Module 3 (Data and Statistics)

Question 1

What are Sir Bradford Hill’s Criteria for research?

Answer 1

These are his criteria for causation (establishing epidemiologic evidence of a causal relationship between a presumed case and an observed effect).

They include:
consistency, specificity, temporality, biological gradient (dose-response relationship), plausibility, coherence, experiment, analogy

Question 2

What is sensitivity versus specificity?

Answer 2

Sensitivity: tests with few false negatives (used more in public health data to avoid missing individuals with condition associated with the disease)

Specificity: tests with few false positives

Question 3

What are common rates used within public health?

Answer 3

Birth rates
Mortality rates
Crude rates (use a raw number, data frequently adjusted for comparison purposes)
Infant mortality rate
Maternal mortality rate
Age adjusted
Gender specific

Question 4

What is the International Classification of Diseases? (ICD)

Answer 4

Published by the World Health Organization (WHO), this is used throughout the world to provide a common classification of diseases, conditions, and causes

Currently in ICD-10 version, but 11 will be out soon

Question 5

What is YPLL?

Answer 5

Years of Potential Life Lost; measures early deaths (before expected life expectancy); can indicate failures or priorities for greater emphasis

Question 6

What is cost / benefit analysis?

Answer 6

Demonstrate that an intervention provides a positive return
(often calculated through monetary means)

(E.g. calculating the costs of MMR vaccinations for children versus costs of treating those with the disease yielded a 13 to 1 ratio of benefit to cost)

Help policy makers decide the best course

Question 7

What are common sources of local data?

Answer 7

birth certificates, death certificates, notifiable diseases, infant mortality statistics, other vital statistics

Question 8

What is the National Vital Statistics System?

Answer 8

the oldest and most successful example of inter-governmental data sharing in Public Health and the shared relationships, standards, and procedures form the mechanism by which NCHS collects and disseminates the Nation’s official vital statistics.

Purpose: to answer the question, “Are people living healthier lives?”

Formed around 1880

Question 9

What are the functions of the US Census?

Answer 9

The census is mandated by the US Constitution and serves as the denominator for most public health data, including:
age, sex, race, ethnicity

education, housing, health insurance (American Community Survey)

American Housing Survey

Question 10

What section of the US Constitution mandates the US Census?

Answer 10

Article 1, Section 2 (in determination of # of leaders):

“Section 2
The House of Representatives shall be composed of Members chosen every second Year by the People of the several States, and the Electors in each State shall have the Qualifications requisite for Electors of the most numerous Branch of the State Legislature.

No Person shall be a Representative who shall not have attained to the Age of twenty five Years, and been seven Years a Citizen of the United States, and who shall not, when elected, be an Inhabitant of that State in which he shall be chosen.

Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons. The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct. The Number of Representatives shall not exceed one for every thirty Thousand, but each State shall have at Least one Representative; and until such enumeration shall be made, the State of New Hampshire shall be entitled to chuse three, Massachusetts eight, Rhode Island and Providence Plantations one, Connecticut five, New-York six, New Jersey four, Pennsylvania eight, Delaware one, Maryland six, Virginia ten, North Carolina five, South Carolina five, and Georgia three.

When vacancies happen in the Representation from any State, the Executive Authority thereof shall issue Writs of Election to fill such Vacancies.

The House of Representatives shall chuse their Speaker and other Officers; and shall have the sole Power of Impeachment.”

Question 11

What are some of the major national health surveys?

Answer 11

National Maternal and Infant Health Survey
National Health Interview Survey (NHIS)
National Health and Nutrition Examination Survey (NHANES)
Behavioral Risk Factor
National Survey on Drug Use and Health (NSDUH)
Surveillance Survey (BRFSS)
Youth Behavioral Risk Factor Survey

Question 12

What can one access through Georgia’s OASIS database?

Answer 12

vital statistics
hospital data
behavioral survey
population
Specific data like counts and ranks
Tools like making maps

Question 13

Pandemic Versus Epidemic Versus Endemic

Answer 13

An epidemic is a disease outbreak that is rapidly spreading in a limited region. A pandemic is an epidemic that is actively spreading to multiple regions across the globe.

Though an endemic is a constant presence in a community, it differs from a pandemic because the virus is somewhat contained and not spreading out of control and not stressing the health care infrastructure, therefore we can more easily prevent and treat it.

Question 14

What is the p value?

Answer 14

It expresses the probability that the observed result could have occurred by chance alone.

A p value of .05 means that if an experiment were repeated 100 times, the same answer would result 95 of those times, while 5 times would yield a different answer.

Question 15

What is a confidence interval?

Answer 15

a range of values within which the the true result probably falls. The narrower the confidence interval, the lower the likelihood of random error.

These are often expressed as margins of error. e.g. when a politician’s supported is estimated at 50% plus or minus 3%.

Question 16

What is lead time bias?

Answer 16

This occurs when increased survival time after diagnosis is counted as an indicator of success.

Question 17

What is overdiagnosis bias?

Answer 17

This occurs when symptoms detected by screening are not likely to progress to the next stage (life-threatening), but remission or survival is still considered a measure of success.

Question 18

What are crude rates versus adjusted rates?

Answer 18

Crude rates are raw data
Adjusted rates use statistical calculation to make the populations being examined equivalent to one another (often used for age adjustments).

E.g. crude mortality in Florida is much higher than crude mortality in Alaska, but the average age of Floridians is also much higher than the average age of Alaskans.

Question 19

What is a risk assessment?

Answer 19

A formal process which identifies events and exposures which may be harmful to humans and estimates the probabilities of their occurrence as well as the extent of harm they may cause.

Question 20

What is cost / effectiveness analysis?

Answer 20

Compare the effectiveness of one intervention to another

E.g. It may be so expensive to give prevent heart attacks in men by prescribing cholesterol drugs – it may be more effective to provide cardiac care for those who do suffer an attack. (ethics questions…)

Help policy makers decide the best course

Question 21

What is the federal agency that collects, analyzes, and reports data on the health of Americans?

Answer 21

National Center for Health Statistics (NCHS)

Question 22

What are some examples of vital statistics?

Answer 22

births, deaths, marriages, divorces, spontaneous fetal deaths, and abortions

Question 23

What is the US Census?

Answer 23

a national survey that provides data not only on the geographic distribution of the population and its sex, age, and ethnic characteristics, but also on a wide variety of social and economic characteristics.

Part of the Department of Commerce

Question 24

What is the Behavioral Risk Factor Surveillance Survey (BRFSS)?

Answer 24

A study collected by the federal government in conjunction with the states which obtains information on health-related behaviors.

Specifically, it asks about risk factors (high blood pressure, high blood cholesterol, diabetes, and weight), health related behaviors (diet, physical activity, cigarette smoking, alcohol use, seatbelt use, drinking and driving), and preventative medical care (mammograms, PAP smears, colon cancer screenings, immunizations, etc.)

Question 25

How is the BRFSS different from the National Health and Nutrition Examination Survey (NHANES) and other publications?

Answer 25

The BRFSS is the largest continuously conducted health survey in the world, completing more than 400,000 interviews per year (and allows state level analysis).

However, it is also self reported and so less accurate than NHANES and several other surveys.

Question 26

What are some examples of Public Health Informatics?

Answer 26

Any example of information technology concerning public health:

Online databases (like OASIS)

the Morbidity and Mortality Weekly Reports (MMWR) online via the CDC

The National Cancer Institute website provides its latest information on cancer therapies and prognoses tailored for doctors and for patients.

Question 27

Function of the Environmental Protection Agency

Answer 27

Carries out surveillance for health hazards in the environment including air pollutants and releases of toxic chemicals

Question 28

Function of the Food and Drug Administration

Answer 28

Collects reports of adverse reactions to drugs after they have been approved and are on the market, sometimes recommending recalls if a serious problem appears that was not noted during pre-approval testing

Question 29

Function of the National Cancer Institute related to data collection

Answer 29

Coordinates a program called Surveillance, Epidemiology, and End-Results (SEER)

Question 30

Function of the Centers for Medicare and Medicaid Services in Public Health

Answer 30

Maintains billing records which are useful for research on utilization and outcomes of medical care

Question 31

What is risk perception?

Answer 31

Developed as a result of the apparent irrationality of the public in response to the risks that the experts estimated to be small

Question 32

What is a cancer cluster?

Answer 32

a greater than expected number of the same or etiologically related cancer cases that occurs within a group of people in a geographic area over a defined period of time.

Question 33

What is an outbreak?

Answer 33

a sudden rise in the number of cases of a disease.

Question 34

What survey did the Census Bureau launch in 2005 (created for the sake of efficiency)?

Answer 34

The American Community Survey

Question 35

What is the main function of qualitative research in public health?

Answer 35

In healthcare, qualitative research is widely used to understand patterns of health behaviors, describe lived experiences, develop behavioral theories, explore healthcare needs, and design interventions.

Question 36

What is small area variation analysis?

Answer 36

Small area variation analysis is a research tool used by health services researchers to describe how rates of health care use and events vary over well-defined geographic areas

Question 37

What is outcomes research?

Answer 37

Outcomes research is a broad umbrella term without a consistent definition. However it tends to describe research that is concerned with the effectiveness of public-health interventions and health services; that is, the outcomes of these services.

Question 38

Did prohibition reduce death by liver cirrhosis?

Answer 38

Yes, by about 50%.

In the early 1900s, the death rate due to cirrhosis of the liver was as high as 14.8 deaths per 100,000 people, however it gradually fell in the wartime Prohibition of the First World War, and then plateaued at half of this level, between 7.1 and 7.5 deaths per 100,000 people, during federal Prohibition in the 1920s and early 1930s.