheoretical Model (Esperanza is a 35-year-old female living in Buenos Aires, Argentina in an area known as Villa Miseria, an overcrowded slum near Buenos Aires. There is no sanitation system and the electrical power is not always consistent. Approximately a mile away is the vibrant city of Buenos Aires. The health and economic disparities between these two areas is glaring. Esperanza does not have access to the same services as a mother living in Buenos Aires and is 35% more likely to die in childbirth than a mother in Buenos Aires. )

Answer 239

Social justice

Question 240

The single best predictor of poor health is Esperanza’s community, as well as in society in general is: a. Poverty b. Race c. Religion d. Gender (Esperanza is a 35-year-old female living in Buenos Aires, Argentina in an area known as Villa Miseria, an overcrowded slum near Buenos Aires. There is no sanitation system and the electrical power is not always consistent. Approximately a mile away is the vibrant city of Buenos Aires. The health and economic disparities between these two areas is glaring. Esperanza does not have access to the same services as a mother living in Buenos Aires and is 35% more likely to die in childbirth than a mother in Buenos Aires. )

Answer 240

Poverty

Question 241

A public health team was interested in assisting in Villa Miseria to address concerns with water and sanitation. They seek to do so in a culturally appropriate way. Which of the following is the best example of culturally appropriate community engagement and empowerment strategies? a. Providing health services and implementing programs that have proven to be successful in communities that are culturally distinct from the focus community b. Avoiding bias by developing programs prior to meeting with community leaders, and investigating the specific needs of the community c. Choosing interventions that have previously been applied in the community by local and national political leaders. d. Implementing health projects that result in the reciprocal transfer of knowledge and skills among all collaborators and partners. (Esperanza is a 35-year-old female living in Buenos Aires, Argentina in an area known as Villa Miseria, an overcrowded slum near Buenos Aires. There is no sanitation system and the electrical power is not always consistent. Approximately a mile away is the vibrant city of Buenos Aires. The health and economic disparities between these two areas is glaring. Esperanza does not have access to the same services as a mother living in Buenos Aires and is 35% more likely to die in childbirth than a mother in Buenos Aires. )

Answer 241

Implementing health projects that result in the reciprocal transfer of knowledge and skills among all collaborators and partners.

Question 242

A stakeholder in the proposed water and sanitation program is best described as: a. Anyone involved in the operations or affected by the program in Villa Misera b. The beneficiaries and participants in the program in Villa Misera c. The sponsors and administrators of the program in Villa Misera d. The financial investors in the program in Villa Misera (Esperanza is a 35-year-old female living in Buenos Aires, Argentina in an area known as Villa Miseria, an overcrowded slum near Buenos Aires. There is no sanitation system and the electrical power is not always consistent. Approximately a mile away is the vibrant city of Buenos Aires. The health and economic disparities between these two areas is glaring. Esperanza does not have access to the same services as a mother living in Buenos Aires and is 35% more likely to die in childbirth than a mother in Buenos Aires. )

Answer 242

Anyone involved in the operations or | affected by the program in Villa Misera

Question 243

The biological, environmental, behavioral, organizational, political and social factors that are contributing to health in Villa Miseria are commonly referred to as: a. social justice b. determinants of health c. health behaviors d. causal factors

Answer 243

determinants of health

Question 244

Model includes individual, interpersonal, organizational, , community, and public policy levels

Answer 244

Social ecological model

Question 245

Individual Level Theories/Models withing the social ecological model

Answer 245

Health Belief Model | Transtheoretical Model

Question 246

Individual Level Theories/Models withing the social ecological model

Answer 246

Health Belief Model | Transtheoretical Model

Question 247

``` Identify the Model: • Moderating factors • Perceived Sus + Sev= Perceived Threat • Perceived Benefits-Barriers • Cues to Action Self efficacy ```

Answer 247

Health Belief Model

Question 248

Interpersonal Level Theories/Models withing the social ecological model

Answer 248

Theory of Planned Behavior & the Social Cognitive theory

Question 249

Includes behavioral intention, norms and beliefs and also control beliefs and perceived power

Answer 249

Theory of Planned Behavior

Question 250

``` Identify the Model: Reciprocal determinism: Person, behavior & environment  Cognitions • Behavioral Capability • Expectancies • Self-efficacy; collective efficacy • Outcome expectations • Social influence  Observational learning  Vicarious reinforcement  Modeling  Reinforcements  Self-regulation ```

Answer 250

Social Cognitive Theory

Question 251

Community Level Theories/Models withing the social ecological mode

Answer 251

Roger’s Diffusion of | Innovations

Question 252

Community Level Theories/Models withing the social ecological mode

Answer 252

Roger’s Diffusion of | Innovations

Question 253

``` Theory which states: Behavior changes as innovations are adopted. Innovators – Early adopters – Early majority adopters – Late majority adopters – Laggards ``` • Innovation: Idea, product, process • Communication channels: Methods to make innovation known to social system • Time: Time is takes for innovation-decision process to occur, and rate of adoption • Social system: Group in which the innovation is introduced

Answer 253

Roger’s Diffusion of | Innovations

Question 254

Process by which an innovation is communicated through channels over time among the members of a social system.

Answer 254

Diffusion

Question 255

Planned, systematic efforts designed to make a program or innovation more widely available to a target audience or members of a social system.

Answer 255

Dissemination

Question 256

A health educator gives a presentation on distracted driving. Following her presentation, she discusses distracted driving with a student who just lost a loved one in a distracted driving crash. The student still texts and drives but is asking for advice and assistance in how to change these behaviors. According to the Transtheoretical Model, the student is in what stage? a. Contemplation b. Preparation c. Action d. Maintenance

Answer 256

Preparation

Question 257

As the health educator engages students further, she finds that many students currently text while driving and do not see the relationship between texting and car crashes. For students at the precontemplation stage of change, the health educator would most likely attempt to: a. encourage their behaviors and actions. b. develop ques that help to remind an individual not to use their phone while driving. c. share testimonials from those who have lost a loved one in a distracted driving event. d. provide training and guidance to prevent relapse behavior.

Answer 257

share testimonials from those who have lost a loved | one in a distracted driving event.

Question 258

Which of the following is characteristic of a health care system based on social justice? a. A distribution of resources that removes human biases by allowing the market to decide how they are allocated. b. An individual’s ability to pay is considered inconsequential to receiving medical care. c. A single-payer healthcare system d. A system where the recipients of healthcare determine how resources should be allocated.

Answer 258

An individual’s ability to pay is considered | inconsequential to receiving medical care.

Question 259

Which of the following models explains the relationship between socioeconomic status and health by illustrating that health status and social standing are linked to a combination of interrelated social, cultural, psychological and environmental factors? a. Transtheoretical Model b. Social Learning Model c. Socio-Ecological Model d. Theory of Reasoned Action

Answer 259

Socio-Ecological Model

Question 260

Which of the following statements are correct in reference to program planning? A. Needs assessments are mostly done mid-way through to check success of the program. B. The vision statement needs to describe exactly what your group is going to do. C. Process objectives describe what your final health outcomes should be. D. Action plans help groups specify how objectives will be accomplished.

Answer 260

Action plans help groups specify how objectives will be | accomplished.

Question 261

Which phase of the PRECEDE/PROCEED planning model addresses the determination of the health problem and related behavioral and environmental determinants? A. Social Assessment B. Educational/Ecological Assessment C. Epidemiological Assessment D. Administrative and Policy Assessment

Answer 261

Epidemiological Assessment The other answers are incorrect due to those phases describing other phases and processes of the model. These other phases cover quality of life (social assessment), determining what factors need to change (educational/ecological assessment) and administrative and policy issues (administrative and policy assessment).

Question 262

Program Planning Concept that is Critical to development of the program and the vision, mission, objectives, strategies, and actions (VMOSA-Vision, Mission, Objectives, Strategies, Action Plans).

Answer 262

Stakeholder Involvement and Feedback

Question 263

Program Planning Concept that works on Identifying, analyzing and prioritizing the needs of a population.

Answer 263

Needs and Resource assessment

Question 264

Program Planning Concept that answers Who? What? How Much? By When? And should be SMART: Specific, Measurable, Achievable, Relevant, and Time-Limited. Example: Bicycle helmet use will increase (what) among children ages 5-11 (who) by 25% (how much) by the end of the program (by when)

Answer 264

Objectives

Question 265

Program Planning Concept that answers How will you reach your objectives? Examples: social marketing campaigns, community outreach, etc.

Answer 265

strategies

Question 266

Program Planning Concept that Details as to Who, When, What will be Needed, Barriers, Collaborators/ who should be involved.

Answer 266

Action Plan

Question 267

Describe the General Model of Planning: All models have these six steps

Answer 267

1. Take stock of your community- do a situational analysis, asset mapping, or a SWOT analysis (or maybe several!). 2. Have a Good Understanding of Need/s 3. Set Goals and Objectives: Goals-broad statements of intent-Objectives are more detailed and focused. 4. Develop the Intervention/s (Use sound theory and logic). 5. Implement the Intervention/s. 6. Evaluate the Results.

Question 268

Planned Approach to Community Health-CDC in partnership with state and local health departments and local communities

Answer 268

PATCH (1983)

Question 269

Assessment Protocol For Excellence in Public Health: included CDC, APHA, and NACCHO. Was replaced by…MAPP

Answer 269

APEX-PH (1987)

Question 270

Planning Models; 1. Organizing for Success and Partnership Development 2. Visioning 3. 4 ____ Assessments 4. Strategic Issues 5. Formulation of Goals and Strategies 6. Action Cycles: Plan, Implement, Evaluate

Answer 270

MAPP Mobilizing for Action through Planning and | Partnerships

Question 271

Developed in 2010 to allow communities to implement their adaptation of Healthy People 2020. Steps: Mobilize, Assess, Plan, Implement, and Track

Answer 271

MAP-IT

Question 272

4 Mapp Assessments

Answer 272

1. Community Health Status Assessment 2. Forces of Change Assessment 3. Community Themes and Strengths Assessment 4. Local Public Health System Assessment

Question 273

Model that starts at the end

Answer 273

PRECEDE-PROCEED

Question 274

Phase one of PRECEDE-PROCEED

Answer 274

- Social Assessment: Quality of Life | - not necessarily just health related here

Question 275

Phase two of PRECEDE-PROCEED

Answer 275

Epidemiological Assessment: Health Issue | and Behavioral, Genetic, and Environmental Issues

Question 276

Phase three of PRECEDE-PROCEED

Answer 276

-Educational and Ecological AssessmentIncludes the Predisposing, Reinforcing, and Enabling Factors (Theory is important in this phase). • Predisposing factors • Enabling factors • Reinforcing factors

Question 277

knowledge, attitudes, beliefs, etc. that predisposes one to change

Answer 277

Predisposing factors

Question 278

resources and new skills to bring about behavior change

Answer 278

Enabling factors

Question 279

feedback and reward system for | behavior change

Answer 279

Reinforcing factors

Question 280

Phase four of PRECEDE-PROCEED

Answer 280

-Administrative and Policy Assessment and Intervention Alignment- • Educational strategies for the program along with the administrative and policy factors; budgets and resources

Question 281

Phase five of PRECEDE-PROCEED

Answer 281

Program Implementation

Question 282

Phases 6-8 of PRECEDE-PROCEED

Answer 282

-Program Evaluation from the most immediate or process evaluation (is the program implemented as planned) through the impact (knowledge, attitudes, beliefs, behaviors and environmental changes) to the farthest outcome evaluation (health and quality of life changes)

Question 283

Expands upon PRECEDE/PROCEED and other planning models through better guidance especially in intervention components and use of theory. 1. Develop a logic model of the problem (similar to PRECEDE-PROCEED). 2. Develop Program Outcomes and Objectives with a logic model of change (uses change objectives). 3. Program Design 4. Producing the Program 5. Developing a Program Implementation Plan 6. Developing an Evaluation Plan

Answer 283

Intervention Mapping

Question 284

• Central focus of this planning model is the involvement of community and planning groups throughout the process-with much brainstorming in each planning step.

Answer 284

Intervention Mapping

Question 285

-general plan of action that may involve several activities and considers the characteristics of the priority population

Answer 285

Strategy

Question 286

-systematic approach or procedures used by the presenters, health educators, or others to share information, objectives, materials, etc.

Answer 286

Methods

Question 287

What is the term used to test if the program is being | implemented as planned

Answer 287

fidelity of implementation.

Question 288

Ensuring _______ involves preparing planning models for those who have the ability to continue your programs after you and your funding are gone. These individuals become your program priority population-not those at risk but those who can make or break your program’s success.

Answer 288

Sustainability

Question 289

Type of evaluation which assesses context in which a program is developed and can include a needs assessment or the development of program components-research that contributes to the design of a program

Answer 289

Formative

Question 290

__________ Evaluation: • Measures and describes the implementation of a program. • Provides feedback on implementation, content, methods, participants, presenters, stakeholder responses. • Describes how a program operates.

Answer 290

Process

Question 291

________ Evaluation: • Occurs after program components have been implemented. • Assess the short-term and long-term effects of the program.

Answer 291

Summative

Question 292

CDC’s evaluation framework uses the following six steps to evaluate programs

Answer 292

1. Engage stakeholders 2. Describe the program 3. Focus the evaluation design 4. Gather credible evidence 5. Justify conclusions 6. Ensure use and share lessons learned.

Question 293

CDC Standards for evaluation

Answer 293

1. Utility-ensures evaluation will be relevant and useful to program participants and stakeholders 2. Feasibility-ensures the scope and activities within an evaluation are not over-reaching 3. Propriety-addresses ethical consideration on behalf of those involved in the evaluation and those who are impacted by the results 4. Accuracy-Addresses validity and adequacy of information used and conveyed

Question 294

Collaboration Model which: -Includes stages for coalition development - formation, maintenance, and institutionalization. • Includes engagement and consensus-building efforts among diverse organizations and individuals to address community-level issues. • Make sure you have trust and representation of the priority population.

Answer 294

Community Coalition Action Theory

Question 295

community aims to develop group identity and cohesion

Answer 295

Community Development

Question 296

relies more on expert | practitioners to solve problems

Answer 296

Social Planning

Question 297

address social inequities

Answer 297

Social Action

Question 298

When a community identifies common problems and goals, mobilize resources, and determine ways to meet goals.

Answer 298

Community Organizing

Question 299

a complete state of physical, mental and social wellbeing and not merely the absence of disease or infirmity

Answer 299

health

Question 300

what we do collectively as societies to create conditions in which people can be healthy

Answer 300

Public Health

Question 301

3 core functions of public health

Answer 301

1. Assessment 2. Assurance 3. Policy Development

Question 302

was a devastating global epidemic of bubonic plague that struck Europe and Asia in the mid-1300s. wiped out a third of World's Population (half of Europe)

Answer 302

Black Death

Question 303

Who developed the first vaccine and what was it developed for and when?

Answer 303

Edward Jenner, Small Pox in 1796

Question 304

1664, collected data on how people died, he would nail them to a tree

Answer 304

John Graunt's Bills of Mortality

Question 305

this focused on chronic illnesses, shift to include prevention of chronic illnesses, not just intense diseases,

Answer 305

Lalonde Report, A New Perspective on the Health of Canadians,

Question 306

The initiative began in 1979, when Surgeon General Julius Richmond issued a landmark report entitled, _____ The Surgeon General's Report on Health Promotion and Disease Prevention. This report focused on reducing preventable death and injury.

Answer 306

Healthy People

Question 307

What are the four minimum things established that stat health depts should do?

Answer 307

1. Health surveillance, planning and program development 2. Promotion of Local Health Coverage 3. Setting and enforcement of standards 4. Providing Health Services

Question 308

“The legal powers and duties of the state to assure the conditions for people to be healthy, and … the limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the protection or promotion of community health.

Answer 308

Public Health Law

Question 309

Free from external influence over independent decision-making. Public health law that limit this through: – Mandatory vaccination – Isolation - Separation of an infected person – Quarantine - Detention of healthy persons exposed to contagious disease

Answer 309

Autonomy

Question 310

Protects against unreasonable searches and seizures (not licensed businesses)

Answer 310

4th Amendment

Question 311

10th Amendment of the U.S. Constitution gives | the states all powers that are

Answer 311

neither given to the federal government | – nor prohibited by the Constitution.

Question 312

Constitution establishes authority to enact laws, | including those pertaining to public health

Answer 312

Federalism

Question 313

– Doctrine giving federal law precedence –____________ occurs in many areas of public health law

Answer 313

Federal preemption

Question 314

States retain _____powers to protect public’s health • Powers exercised by states to: – Enact laws and promulgate regulations – That are used to protect public and to promote the common good • Contrasted with criminal law powers – Don’t require probable-cause warrants – Enforce protections without a court hearing – “More probable than not" standard of evidence

Answer 314

Police Power

Question 315

gives local officials the ability to enact ordinances or regulations that are specific to the community, not otherwise prohibited.

Answer 315

Home Rule Authority

Question 316

Public health _______ are the system of rules created for the protection or promotion of community health. congress/ legislative branch /executive branch

Answer 316

laws

Question 317

______ are the set of rules that describe the implementation of legislation. fda

Answer 317

Regulations

Question 318

any identifiable info of individual: demo data, health | condition, or receipt of services

Answer 318

HIPPA PHI

Question 319

Freedom from intrusion; having control over the extent, timing, and circumstances of sharing PHI

Answer 319

HIPPA Privacy

Question 320

Practices, policies, and procedures | created to protect a person’s PHI

Answer 320

HIPPA Security

Question 321

Patient disclosing information in | a relationship of trust

Answer 321

HIPPA confidentialy

Question 322

Belmont Report: | 3 Ethical Principles of Human Subject Research

Answer 322

1. Respect for persons a. Treat participants as autonomous agents b. Informed consent, free from coercion. 2. Beneficence a. Protecting participant well-being b. Ensuring benefits of research > risks 3. Justice a. Burdens distributed fairly (distributive justice) b. Participate in decisions (procedural justice

Question 323

Promotes the goal of the “greatest good for the | greatest number”

Answer 323

• Utilitarianism

Question 324

– Individuals inseparable from community life and no one person and no one community can ever be completely self-determining.

Answer 324

Communitarian

Question 325

Focuses on individual rights and freedom to choose, seeks to guarantee individual freedom without state infringement on personal choice

Answer 325

Liberalism

Question 326

– A component of health planning that involves the community in decisions related to allocation of scarce resources.

Answer 326

Priority Setting

Question 327

Community input regarding decisions by listening and speaking to the community

Answer 327

Reciprocity

Question 328

– Not concealing information

Answer 328

Transparency

Question 329

To keep this, avoid interventions that employ force or command without reason

Answer 329

Public Trust

Question 330

– Serving public in a way that maintains public’s | trust

Answer 330

Fiduciary duty

Question 331

–Occurs when Actions regarding a primary interest are influenced by a secondary interest

Answer 331

Conflicts of Interest

Question 332

Field of study concerned with: • 1) the collection, organization, summarization, and analysis of data (descriptive) • 2) the drawing of inferences about a body of data when only a part of the data is observed (inferential)

Answer 332

Statistics

Question 333

A branch of statistics where the data analyzed are | derived from biological sciences and medicine

Answer 333

Bio statistics

Question 334

• the largest collection of entities for which we have an | interest at a particular time; \are defined by our sphere of interest

Answer 334

Populations

Question 335

Characteristic or measure obtained from a | population

Answer 335

Parameter

Question 336

A subgroup or subset of the population

Answer 336

Sample

Question 337

Characteristic or measure obtained from a sample

Answer 337

Statistic

Question 338

Characteristic or attribute that can assume different values (it varies depending the person, place, or thing being characterized). – Ex. Height, weight, blood pressure, heart rate, level of satisfaction with wait time at an ER – Ex. Height is 64 inches (data = 64, _____ = height)

Answer 338

Variable

Question 339

Variable that can be measured; conveys information regarding amount (how many

Answer 339

Quantitative

Question 340

Variables that assume non-numerical values; conveys information about an attribute (race, marital status, ethnicity)

Answer 340

Qualitative

Question 341

The procedure by which we reach a conclusion about a population on the basis of the information contained in a sample that has been drawn from that population – We generalize findings back to the population from which the sample was drawn

Answer 341

Statistical Inference

Question 342

The assignment of numbers to objects or events according to a set of rules

Answer 342

Measurement

Question 343

The lowest measurement scale. Used for naming or labeling. Although it can be done with numbers, the relationship between the numbers are not meaningful. (Categorical and Dichotomous Variables) • Ex. Marital Status, DL number, SS number

Answer 343

Nominal

Question 344

Observations are ranked according to some criterion. We can order the measurements/categories but we don’t know the distance between two ranks • Ex. Low, Med, High SES; unimproved, improved, much improved, Likert-type scale

Answer 344

Ordinal

Question 345

Level of measurement which classifies data that can be ranked and differences are meaningful. However, there is no meaningful zero, so ratios are meaningless. The scale isrelative. (Continuous Variable) • ex. Temperature in º F or ºC (for these scales, 0 does not represent the absence of heat. The scale is relative. pH (a pH of 0 does not mean the absence of acidity) No true zero point for these variables.

Answer 345

Interval

Question 346

Level of measurement which classifies data that can be ranked, differences are meaningful, and there is a true zero. – Ex. Height, length, Kelvin Temperature scale

Answer 346

Ratio scale

Question 347

A researcher is designing a new questionnaire to examine patient stress levels on a scale of 0 – 5. What scale of measurement is being used for the outcome variable?

Answer 347

Ordinal

Question 348

refers to the number of cases of a disease or other health phenomenon being studied. – Ex. College dorm students who had Hepatitis

Answer 348

Count

Question 349

A measure that states a count relative to the size of the group. The upper part (numerator) of the fraction is the piece, the lower part (denominator) is the whole. – Ex. College dorm students who had Hepatitis B/ all dorm students

Answer 349

Proportion

Question 350

Divide one number into another number, but the numerator does not have to be a subset of the denominator – Ex. College dorm students who had Hepatitis B / College dorm students who had Hepatitis A

Answer 350

Ratio

Question 351

Similar to proportions and ratios, but includes a time component – % of dorm students who had Hepatitis B in 2018

Answer 351

Rate

Question 352

Which of the following is expressed as a count? • Which of the following is expressed as a proportion? • Which of the following is expressed as a ratio? • Which of the following is expressed as a rate? A. Male Births / Female Births B. Female Births C. Female Births / Male + Female Births D. Male Births + Female Births in 2019 / Population at midpoint of 2019

Answer 352

A. Male Births / Female Births = Ratio B. Female Births = Count C. Female Births / Male + Female Births = Proportion D. Male Births + Female Births in 2019 / Population at midpoint of 2019 = Rate

Question 353

– Disease in excess of expected | – Think : epidemic threshold

Answer 353

Epidemic

Question 354

Habitual presence of disease within an area – Think: epidemic threshold

Answer 354

Endemic

Question 355

– Worldwide epidemic | – Think: epidemic threshold + geography

Answer 355

Pandemic

Question 356

What type of Studies are? -Case studies / reports – Cross-Sectional Studies – Ecological Studies

Answer 356

Descriptive

Question 357

What type of Studies are? – Case-Control studies – Cohort Studies – Randomized Control Studie

Answer 357

Analytical

Question 358

Begin with a group of people who are disease free at baseline • Follow them over time and record exposures • Classified on exposure • Incident cases • MOA: Relative Risk • Rare exposures • Prevalent diseases

Answer 358

Cohort Study

Question 359

``` Compare Disease + (Cases) to Disease – (Controls) • Collect exposure data retrospectively • Classified on disease status • Prevalent cases • MOA: Odds Ratio • Rare Diseases ```

Answer 359

Case-Control Studies

Question 360

Interpret RR and OR, what does 1 equal? >1? <1? range?

Answer 360

If RR or OR = 1: no association between exposure and outcome • If OR > 1: exposure increases the risk of the outcome • If OR < 1: exposure decreases the risk of the outcome • OR and RR range from 0 and up(no negatives, can be infinitely higher than 0)

Question 361

How would you verbally interpret OR vs RR?

Answer 361

OR of 2.0: Think: Case Control Study..organized on disease status. Begin conclusion with outcome – The odds of having diabetes are 2 times higher among those who are sedentary compared to those who are not sedentary – Those who have diabetes are 2 times more likely to be sedentary than those without diabetes • RR of 2.0: Think: Cohort Study…organized on exposure. Begin conclusion with exposure. • Those who are sedentary have 2 times the risk of diabetes as those who are not sedentary

Question 362

A case-control study comparing ovarian cancer cases with community controls found an odds ratio of 2.0 in relation to exposure to radiation. Which is the correct interpretation of the measure of association? A. Women exposed to radiation had 2.0 times the risk of ovarian cancer when compared to women not exposed to radiation B. Women exposed to radiation had 2.0 times the risk of ovarian cancer when compared to women without ovarian cancer C. Ovarian cancer cases had 2.0 times the odds of exposure to radiation when compared to controls D. Ovarian cancer cases had 2.0 times the odds of exposure to radiation when compared to controls with other cancers

Answer 362

Ovarian cancer cases had 2.0 times the odds of exposure to radiation when compared to controls

Question 363

Interpret an OR of .75 if the exposure is eating kale | and the outcome is obesity

Answer 363

Think…OR…Case Control..organized on disease status – Those who are obese are .75 times as likely to have eaten kale than those who are not obese – The odds of developing obesity are .75 times as high among those who ate kale compared to those who did not eat kale

Question 364

Interpret an RR of .75 if the exposure is eating kale | and the outcome is obesity

Answer 364

– Think…RR…Cohort study…organized on exposure – Those who ate kale are .75 times as likely to become obese than those who did not eat kale

Question 365

• Whereas RR tells you the strength of an association, _______ tells you how much of the disease that occurs can be attributed to a certain exposure. • We can calculate this among exposed individuals or for an entire population. = (Incidence in exposed) – (Incidence in unexposed)

Answer 365

Attributable Risk

Question 366

: the risk of non-exposed people is not zero. – Ex. We can attribute lung caner to smoking, but some people who don’t smoke still get lung cancer. The risk in our unexposed population is ______

Answer 366

Background Risk

Question 367

Enumerate all members of population N (sampling frame), select n individuals at random (each has the same probability of being selected

Answer 367

Simple random sample

Question 368

Start with sampling frame; determine sampling interval (N/n); select first person at random from first (N/n) and every (N/n) thereafter

Answer 368

Systematic Sample

Question 369

– Organize population into mutually exclusive strata; select individuals at random within each stratum

Answer 369

Stratified Sample

Question 370

model for discrete outcome – Process or experiment has 2 possible outcomes: success and failure – Replications of process are independent – P(success) is constant for each replication

Answer 370

Binomial Distribution

Question 371

Notation: m=mean s=st. dev. • Mean, Median, Mode are the same and located at the center of the distribution (not skewed)

Answer 371

Normal Distirbution

Question 372

Scores of a certain exam for a group of students were normally distributed with a mean of 100 and standard deviation 20. Based on the information provided what is the percentage of students who scored between 80 and 120? A. 50% B. 68% C. 75% D. 95%

Answer 372

B. 68% (refer to screenshot on CPH Exam prep for image to study)

Question 373

Two statistical inference methods:

Answer 373

Estimation and Hypothesis Testing

Question 374

statistical inference method when the population parameter (e.g, population mean) is unknown, corresponding sample statistics (e.g., sample mean) are used to generate estimates.

Answer 374

Estimation

Question 375

statistical inference method where an explicit statement or hypothesis is generated about the population parameter. Sample statistics are analyzed and determined to either support or reject the hypothesis about the parameter. – It is assumed that the sample drawn from the population is a random sample.

Answer 375

Hypothesis Testing

Question 376

A sample mean can be used to estimate the population mean. • If a second sample from the same population is obtained, the sample mean of the second sample is likely to be different from the first sample mean. • How should we account for this variation? • Imagine that we repeat the random sampling process many times with the same sample size, we are going to have many different sample means. • These many sample means constitute their own distribution: _________

Answer 376

Sampling Distribution

Question 377

A ________ for a population parameter is the "best" single number estimate of that parameter.

Answer 377

Point Estimate

Question 378

A_________ estimate is a range of values for the population parameter with a level of confidence attached.

Answer 378

Confidence Interval

Question 379

reflects the likelihood that the confidence interval contains the true, unknown parameter (90%, 95% and 99%) as this goes up, the confidence interval gets wider

Answer 379

Confidence Level

Question 380

reflects the variability of the sampling distribution of the sample statistic – Sample size has an impact on this

Answer 380

Standard Error

Question 381

As sample size goes up, error term....

Answer 381

decreases

Question 382

The midpoint of your CI is your

Answer 382

Mean (X line above)

Question 383

Suppose that we would like to estimate a population mean using a 95% confidence level. • Since the population mean is a fixed value, the confidence interval generated based on a specific sample may or may not contain the population mean. • If we repeatedly compute a 95% CI with different random samples of the same size, 95% of the CIs will contain the________

Answer 383

true population mean

Question 384

The point estimate and margin of error of the mean age of a group in a study is 35.5 ± .3. What would be the center value of the 95% Confidence Interval? • A. 35.2 • B. 35.8 • C. 35.5 • Cannot be determined by the information given

Answer 384

35.5

Question 385

If the 95% confidence interval is found to be (100 – 300), which would be potential values for a 99% Confidence Interval? A. 50 – 350 B. 100 – 300 C. 150 – 250 D. Cannot be determined from the given information • What about a 90% CI?

Answer 385

A. 50 – 350 it would be smaller so probably 150 – 250

Question 386

With Hypothesis Testing: • Two rival hypotheses: –____ hypothesis: assumes that nothing is going on, usually carries equality – _______ hypothesis: the “research hypothesis”. It is the one that reflects the researcher’s belief. – We write both in terms of the population (think: the population from which the sample was drawn) • Two possible “conclusions” – _____________ – _____________

Answer 386

Two rival hypotheses: – Null hypothesis: assumes that nothing is going on, usually carries equality – Alternative hypothesis: the “research hypothesis”. It is the one that reflects the researcher’s belief. – We write both in terms of the population (think: the population from which the sample was drawn) • Two possible “conclusions” – Reject the null hypothesis – Fail to reject the null hypothesis

Question 387

``` Hypothesis Testing Procedures • Set up ___________ • Select _______ • Compute ______- • Calculated ________ vs _______ • Draw conclusion & summarize significance ```

Answer 387

Hypothesis Testing Procedures • Set up null and research hypotheses • Select test statistic • Compute test statistic • Calculated test statistic vs critical value • Draw conclusion & summarize significance

Question 388

Suppose that you know that the mean age of a certain population is 30 with a standard deviation of 4.47. We draw a sample of n=10 that has a sample mean( ) = 27. Can we conclude that the mean of this population is different from 30 years? Alpha (α) = .05

Answer 388

different from (not less than or greater then) so rejection reason is split on both sides of the graph Calculate the Test statistic: in this it is the Z statistic. Each situation has a different formula. • Z= -2.12 • This is your test statistic (Zcalc) Determine the Critical Region: Now we need to determine if our test statistic that we calculated is in the rejection region. We need to look up our critical value. Here are the critical values for Z: • Our problem was two tailed, α = .05 So, Zcrit = 1.960 It helps to graph this result to show what it means This is a graph of our critical region. Notice it goes in both directions (b/c our hyp was non directional) If our Zcalc falls in the tail of our rejection region, then we reject the null. If |Z calc| > |Z crit| then we reject the null |-2.12| > | ±1.96| so we must reject the null Conclusion: The population from which our sample was drawn has a mean age that is statistically significantly different than our reference population. • The population from which or sample was drawn has a mean age that is statistically significantly different than 30. • Use the formula for CI that corresponds to your test statistic. • We need a CI for the Z test All of the info is given in the original problem = 27 = 4.47 n = 10 If you want 95% CI, the Zcrit you use corresponds to =.05 (1.96) If you want 99% CI the Zcrit you use corresponds to =.01 (2.58) =27 ± (1.96) (1.414) =27 ± (2.77) (27 + 2.77) , (27 – 2.77) (29.77, 24.23) We are 95% confident that the population from which the sample was drawn has a mean age that lies b/t 24.23 and 29.77 (see slides from webinar for images

Question 389

``` We have 3 choices for a hypothesis statement • 1) _______ (key word = “difference”) H0: µ=30 Ha: µ≠30 • 2) _________: 2 choices – A) key word=more, greater, positive direction H0: µ≤30 Ha: µ>30 – B) key word=less, smaller, negative direction H0: µ≥30 Ha: µ<30 D ```

Answer 389

We have 3 choices for a hypothesis statement • 1) Non-Directional (key word = “difference”) H0: µ=30 Ha: µ≠30 • 2) Directional: 2 choices – A) key word=more, greater, positive direction H0: µ≤30 Ha: µ>30 – B) key word=less, smaller, negative direction H0: µ≥30 Ha: µ<30

Question 390

The probability of observing the obtained data (or more extreme values) given the null hypothesis was true

Answer 390

P value

Question 391

Reject the null hypothesis if the p-value is ____ than | the alpha level (α)

Answer 391

lower

Question 392

Type-I error is when you....

Answer 392

reject the null hypothesis when it is true. – Probability of making a Type-I error = α - the most dangerous error

Question 393

Type-II error is when you....

Answer 393

fail to reject the null hypothesis when it is false. | – Probability of making a Type-II error = β

Question 394

the probability that we will correctly reject a false null. = 1-β; % probability that detected

Answer 394

Power

Question 395

A research study with a statistical power of 60% and alpha is set at 0.05 reports finding no statistically significant difference (p=0.11). To interpret the findings of this study, if a true difference really exists then there is: A. An 89% probability that it would be detected. B. A 60% probability that it would be detected. C. A 40% probability that it would be detected. D. An 11% probability that it would be detected.

Answer 395

B. A 60% probability that it would be detected.

Question 396

This test determines whether two categorical variables are independent • Test statistic is formed by summarizing difference between observed values and expected values.

Answer 396

Chi-Square Test of Independence

Question 397

``` • _______________ concerns the difference of two population means of continuous outcomes. Examples are: – Compare gender difference – Evaluate treatment effects ```

Answer 397

Two independent t test

Question 398

What type of test is the below: A clinical trial aims to assess the effectiveness of a new drug in lowering cholesterol. Patients are randomized to receive the new drug or placebo and total cholesterol is measured after 6 weeks on the assigned treatment. Sample Size Mean Std Dev New Drug 15 195.9 28.7 Placebo 15 227.4 30.3

Answer 398

Two independent t test concerns the difference of two population means of continuous outcomes.

Question 399

What type of test is the below: ``` Is there a relationship between students’ living arrangement and exercise status? Exercise Status None Sporadic Regular Total Dormitory 32 30 28 90 On-campus Apt 74 64 42 180 Off-campus Apt 110 25 15 150 At Home 39 6 5 50 Total 255 125 90 470 ```

Answer 399

Chi-Square Test of Independence This test determines whether two categorical variables are independent

Question 400

Hypothesis testing looks at what types of parameters?

Answer 400

Population

Question 401

National Physical Activity Guidelines for Americans suggest adults need to participate in at least 150 minutes per week in moderate intensity physical activity for substantial health benefits. A study was designed to test whether there is a difference in mean time (in minutes) spent in moderate intensity physical activity in adults with no, mild, moderate and severe depression. Time spent in moderate intensity physical activity is a continuous measure which can be assessed using an accelerometer. Which among the following is the most appropriate statistical technique to test the difference in time spent in moderate intensity physical activity between adults with no, mild, moderate and severe depression? A. Chi-Square test B. t-test C. ANOVA D. z-test

Answer 401

ANOVA 4 groups of adults; difference in minutes

Question 402

– Concerned with measuring the strength of the relationship between variables

Answer 402

Correlation

Question 403

Used to predict or estimate the value of one variable corresponding to a given value of another variable

Answer 403

Regression

Question 404

is a measure of the strength of the linear relationship between x and y

Answer 404

Population Correlation Coefficient (r)

Question 405

Interpret R (Population Correlation Coefficient (r)) and state the range

Answer 405

-1 < r < +1 • Sign indicates nature of relationship (positive or direct, negative or inverse) • Magnitude indicates strength

Question 406

Percent variation attributed to predictor variables

Answer 406

r-squared (r is the population correlation coeffiicient)

Question 407

Y is the

Answer 407

Dependent, Outcome variable (e.g., SBP)

Question 408

X is the

Answer 408

Independent, Predictor variable (e.g., | BMI)

Question 409

• β0 is the ____and β1 is the ____

Answer 409

• β0 is the intercept and β1 is the slope

Question 410

Population regression equation:

Answer 410

• Y = β0 + β1X + error

Question 411

``` The most useful visual tool for exploring relationships in bivariate data (paired measurements of two quantitative variables) is the: A. Histogram B. Choropleth Map C. Box and Whisker Plot D. Scatterplot ```

Answer 411

Scatterplot

Question 412

Assume that a linear regression analysis is performed with predictor variables age and socio-economic status, and the correlation coefficient r is 0.4. What percent of the variation in the outcome is explained by age and socioeconomic status? A. 25% B. 40% C. 16% D. 8%

Answer 412

16% Whenever we have r, we can square that number to determine the percent of variation explained

Question 413

3 main Phases in the policy making process

Answer 413

Policy Formulation Phase Policy Implementation Phase Policy Modification Phase

Question 414

Occurs when there is a favorable confluence of problems, possible solutions and political circumstances

Answer 414

Window of Opportunity

Question 415

1 of the 3 main Phases in policy making process which contains: problems, possible solutions and political circumstances, with a window of opportunity that leads to development of legislation

Answer 415

Policy Formulation Phase

Question 416

1 of the 3 main Phases in policy making process which occurs after formal enactment of legislation and contains: rulemaking and operation which leads to the policy

Answer 416

Policy Implementation Phase

Question 417

1 of the 3 main Phases in policy making process which occurs after policy implementation and contains: feedback from individuals, organizations, and interest groups experiencing the consequences of policies, combined with the assessments of the performance and impact of the policies by those who formulate and implement them, influence future policy formulation and implementation

Answer 417

Policy Modification Phase

Question 418

``` What type of of budget category do the following fall in? – Services provided – Grant and contract funding – Investment income – Donations ```

Answer 418

Revenue

Question 419

``` What type of of budget category do the following fall in? – Staffing – Fringe benefits – Supplies & equipment – Rent – Utilities – Printing – Postage – Travel ```

Answer 419

Expenses

Question 420

What type of expense is below? Supplies used for each unit of service provided

Answer 420

Direct Variable

Question 421

``` What type of expense is below? Staff costs, if paid an annual salary regardless of volume of units of service provided ```

Answer 421

Direct Fixed

Question 422

What type of expense is below? Electricity costs that vary on the basis of units of services provided *

Answer 422

Indirect Variable (it is unusual to have variable indirect texts)

Question 423

What type of expense is below? Rent, insurance, management support services

Answer 423

Indirect Fixed

Question 424

``` Define the Below expense types: Direct: Indirect: Variable: Fixed; ```

Answer 424

Direct: actual services themselves Indirect: things not directly related to service but are an expense Variable: the more you do it, the more it goes up Fixed; no matter how much you do it, it remains the same

Question 425

The below are an example of what? | – FICA, vacation, PTO, health insurance

Answer 425

Fringe benefits

Question 426

shows the difference between budget and actual

Answer 426

budget variance chart

Question 427

All the tasks that you need to do along with the timeline of when you believe everything will be completed (can have milestones)

Answer 427

Task lists and timelines

Question 428

Similar to timeline, but have specific features such as project tasks (can be grouped), responsible party, duration of start to end, and dependencies

Answer 428

Gantt Charts

Question 429

Illustrates steps of process in a visualization

Answer 429

Flow charting or process flows

Question 430

Plan, Do, Study, Act process to make changes/improvements

Answer 430

Continuous Quality Improvement

Question 431

What are three area in which we need to ensure sustainability?

Answer 431

Workforce Financing Programs

Question 432

Type of Sustainability which: 1. Effort to professionalize: the CPH! 2. Education and training 3. Setting career progression paths 4. Clear job specifications 5. Give constructive feedback about performance

Answer 432

Workforce Sustainability

Question 433

Type of Sustainability which: • Acknowledge need for diversified and reliable long-term funding base • Engage in active financial planning, including costs and revenues • Strategize: Prioritize your program within existing government budget • Market effectiveness to funders and supporters

Answer 433

Financing Sustainability

Question 434

The three Methods for communicating the value of public health programs

Answer 434

Benchmarking 2. Calculating return on investment (ROI) 3. Economic evaluation

Question 435

Type of Sustainability which: shows the value proposition • Cost competitiveness of public health vs. medical interventions is high! • Methods for communicating the value of public health programs

Answer 435

Program Sustainability

Question 436

Methods for communicating the value of PH program which: | Compare to “best in class” or other standard

Answer 436

Benchmarking

Question 437

Methods for communicating the value of PH program which: | investment gain minus investment cost, over investment cost x 100

Answer 437

Return on Investment (ROI)

Question 438

Methods for communicating the value of PH program which: | include Cost benefit analysis , cost effectiveness analysis, and cost utility analysis

Answer 438

Economic Evaluations

Question 439

Type of economic evaluation which: quantifies tangible and “soft” outcomes into a monetary number

Answer 439

Cost Benefit Analysis

Question 440

Type of economic evaluation which: measures program outcomes in similar units across programs (e.g., life-years saved) rather than trying to quantify the outcome in dollars.

Answer 440

Cost-effectiveness analysis

Question 441

Type of economic evaluation which: measures outcomes by using a standardized morbidity or mortality measure, often a metric called a quality-adjusted life-year (QALY).

Answer 441

Cost-utility analysis

Question 442

The 4 step cycle used to Develop Monitoring and Evaluation Frameworks to Assess Programs

Answer 442

A cycle: 1. Performance standard setting 2. Performance measuring 3. Quality improvement (QI) 4. Reporting progres

Question 443

``` Public Health is Based on premise health events are ___________ and • Occur as a result of risk factors Risk factors are __________distributed in the population ```

Answer 443

not random | not randomly

Question 444

WHO estimates that more than 13 million deaths are due to preventable ________________________

Answer 444

environmental causes

Question 445

What is the chain of infection a model of?

Answer 445

How pathogenic microorganisms are transmitted from one person to another

Question 446

Father of germ theory and bacteriology (proved germs cause diseases) • created the first vaccines for rabies and anthrax • Best known for:  Invention of the technique of treating milk to stop bacterial contamination -- pasteurization.

Answer 446

Louis Pasture

Question 447

Chain of Infection

Answer 447

``` Germs (agent) Where germs live (reservoir) How germs get out (portal of exit) germs get around (mode of trasmission) how germs get in (portal of entry) Next sick person (susceptible host) ```

Question 448

4 criteria designed to establish a causal relationship between a positive microbe and a disease (fulfillment of all 4 postulates is not required for causality in modern day) 1. microorganism should be in abundance in diseased animal 2. microorganism isolated and grown in pure culture 3. cultured should cause disease when introduced to healthy animal 4. The microorganism must be re-isolated from the inoculated, diseased individual and matched to the original microorganism.

Answer 448

Koch's Postulates

Question 449

A mosquito bites an individual who later develops a fever and abdominal rash. What type of transmission would this be?

Answer 449

Biological vector transmission

Question 450

a ________ carries a pathogen on its body from one host to another, not as an infection.

Answer 450

Mechanical vector

Question 451

a _________ carries a pathogen from one host to another after becoming infected itself.

Answer 451

Biological vector

Question 452

The main animals responsible for biological vector transmission

Answer 452

Arthropods (invertebrate animals spiders crustaceans etc) that usually transmit through bite

Question 453

person to person contamination

Answer 453

direct contact

Question 454

A blanket belonging to a child who has chickenpox is likely to be contaminated with Varicella-zoster virus, the virus that causes chickenpox. What is the blanket called?

Answer 454

Fomite

Question 455

Inanimate object which become contaminated with infectious agents • Serve as a mechanism for transfer between hosts. (park water fountain)

Answer 455

Fomite

Question 456

The infectious agent that causes malaria is known as which of the following?

Answer 456

Protozoan parasite

Question 457

SEIR infection model stands for what?

Answer 457

Susceptible, Exposed, | Infectious, Recovered

Question 458

``` VITAL to public health: – Monitoring disease trends – Describing natural history of diseases – Identifying epidemics or new syndromes – Monitoring changes in infectious agents – Identifying areas for research – Planning public health policy – Evaluating public health policy/interventions ```

Answer 458

Surveillance

Question 459

``` – local and state health departments rely on health care providers or laboratories to report cases of disease • Advantage – Efficiency – Simple and requires relatively few resources – Occurs continuously • Disadvantage – Incomplete data due to underreporting ```

Answer 459

Passive Surveillance can't enforce compliance

Question 460

– health department contacts health care providers and laboratories requesting information about conditions or diseases • Advantage – More complete data – Occurs when proactively requesting information • Disadvantage: – Requires resources and time – Useful when you must identify all cases

Answer 460

Active surveillance

Question 461

Majority of public health surveillance systems are _______

Answer 461

Passive

Question 462

``` Network of organs, cells, tissues – Skin – Lymphatic system – Thymus – Bone marrow – Spleen – White blood cells (leukocytes) ```

Answer 462

Immune system

Question 463

How do most vaccines work?

Answer 463

Most vaccines work by triggering the body's adaptive immune system including antibody production that can target a specific pathogen

Question 464

Immunity that develops during your lifetime

Answer 464

Acquired immunity

Question 465

Immunity that develops in response to an infection or vaccination

Answer 465

Active immunity

Question 466

Immunity that develops after you receive antibodies from someone or somewhere else

Answer 466

Passive

Question 467

Antibodies developed in response to an infection

Answer 467

Natural Active immunity

Question 468

Antibodies developed in response to a vaccination

Answer 468

Artificial Active Immunity

Question 469

Antibodies received from mother (through breast milk)

Answer 469

Natural Passive Immunity

Question 470

Antibodies received from a medicine (a gamma globulin injection)

Answer 470

Artificial Passive Immunity

Question 471

Resistance within a population to a certain infection

Answer 471

herd immunity

Question 472

proportion of the poulation that has to be immunized to protect the population

Answer 472

herd immunity threshold (very high for pertussis and measles as they are highly contagious and can linger in the air for a while)

Question 473

New vaccines for influenza must be developed every year because

Answer 473

new strains of the virus evolve that are not affected by existing vaccines

Question 474

Minor change within subtype of influenza • Point mutations – Occurs in A and B Subtypes – May cause Epidemics

Answer 474

Antigenic Drift (the reason we need new flu vaccines every year and the reason we can get sick from the flu multiple times in our lives)

Question 475

``` Major change in influenza • New subtype • Exchange of gene segments – Occurs ONLY in A subtypes – May cause Pandemic ```

Answer 475

Antigenic shift

Question 476

How populations have seen lower death rates, and increased population size

Answer 476

demographic transition

Question 477

Compared with the situation in 1900, the prevalence of deaths due to infectious diseases in the USA is

Answer 477

much less

Question 478

Cause 1 in 5 deaths during first year of life

Answer 478

Congenital disorders | birth defects, 1 in 33 babies in the US

Question 479

Which of these groups of conditions include one or more single gene disorders that are part of the recommended uniform newborn screening panel? - Metabolic disorders - endocrine disorders - hemoglobin disorders - hearing loss - all of the above

Answer 479

All of the above. - Metabolic disorders - endocrine disorders - hemoglobin disorders - hearing loss - all of the above

Question 480

Which of the following is true about newborn screening programs? - All states screen for the same genetic conditions - Most of the genetic conditions screened for follow an autosomal recessive pattern of inheritance - Almost all babies who have a positive newborn screen end up being diagnosed with the condition - In the US most state newborn screening programs began in 1990s

Answer 480

Most of the genetic conditions screened for follow an autosomal recessive pattern of inheritance

Question 481

True or False: All states are responsible for newborn screenings (began in the 60s) but decision making as to the number and types of conditions found on the panel is up to the states

Answer 481

True

Question 482

_______ are agents that induce structural abnormality, growth deficiency or functional alteration during prenatal development

Answer 482

Teratogens

Question 483

3 Categories of Teratogens with examples:

Answer 483

Ionizing Radiation – Gamma or x-rays: Microcephaly or intellectual disabilities • Chemicals – Accutane: birth defects – Alcohol: Fetal Alcohol syndrome – Cigarette use: LBW, stillbirth, miscarriage – Dioxin: linked to cancer – Thalidomide: absence of long bones • Pathogens – Rubella: Congenital defects – Syphilis: Microcephaly or intellectual disabilities – Toxoplasmosis: stillbirth, miscarriage, developmental

Question 484

Which of the following is currently the most common cause of unintentional death for adults in the U.S.? - Motor vehicle accidents - Unintentional poisoning (drug abuse) - Unintentional gunshot wounds - Unintentional falls

Answer 484

Unintentional poisoning (drug abuse)

Question 485

The leading cause of death for american between the ages of 1-45

Answer 485

Injuries

Question 486

The Clean Air Act requires the Environmental Protection Agency’s (EPA) to set National Ambient Air Quality Standards for 6 primary criteria air pollutants:

Answer 486

1. Sulfur dioxide (acid rain): 2. Nitrogen oxides (smog, acid rain) 3. Carbon monoxide: . 4. Ozone 5. Lead: 6. Particulate matter:

Question 487

AP: Causes respiratory effects | • People with asthma and other susceptible populations

Answer 487

Sulfur dioxide (acid rain)

Question 488

AP: Linked to respiratory effects | • People with asthma

Answer 488

Nitrogen oxides (smog, acid rain)

Question 489

AP: Reduces oxygen to body tissues. | • Those with cardiovascular conditions

Answer 489

Carbon Monoxide

Question 490

AP: Causes airway irritation, coughing, and difficulty breathing. • Those with chronic obstructive pulmonary disease (COPD) or asthma

Answer 490

Ozone

Question 491

AP: Can cause neurological effects | • Children; Can also affect kidney, immune, development, and reproductive systems

Answer 491

Lead

Question 492

AP: Smaller than 10 micrometers. Can cause respiratory effects • People with asthm

Answer 492

Particulate Matter

Question 493

How often are air pollutant limits revised?

Answer 493

every 5 years

Question 494

chemicals in the atmosphere whose concentrations are high enough to cause harm

Answer 494

Air Pollutants

Question 495

What is the most likely contaminant causing the symptoms? (In a small community in the highlands (elevation of 1,000 meters above sea level) of Ecuador, locals earned their living by manufacturing rugs. Rugs were made in indoor, closed rooms. The crowded rooms were heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person. • Workers began to complain of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day.)

Answer 495

Carbon Monoxide

Question 496

What was the portal of entry? (In a small community in the highlands (elevation of 1,000 meters above sea level) of Ecuador, locals earned their living by manufacturing rugs. Rugs were made in indoor, closed rooms. The crowded rooms were heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person. • Workers began to complain of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day.)

Answer 496

Respiratory/inhalation

Question 497

Whats is a solution to the problem posed in the scenario? (In a small community in the highlands (elevation of 1,000 meters above sea level) of Ecuador, locals earned their living by manufacturing rugs. Rugs were made in indoor, closed rooms. The crowded rooms were heated by an open charcoal fire, provided approximately 5 cubic meters of air volume per person. • Workers began to complain of stiffness in the shoulders, backache, fatigue, and dizziness. As the disease progressed, workers became short of breath on exertion and experienced tightness and pain below the breast bone, numbness in the arms and hands, and swelling of the face. The attacks of shortness of breath occurred mostly at night, whereas the episodes of pain and tightness around the heart, a condition known as angina pectoris, followed light work during the day.)

Answer 497

Larger, well ventilated rooms

Question 498

– ________ contains high concentrations of ozone (O3) compared to other parts of the atmosphere (relatively small compared to other gases)

Answer 498

Stratosphere

Question 499

_________ ozone can have a positive effect.

Answer 499

Atmospheric

Question 500

______ is a principal component of smog. – Result of the chemical reactions between VOCs and nitrogen – Harmful to human health – Responsible for aging lung tissue, reducing resistance to colds, and breathing problems

Answer 500

Ground level ozone

Question 501

``` • EPA ________ the guidelines for Ozone – Reduced the NAAQS acceptable level of ground-level ozone to 70 parts per billion (ppb) or 0.07 parts per million (ppm) ```

Answer 501

strengthened

Question 502

Earths temperature increased by __ in the past 100 years

Answer 502

1.5F

Question 503

Greatest driver of Climate change, created by humans

Answer 503

Greenhouse gases

Question 504

The primary______ found in Earth’s atmosphere include: | carbon dioxide, methane, nitrous oxide, ozone, and water vapor

Answer 504

Greenhouse gases

Question 505

Percentages of water types on the earth?

Answer 505

97% salt water; 3% fresh water

Question 506

Percentages of water?

Answer 506

97% salt water; 3% fresh water (<1% is easily accessible by us)

Question 507

When the accumulation of rain flows over roadways and grasses, it washes pollutants into local bodies of water. How is this classified?

Answer 507

Non-point source pollution

Question 508

– widely used in insecticides impacts water quality

Answer 508

Organophosphates

Question 509

– volatile organic compounds in water quality

Answer 509

• Chlorofluorocarbon

Question 510

– Direct source of water quality (sewage treatment plants)

Answer 510

Point source pollution

Question 511

Run off effect on water quality is what type of pollution?

Answer 511

Non-point source pollution

Question 512

Drinking water standards are regulated by the:

Answer 512

EPA

Question 513

first discovered in 1976 – 34 people attending the American Legion bicentennial conference in Philadelphia, USA died of a severe respiratory flu-like disease. – The bacterium responsible: – Source: contaminated water that contained the bacteria – Approximately 8,000 to 18,000 individuals are hospitalized with this disease each year in the U.S. • To prevent major outbreaks – Proper maintenance of water systems • drinking water systems, hot tubs, air conditioning lines, plumbing lines can also cause pontiac fever

Answer 513

Legionella

Question 514

First steps in water treatment. Chemicals with a positive charge areadded to the water – Neutralizes the negative charge of dirt and other dissolved particles in the water – Causes the particles bind with the chemicals and form larger particles, called floc.

Answer 514

Coagulation and Flocculation

Question 515

Floc settles to the bottom of the water supply, due to its weight.

Answer 515

Sedimentation

Question 516

Once floc has settled, the clear water on top will pass through filters – Varying compositions (sand, gravel, and charcoal) and pore sizes – Remove dissolved particles, parasites, bacteria, viruses, and chemicals

Answer 516

Filtration

Question 517

After filtration, a disinfectant is added – Chlorine or chloramine – Kills any remaining parasites, bacteria, and viruses – Protect the water from germs when it is piped to homes and businesses

Answer 517

Diseinfection

Question 518

The most common 4 steps in water treatment used by community water systems (mainly surface water treatment) include:

Answer 518

Coagulation and Flocculation: First steps in water treatment. Chemicals with a positive charge are added to the water – Neutralizes the negative charge of dirt and other dissolved particles in the water – Causes the particles bind with the chemicals and form larger particles, called floc. 2. Sedimentation: Floc settles to the bottom of the water supply, due to its weight. 3. Filtration: Once floc has settled, the clear water on top will pass through filters – Varying compositions (sand, gravel, and charcoal) and pore sizes – Remove dissolved particles, parasites, bacteria, viruses, and chemicals 4. Disinfection: After filtration, a disinfectant is added – Chlorine or chloramine – Kills any remaining parasites, bacteria, and viruses – Protect the water from germs when it is piped to homes and businesses.

Question 519

``` Which of the following should not be in potable water? Chlorine Disinfection residual Radionuclides Flourides ```

Answer 519

Radionuclides | emit radiation and may cause cancer after many years

Question 520

Food safety danger zone

Answer 520

40F - 140F

Question 521

If a food contaminated with a virus, such as Hep A, is left out for 4 hours in a kitchen at temp of 85F, the virus count...?

Answer 521

does not change (because it is virus)

Question 522

In some cases of food bourne illness, hemolytic uremic syndrome is caused by which organism?

Answer 522

E. Coli strain 0157:H7

Question 523

``` Pregnant women are 10 times more likely to become infected with______ Poses a risk to both the woman and the fetus, potentially causing miscarriage, stillbirth or preterm labor. ``` Can get into CNS.

Answer 523

Listeria

Question 524

An internationally recognized system for reducing the risk of safety hazards in food which is employed to identify potential problems that may cause foodborne illness.

Answer 524

Hazard Analysis Critical Control Point (HACCP)

Question 525

The most deadly foodborne illness

Answer 525

Listeria

Question 526

Potentially hazardous to human or environmental health when not disposed of properly – From home: pesticides, cleaning products, paint and auto products – Medical waste – Industrial hazardous waste (Chemicals, solvents and heavy Smetals) – Radioactive waste – Mining waste

Answer 526

Hazardous waste

Question 527

Near Niagara Falls – Disposal of toxic chemicals in 1952 • Halogenated organic compounds, chlorobenzenes, and dioxin – High rates of miscarriage, birth defects and cancer Illustrated link between hazardous chemicals and human health

Answer 527

The love canal (toxic waste site)

Question 528

Created and administered by the EPA | • Requires that responsible parties must assume liability for the cleanup of environmental hazards they cause.

Answer 528

Superfund regulations

Question 529

Any land contaminated by hazardous waste and identified by the EPA as a candidate for cleanup because it poses a risk to human health and/or the environment. – Sites are placed on the National Priorities List (NPL).

Answer 529

Superfund Sites

Question 530

In the US, which is the largest source of radiation to the general public?

Answer 530

Radon Gas

Question 531

water that passes though waste in modern landfills

Answer 531

leachate

Question 532

– The study of how chemicals cause injury to living cells

Answer 532

Toxicology

Question 533

The amount of the chemical in the body

Answer 533

Dose

Question 534

The probability that harm will occur (toxicity x exposure)

Answer 534

Risk

Question 535

The ability of a substance to do systemic damage as a result of a one time exposure.• Example: Hydrogen Sulfide exposure

Answer 535

Acute toxicity

Question 536

– The harmful systemic effects produced by longterm, low level exposure to chemicals. • Example: Asbestos exposure

Answer 536

Chronic toxicity

Question 537

Assumed: higher dose = greater effects • Deleterious effects are expected after reaching a threshold amount – Exception: Carcinogen Rule

Answer 537

Dose Responses curve

Question 538

Is there a safe threshold for carcigens?

Answer 538

no

Question 539

– The most common measure of acute toxicity | – The dose level at which 50% of the test population will die

Answer 539

Lethal Dose 50 (LD50)

Question 540

Dose level where there are no resultant deaths

Answer 540

LD0

Question 541

The exposure standard for lead in children has been lowered over the years because even small amounts can result in

Answer 541

Impaired cognitive development

Question 542

In 1980, the US Congress enacted the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) which commonly called?

Answer 542

Superfund.

Question 543

The Clean Air Act directs the EPA to establish national _________ air quality standards

Answer 543

Ambient

Question 544

In environmental public health, the latent period refers to: 1. The range of concentrations of a chemical that is below threshold 2. The period of time between exposure to a chemical and occurrence of a health outcome 3. The period of time required to remove half of the dose of a chemical from the body 4. The period of time between contact with a chemical and an increase in blood concentration

Answer 544

The period of time between exposure to a chemical and occurrence of a health outcome

Question 545

From Peter Drucker, often identified as the founding father of the science of management, it is clear that efficiency is most meaningful measured in terms of the: 1. perspective within an organization. 2. perspective outside an organization. 3. financial costs and efforts of the organization 4. units of time.

Answer 545

perspective outside an organization. In “The Effective Executive” (Harper & Row Publishers, 1967), Drucker comments that “…the organization is an abstraction… Specifically, there are no results within the organization. All the results are on the outside. The only business results, for instance, are produced by a customer who converts the costs and efforts of the business into revenues and profits through his willingness to exchange his purchasing power for the products or services of the business… Similarly, a hospital has results only in respect to the patient. But the patient is not a member of the hospital organization. For the patient, the hospital is ‘real’ only while he stays there. His greatest desire is to go back to the ‘nonhospital’ world as fast as possible.”

Question 546

Total coliform and E. coli counts are performed in routine monitoring of drinking water reservoirs because: 1. These bacteria commonly cause gastrointestinal infection in humans. 2. They are a more easily grown indicator of Legionella spp. contamination. 3. Outdated laws require heterotrophic plate count monitoring of water. 4. Their numbers give general indication of a water supply's sanitary condition.

Answer 546

Their numbers give general indication of a water supply's sanitary condition Coliform bacteria are a group of bacteria present in the environment, and in the feces of humans as well as all warm-blooded animals. Few cause disease in humans. Some strains of E. coli are common only in wild or domestic animals, others in humans. They all are heterotrophic (meaning that they require nutrients in growth media) and are monitored by plate counts as an indicator of sanitary quality of food or water. When their heterotrophic plate count numbers are high, this is an indication of contamination from sources that also might introduce disease-causing organisms (pathogens, including bacteria, viruses or protozoa). High counts trigger public health responses like boil water advisories, product recalls, additional investigation of water treatment or food production practices, etc.

Question 547

Facilitation takes work and in a meeting of multiple stakeholders it becomes important for the facilitator to prioritize his or her role. Above all the facilitator should: 1. Be neutral 2. Focus on the content 3. Take notes 4. Listen to the active speakers

Answer 547

Be Neutral (A facilitator's job is to encourage participants of a meeting to contribute ideas not to be weighing in on people's ideas as this may be polarizing.)

Question 548

A Type I error is defined as the probability of rejecting the: 1. Null hypothesis when the null hypothesis is true 2. Alternative hypothesis when the null hypothesis is true 3. Null hypothesis when the alternative hypothesis is true 4. Alternative hypothesis when the alternative hypothesis is true

Answer 548

Null hypothesis when the null hypothesis is true

Question 549

Which of the following is the most commonly occurring mosquito-borne disease in the United States? 1. West Nile neuro-invasive disease 2. Malaria 3. Dengue Fever 4. Yellow Fever

Answer 549

West Nile neuro-invasive disease West Nile virus neuro-invasive disease (WNVND) is common throughout the US, particularly in the warm months when mosquito populations are highest and people spend more time outdoors. Malaria, Dengue Fever, and Yellow Fever rarely occur in the US.

Question 550

Which of the following is the least acceptable method for making drinking water available in an emergency situation? 1. Using a tank truck to deliver water from a potable source 2. Using a community tap connected to a potable source 3. Pumping water from an uncontaminated aquifer 4. Pumping water directly from a river

Answer 550

Pumping water directly from a river Pumping water directly from a river is the least acceptable method of making water available during an emergency. River water is a type of surface water, which is more vulnerable to contamination than groundwater, which can be pumped from underground aquifers. Surface water can easily be contaminated by chemical pollutants discharged from a drainage pipe (point source) or agricultural runoff (nonpoint source) or micro-organisms that live in the water or enter the water through point sources or nonpoint sources. Both types of contaminants can lead to serious illness. River water and other surface water can be made potable through water treatment, but this can be very expensive.

Question 551

A population-based cancer registry collects data on newly diagnosed invasive breast cancers. These data would be used as numerator data when calculating which of the following measures for invasive breast cancer? 1. Incidence rates 2. Cause-specific death rates 3. Prevalence rate 4. Case fatality ratios

Answer 551

Incidence rates

Question 552

Which of the following measures of variability is calculated by subtracting the 25th percentile of data from the 75th percentile of data? 1. Variance 2. Interquartile range 3. Median absolute deviation 4. Coefficient of variation

Answer 552

Interquartile range The inter-quartile range is calculated by subtracting the 25th percentile of the data from the 75th percentile of the data and is used to measure variability.

Question 553

Can a state public health agency authorize its employees to use or donate frequent flyer miles for personal travel that were acquired during state business travel? 1. Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use or to specify their preferred airline for business travel. 2. Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use, but they cannot specify their own preferred airline for business travel. 3. No, this would violate the "de minimis" use of government resources so any frequent flyer miles acquired during business travel must be retained by the government agency. 4. No, this would violate several ethical constructs, so any participation in frequent flyer programs during government service must be prohibited.

Answer 553

Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use, but they cannot specify their own preferred airline for business travel.

Question 554

Rocky Mountain spotted fever and Lyme disease are examples of diseases transmitted by: 1. Mosquitoes 2. Polluted water 3. Contaminated food 4. Ticks

Answer 554

Ticks

Question 555

CHIP is a federal program that has been important for public health because: 1. It remedies the state differences in health insurance that characterize Medicaid 2. It covers preventive services for children who otherwise might not have access to them 3. It provides block grant funding that supports state public health programs 4. It increases funding for school health initiatives

Answer 555

It covers preventive services for children who otherwise might not have access to them The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Question 556

Count data, such as the number of events occurring in a specified period of time, are often described by which probability distribution? 1. Binomial 2. Chi-square 3. Normal 4. Poisson

Answer 556

Poisson The Poisson distribution is often used to describe count data and can be used to describe rate data by including an offset term for the denominator of the rate. A binomial distribution is the probability distribution for the number of successes in a sequence of Bernoulli trials, which are a series of trials where each trial can either succeed or fail, the trials are independent, and the probability of success is the same for each trial. A chi-square distribution is a right-skewed distribution where the area under the curve is equal to one, it starts at 0 on the x-axis and extends infinitely to the right but never touches the x-axis, and where the curve looks increasingly normal as the degrees of freedom increase. A normal distribution is a type of bell-shaped curve that is centered around a mean and approaches the x-axis when it is greater than 3 standard deviations away from the mean.

Question 557

The term “nosocomial” refers to infections acquired in what place? 1. The patient's home 2. The patients's workplace 3. A hospital 4. Public transportation

Answer 557

A hospital

Question 558

A researcher is interested in identifying potential risk factors for a rare form of bone cancer in children. Which of the following study designs would be best suited to investigate the risk factors for this type of cancer? 1. Prevalence-survey 2. Case-control 3. Cohort 4. Case crossover

Answer 558

Case-control Case-control studies are best suited to study rare outcomes because investigators enroll participants based on the outcome. As such, investigators can intentionally recruit participants who have the disease of interest, as opposed to having to recruit a very large group of people, most of whom will not develop the outcome of interest.

Question 559

Which statement is correct about scatterplots? 1. They are the preferred graphical method for displaying any type of data. 2. They are the preferred method to compare the means in bivariate data. 3. They are useless when the relationship between two variables is nonlinear. 4. They are useful for initial exploration of relationships in bivariate data.

Answer 559

They are useful for initial exploration of relationships in bivariate data. A typical scatterplot graph is a plot of paired (x,y) data with a horizontal x-axis and a vertical y-axis. It has many applications, and is useful as a first step to investigate the relationship between two variables (or more than two by use of 3-dimensional scatterplots or a scatterplot matrix). It can also help identify outliers within data sets. Curve-fitting techniques, such as LOWESS (locally-weighted scatterplot smoothing) and other tools, can be applied to derive even more information from these graphs.

Question 560

The Central Limit Theorem states that the: 1. Sample mean statistic is not always an unbiased estimator. 2. Sample mean is approximately normally distributed. 3. Population from which a sample is drawn is normally distributed. 4. Population standard deviation is approximately normal.

Answer 560

Sample mean is approximately normally distributed. The Central Limit Theorem states that if sample size is large enough, then distribution of the sample means can be approximated by a normal distribution, even if the original population is not normally distributed. In other words, the distribution of the sample means approaches a normal distribution as the sample size increases.

Question 561

Which of the following survey items best assesses an individual's socioeconomic status in terms of increasing validity and response rate? 1. Income in the past month 2. Highest level of education attained 3. Eligibility for public assistance 4. Perception of economic insecurity

Answer 561

Perception of economic insecurity Of all the options, perception of economic insecurity (e.g., concern about food insecurity) best assesses an individual's current economic status while reducing non-response due to concern about stigma. Respondents are least likely to respond to income and public assistance questions, while educational attainment does not accurately reflect one's economic situation

Question 562

In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called: 1. Behavioral assessment 2. Needs assessment 3. Ecological assessment 4. Environmental assessment

Answer 562

Needs assessment Needs assessment provides information about what is needed in the target community. In the PRECEDE-PROCEED model, a needs assessment is the general umbrella term and may involve a social assessment, epidemiological assessment, behavioral, environmental, educational, or ecological assessment. Using a needs assessment allows the planner to determine the degree to which the needs is are being met. Needs assessment help to identify the gap between what is and what should be.

Question 563

New to your leadership position, you realize that two of the programs you manage have similar functions, and work with the same population in the same area. Data trends over the past 5 years suggest that the health condition has improved significantly. You decide that only one program is needed to provide the necessary services to the community. This is an example of: 1. An analysis to justify and allocate resources 2. Applying a health equity and social justice lens 3. Strategic planning 4. Community Health Needs Assessment

Answer 563

An analysis to justify and allocate resources In this scenario, you compared the programs and analyzed the data trends to justify and allocate resources to one program.