Sample Questions Flashcards
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
Host, agent and environment
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
-0.9
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
Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease
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
Proportionate mortality ratio
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
Case-control
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
Product, price, place, and promotion
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
Take into account characteristics of the target population
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.
indication of the best diagnostic and treatment practices based on the best available evidence.
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
To promote the agency and engage continin advocacy
- 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
They provide strategic leadership in leading local and international solutions
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
Goals and objectives
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
Transactional
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
cultivate a new group of leaders
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
inherent in privacy by design at all stages.
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.
should plan to confirm the team norms and dynamics are productive.
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
Social determinants
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
Obtaining a waiver or an approval from an Institutional Review Board prior to the start of the study
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.
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.
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
Creating maximum benefit for all while minimizing individual harm
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
Police powers permit each state the right to define and delegate authority and responsibility for public health services
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
Metastatic
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
They can cause disease in an immunocompromised individual
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
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.)
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
Biomonitoring of chemicals or metabolites of the chemicals in blood and urine
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
Chlorination
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
Sludge
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
Nitrates can cause “Blue-Baby Syndrome” in infants
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
No one set of traits has been established as necessary
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
By using a State Implementation Plan (SIP) approved by the EPA
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
Improvements in sanitation and hygiene
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
Societal values
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
Consulting stakeholders to decide what best serves public interest
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
Process evaluation
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
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.).)
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
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)
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
Impact evaluation
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
Negative feedback loop
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
Personnel
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
Priority Population
(priority population is the people for whom the program is intended. In the past, this has also been called the target popluation.)
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
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.)
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.
Prepare by developing a “feedback sandwich” approach with two reinforcing statements surrounding a corrective statement.
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.
need explanation in a budget narrative.
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
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.)
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
Yes, if no less stringent than federal standards
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
Identify and control problems that may cause foodborne illness before they happen
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
Individual autonomy versus community welfare
The first step in the policy process typically is:
1) Undertake Consultation
2) Problem definition
3) Policy analysis
4) develop options and proposals
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.)
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)
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.)
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
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)
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
Environmental justice
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
Needs assessment
An incremental approach to program planning in public health:
- Uses multiple sources and methods to collect similar information
- Provides an intensive, detailed description and analysis of a single project
- Produces a plan where the specification of every step depends upon the results of previous steps
- Results in plans that may be immediately necessary but may overlap or leave gaps
Results in plans that may be immediately necessary but may overlap or leave gaps
An individual’s capacity to obtain, process, and understand basic health information and services needed to make basic health decisions is called:
- Medical informatics
- Health literacy
- Health education
- Numeracy
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.)
An individual’s capacity to obtain, process, and understand basic health information and services needed to make basic health decisions is called:
Health Literacy
the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning
Medical Informatics
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
Health education
is the ability to understand and work with numbers
Numeracy
A primary technique for preventing food-borne disease in cafeteria-type food service establishments is:
Why?
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.
Which of the following pairs of values are most likely to conflict during a response to a public health emergency?
- Truth-telling versus community welfare
- Beneficence versus justice
- Individual autonomy versus community welfare
- Community welfare versus justice
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.)
Which of the following principles of medical and public health ethics requires doing no harm while promoting the welfare of others?
- Autonomy
- Beneficence
- Privacy
- Justice
Beneficence (is defined as promoting the welfare of others while avoiding behavior that results in harm).
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:
- an agency website redesign is indicated
- the ad is not motivating those who read it.
- websites are not the best way to reach this audience.
- a formal review of communication strategy is indicated.
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)).
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?
Impact evaluation
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.
Impact evaluation
The minimal effective dose of any environmental agent that evokes a stated all or none response is known as
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).
Which of these has been defined as a core function of public health?
- Maintaining the census to define populations
- Consulting stakeholders to decide what best serves public interest
- Conducting research to solve all population health problems
- Acting in an ethical manner
Consulting stakeholders to decide what best serves public interest
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:
- internal assessment and strategic goals
- External assessment and department policy review
- Internal assessment and external assessment
- Strategic planning and maximizing program efficiency.
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.)
In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called:
- Behavioral assessment
- Needs assessment
- Ecological assessment
- Environmental assessment
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)
Which of the following makes community-based participatory research (CBPR) unique compared to other research methods?
- Approval from the institutional review board (IRB) is needed
- The methods are heavily survey based
- The participants (target population) becomes a part of the research process
- It is only used with specific populations
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.)
Waiting until a program or intervention is complete to begin evaluation activities misses important and valuable opportunities for what type of evaluation?
- Outcome and impact evaluation
- Summative evaluation
- Process evaluation
- Participant evaluation
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
These types of evaluations typically occur after a program or intervention concludes and assess its impact on participants and the broader community, respectively
Outcome and Impact
This type of evaluation assess the extent to which a program has achieved its goals
Summative
Which of the following statements best characterizes research findings about trait-based approaches to leadership theory?
- Intelligence, high energy, and initiative are necessary
- Personality traits are irrelevant
- No one set of traits has been established as necessary
- Leaders are born, not made
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.)
The biggest change in competencies for public health career professionals circa 2019 is
more emphasis on ‘soft’ skills for leading teams and on integration across technical skills
Generally, the largest single component in most public health budgets, and therefore the one with which managers must be most familiar is:
- computer software and hardware
- pharmaceuticals
- personnel
- shortfalls
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.)
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:
- Police powers prohibit states from defining standards of care and required the federal government to do so
- Standards of care are implied by police powers but implementation is left to the states
- Police powers permit each state the right to define and delegate authority and responsibility for public health services
- States use police powers to fund public health services only through property taxes, and these vary from state to state
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.)
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:
- Submitting another budget with no new positions.
- Asking another department to decrease their budget by 6.0 FTE positions.
- Provide information to justify the increased number of positions.
- Reaching out to the media to gain citizen support for the new positions.
Provide information to justify the increased number of positions.
The epidemiologic triangle (triad) describes the occurrence of disease as an interaction between what three factors?
- Person, place and time
- Host, agent and environment
- Person, environment and immunity
- Host, agent and exposure
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.)
Determining whether to continue or modify but not terminate a program is a reasonable objective of a:
- formative evaluation
- summative evaluation.
- qualitative evaluation.
- quantitative evaluation
Formative Evaluation
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
Formative
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)
Summative
What is an evaluation designed to present conclusions about whether a program should be sustained, changed, or eliminated?
- Formative evaluation
- Implementation evaluation
- Process evaluation
- Summative evaluation
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.)
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:
- Symmetric.
- Right skewed
- Left skewed
- Bimodal.
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
Waterborne diseases can result from fecal contamination. Which of the following would be classified as a waterborne disease?
- Cryptosporidium parvum
- Flavivirus
- Plasmodium spp.
- Borrelia burgdorferi
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)
Answer is a family of parasites that causes malaria, which, like flavivirus, is water-related
Plasmodium spp.
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
Flavivirus
Answer is a bacterial species that causes Lyme disease, the vector for which is the deer tick.
Borrelia burgdorferi
In the planning process, the group being served is referred to as the:
- Pilot population
- Key informants
- General population
- Priority population
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.)
The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is to:
- Subject a proposed major project or action to a comprehensive environmental review study
- Ensure that an important industrial project or action is constructed
- Ensure that the environment is protected at all cost
- Achieve sustainable development while relieving communities concerns
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.)
Public Health law fundamentally attempts to balance the greater good of the community with…
- the cost of implementation of the law
- the acceptability of interventions
- the autonomy of the individual
- the ease of enforcement
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).)
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
- National Standards for Culturally and Linguistically Appropriate Services (CLAS) Assessment
- Language Needs Assessment
- Health Resource Access Assessment
- Community Literacy Assessment
Language Needs Assessment
Four Factor Analysisfor lep
- 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
A management/leadership theory which posits that when staff are able to grow and develop staff performance results are better, is an example of:
- Situational Leadership Theory
- Douglas McGregor Theory Y
- Contingency Leadership Theory (CLT)
- Path-goal Theory
Douglas McGregor Theory Y
This theory of leadership maintains that the leader can affect the performance, motivation, and satisfaction of followers
Path-goal Theory
This theory involves the adoption of management style to meet the needs of all personne
Contingent Theory
This theory employees are generally not satisfied with work and are motivated by salary alone
Douglas McGregor Theory X
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:
- Social Epidemiology
- Institutional racism
- Structural racism
- Causative factors
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.)
Public Health professionals have to learn to work effectively with the media. Public health is potentially appealing for the popular press because:
- its stories have urgency, drama and novelty.
- it is a source rich in detail, facts and figures.
- scientists and journalists have a long history of mutual trust.
- public information officers issue press releases.
its stories have urgency, drama and novelty.
Measure of evaluation for a cohort study
Relative Risk
Measure of evaluation for a case control
Odds Ratio
May government employees use the government room rate offered by hotels if they are on a personal rather than a business trip?
- Yes, being a government employee one always is eligible to accept hotels’ government rates regardless.
- Yes, hotels and government agencies generally maintain a “don’t ask, don’t tell” position on this question.
- Yes, if the hotel offers this rate to all government officials traveling on official business or not.
- Yes, if the hotel offers it to you specifically by name.
Yes, if the hotel offers this rate to all government officials traveling on official business or not.
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?
- Veterinary Public Health
- Environmental Health
- One Health
- Population Health
One Health (One Health focuses on the interface of humans, the environment, and animals)
has been defined as “the health outcome of a group of individuals, including the distribution of such outcomes within the group”
Population Health
the relationships between people and their environment; promotes human health and well-being; and fosters healthy and safe communities
Environmental Health
Which of the following is not a disease that can be contracted by the food-borne route?
- Salmonellosis
- Giardiasis
- West Nile virus neuro-invasive disease
- Hepatitis A
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.)
Safe Harbor provisions are intended to protect patient privacy by defining:
- the covered entities with which patient data may be shared.
- which data elements to remove to create de-identified data sets.
- encryption protocols and Internet routes for transmitting data.
- data use agreement provisions for sharing confidential data sets.
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.)
In the design and implementation of public health data systems, installing security features should be:
- inherent in privacy by design at all stages.
- a task separately done by an expert cybersecurity team.
- limited to firewalls and administrative control.
- the final step before release of software systems.
inherent in privacy by design at all stages.
Privacy by design is not a new principle, but under GDPR became a legal requirement.
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?
- To promote the agency and engage in advocacy
- To promote favorable legislation
- To provide STI tests and keep the public safe
- To provide vaccinations
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.)
In order to effectively evaluate organizational performance, performance indicators must be:
- approved by all organizational staff
- publicly reported
- benchmarked against previously agreed upon standards
- clear in the organizational mission statement
benchmarked against previously agreed upon
The principal difference between other industrialized countries and the United States in terms of providing universal health care coverage is that:
- This is recognized as a basic human right in the other countries’ founding document but not in the United States Constitution
- All hospitals are owned by and all physicians are employees of the other governments while the United States takes a free market approach
- The other countries spend more per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population.
- The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population
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.)
Which of the following is not a construct from the Health Belief Model?
- Susceptibility
- Cues to action
- Decisional balance
- Barriers
Decisional balance
decisional balance is often employed within stages of change theory, particularly in SOC’s Strong and Weak Principles.
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:
- food handlers for infected cuts and sores
- for dead animals on the property
- resort water supply and storage
- employees who have come to work with influenza
resort water supply and storage
Legionella is transmitted via the air when contaminated water from these and other sources is vaporized and inhaled.
By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with states to implement national environmental standards such as NAAQS?
- By creating a memorandum of understanding focusing on cost-sharing of environmental burdens
- By establishing air quality monitoring stations
- By using a State Implementation Plan (SIP) approved by the EPA
- By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant
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.)
A short narrative or statement that describes the general focus and purpose of a program is called:
- A mission statement
- A long-term goal
- A long-range plan
- An objective
A mission statement
Policy analysis when designing public health programs is:
- involves a straightforward statistical analysis of health and public polling data.
- a subjective political task accomplished by legislative debate and trade-offs.
- complex, involving data collection and clarification of objectives.
- impossible to define because different policy areas require different approaches.
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)
Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities are commonly referred to as:
- Health behavior factors
- Risk markers
- Needs assessment
- Determinants of health
Determinants of health
Select the qualitative method that collects data through a simultaneous conversation with a group of people.
- key informant interviews
- discourse analysis
- surveys
- focus groups
Focus Groups
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)
Discourse Analysis
is the collection of information from a sample of individuals through their response to questions
Surveys
are in-depth interviews with people who have informed perspectives about the topic or community you’re working with
Key Informant Interview
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:
- can be interpreted as the average increase in LDL cholesterol for every one unit increase in SBP.
- can only be interpreted if its value is greater than 1.
- cannot be interpreted without knowing the value of the correlation coefficient.
- can be interpreted as the average increase in SBP for every one unit increase in LDL cholesterol
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.)
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?
- Environmental equity
- Environmental justice
- Environmental pollution
- Environmental democracy
Environmental justice
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?
- Any meal, at any time, can be accepted from anyone except when an actual regulatory transaction is taking place.
- Breakfast or dinner alone at his or her hotel provided in lieu of an honorarium for speaking at an industry-sponsored event.
- Lunch provided on-site by an organization to everyone involved during day-long inspections of their operational facilities.
- Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event
Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event
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?
- Document change in mortality associated with drinking and driving
- Document change in numbers of youth riding with impaired drivers
- Document risks of riding with impaired drivers
- Document number of students who attend a drinking and driving education program
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.)
The Dartmouth Atlas of Healthcare demonstrates that small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in:
- Physician practice styles
- Consumer preferences for high-cost services
- Age of the population served
- Health status of the population served
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.)
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?”
- Contingency
- Path-Goal
- Transactional
- Transformational
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.)
Which of the following would be the best source of information on adult and infant mortality?
- Disease registries
- Vital statistics
- National Health Interview Survey
- Hospital clinic statistics
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.)
The linear relationship between two continuous variables is often described by:
- Odds ratio
- Relative risk
- Correlation coefficient
- F-test
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.)
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:
- Create a new conflict process based solely on examples from other clinics.
- Select a group of patients to provide input on how complaints should be resolved.
- Wait until a new complaint occurs to observe the existing process.
- Ask their coworkers how they personally deal with complaints and conflicts in the office.
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.)
Which of the following statements is not associated with the current paradigm of quality management?
- Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care
- The appropriate locus for ensuring quality is at the system level
- Process improvement is essential to ensuring quality of care
- Employee satisfaction and patient satisfaction are closely linked
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.)
All written intervention messages (whether printed, computer-delivered, or Internet-based) must:
- Start with the most important information first
- Include graphics, pictures, and the like to attract people’s attention
- Be at a reading level suitable to the target population
- Be no longer than four sentences long
Be at a reading level suitable to the target population
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:
- Routine prevention
- Primary prevention
- Secondary prevention
- Tertiary prevention
Secondary Prevention
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.
Secondary Prevention
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.
Primary Prevention
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.
Tertiary Prevention
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?
- Document which participating barbers attended each of the training workshops
- Document the barbers’ change in fruit/vegetable intake
- Document the customers’ change in physical activity
- Convene focus groups in two barber shops to discuss print materials
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.)
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:
- develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner’s office.
- develop agreements with local providers or organizations for the provision of dental services.
- Continue the dental program in-house at the local health department, since it was already financially sustainable and heavily utilized.
- ensure implementation of contracts and other agreements with community partners to provide community dental services.
develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner’s office.
Which of the following components of a strategic planning process in a public health agency has logical priority over the others?
- Preparing an action plan for eradicating giardiasis in the municipal water system
- Developing the operating budget and staffing plan for the agency
- Reviewing (and revising) the vision and mission statements for the agency
- Setting strategic goals for a three-year cycl
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)
When beginning work with a coalition of community groups to improve health outcomes in the community, a key first step would be to:
- Develop a shared vision
- Develop an evaluation plan
- Develop a data collection plan
- Develop a logic model
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.)
As a first step in public health emergency preparedness, jurisdictions should:
- Ask a local government leader what will be expected of them.
- Outsource public health emergency preparedness responsibilities.
- 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.
- Design and conduct at least one table-top exerci
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.)
Effective policy dialogue facilitators:
- value the policy dialogue process over its outcome.
- value an outcome over the policy dialogue process.
- rarely engage in preparatory stages before panels meet.
- moderate rather than interpose with questions.
value the policy dialogue process over its outcome
To evaluate public health performance, we consider capacity, process, and outcomes. Which of the following represents an example of an “outcome?”
- An increase in the types of vaccines offered to protect against common childhood diseases
- Decrease in number of children age 0-2 with vaccine preventable disease
- Routine health care
- Increase in number of patients seen in the mobile immunization van
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.)
What is the “reservoir host” for West Nile Virus?
- Birds
- Mosquitoes
- Humans
- Cattle
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.)
The best example of community engagement and empowerment refers to which of the following?
- Teaching community members how to best communicate with providers
- Conducting health needs and assets assessment with communities and sharing the information
- Teaching self-determination to community members
- Reciprocal transfer of knowledge and skills among all collaborators and community partners
Reciprocal transfer of knowledge and skills among all collaborators and community partners
Informed consent should avoid inclusion of:
- risks and benefits
- technical jargon
- contact information
- purpose
technical jargon
Which of the following is defined as a community’s ability to survive, adapt and thrive?
- Community capital
- Community development
- Community organization
- Community capacity
Community capacity
Generalizing certain characteristics of the population based on the sample data is referred to as:
- Random sample
- Statistical inference
- Descriptive statistics
- Histograms and bar charts
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.)
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:
- Secondary Prevention and Harm Prevention Strategy
- Secondary Prevention and Harm Reduction Strategy
- Tertiary Prevention and Harm Reduction Strategy
- Tertiary Prevention and Harm Prevention Strategy
Tertiary Prevention and Harm Reduction Strategy
The following test would be used to compare the frequency of diabetes between groups:
- Chi-square goodness of fit test
- Chi-square test of independence
- Two independent samples t test
- Analysis of variance
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.
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:
- detecting and reporting sentinel events
- open attitudes and mutual respect
- using standardized checklists
- assuring professional expertise
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.)
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?
- Health Insurance Portability and Accountability Act (HIPAA) and Safe Harbor conventions
- Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA)
- Safe Harbor conventions and the Consolidated Omnibus Budget Reconciliation Act (COBRA)
- Health Information Technology for Economic and Clinical Health Act (HITECH) and Affordable Care Act (ACA)
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.)
The incidence of bacteria that are resistant to antibiotics is:
- Increasing
- Decreasing
- Staying the same
- Difficult to measure
Increasing
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?
- Likelihood ratio
- Absolute risk difference
- Relative risk ratio
- Prevalence rate
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)
______ 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
Relative RIsk
more commonly used in relation to interpreting diagnostic tests.
Likelihood Ratio
__________ alone can be more cumbersome and are not as informative as incidence rates for diseases that are not chronic
Prevalence rates
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?
- Vibrio cholerae (causes cholera)
- Cryptosporidium (causes Cryptosporidiosis)
- Giardia lamblia (causes Giardiasis)
- Escherichia coli (causes acute gastroenteritis)
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)
The most important reason for reduced mortality during the initial stage of a demographic/epidemiologic transition in a population is:
- Increased use of antibiotics
- Improved sanitation
- Increased immunization
- Screening for common infectious diseases
Improved sanitation
When a new treatment is developed that prevents death, but does not produce recovery from disease, the following will occur:
- Prevalence of the disease will increase
- Incidence of the disease will increase
- Prevalence of the disease will decrease
- Incidence of the disease will decrease
Prevalence of the disease will increase
Which of the following statements regarding disease measures is correct?
- Incidence equals duration times prevalence
- Prevalence is a rate
- Cumulative incidence is a proportion
- Incidence density is a proportion
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.)
Prevalence is expressed as incidence times duration, thus it is also a ______
Proportion
In the construction of Box-plots, the upper and lower fences are used to detect which of the following?
- Outliers
- Maximum and minimum values
- Median and range
- Quartiles
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.)
Which of the following best characterizes the contingency theory of leadership?
- The leader’s authority is contingent upon subordinates
- The leader’s effectiveness depends upon factors in the leadership context
- The leader’s effectiveness depends upon the technical competency of staff
- The leader’s authority is contingent upon formal rules and sanctions
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.)
Which of the following is an expected benefit of consolidating independent hospitals and provider groups into an integrated health care system?
- Economies of scale in production
- Lower costs of integration
- Ease of accommodating diverse organizational cultures
- Immediate gains in administrative efficiency
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.)
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?
- Assessment
- Financial performance management
- Policy development
- Assurance
Financial performance management
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?
- Primary
- Secondary
- Tertiary
- Quaternary
Secondary
Secondary prevention includes early detection and treatment.
From a political perspective, which type of analysis provides the weakest identification of social and economic impact?
- Cost-benefit analysis
- Cost-effectiveness analysis
- cost-minimization analysis
- cost-utility analysis
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.)
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:
- Donabedian’s model
- Shewart’s PDCA
- Theory of Change
- Web of Causation
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.)
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:
- Transactional
- Transformational
- Passive-avoidant
- Autocratic
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.)
Ethical standards apply to government officers and employees. For such individuals, these standards apply:
- only during their normal working hours.
- just when performing official duties regardless of time.
- when they identify themselves with their official title.
- at all times, whether they are on or off duty.
at all times, whether they are on or off duty.
Which of the following terms means that a tumor has spread to other locations within the body?
- Malignant
- Metastatic
- Benign
- Hyperplastic
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.)
The use of sun protection like sun screen and/or wearing a hat are examples of which type of prevention strategy?
- Primary Prevention
- Secondary Prevention
- Tertiary Prevention
- Quaternary Prevention
Primary Prevention
(Primary Prevention measures include health promotion and disease prevention activities, before there is any evidence of disease.)
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:
- Health disparity
- Harm reduction
- Modifiable risk factors
- Life expectancy
Health Disparity
(Health Disparity is defined as the difference in health status between two groups).
Which of the following practices enhances equity across populations when making health policy decisions in a community?
- Requiring randomized control evidence of effectiveness
- Allocating resources based on population size
- Collecting health-related data about the individuals in the community
- Including diverse constituencies in the decision-making groups
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.)
Which of the following strategic planning tools is in the form of a 2x2 table?
- Gantt chart
- Network diagram
- Precede Proceed model
- SWOT chart
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.)
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 ?
- A parent/guardian
- Teenager
- Teenager and school official
- Teenager and parent/guardian
Teenager and parent/guardian
The goal of an ANOVA statistical analysis is to determine whether or not:
- The means of two samples are different
- The means of more than two samples are different
- The means of two or more populations are different
- The means of two populations are different
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.)
To determine whether to expand a component of a current intervention, which type of evaluation is needed?
- Formative evaluation
- Process evaluation
- Outcome evaluation
- Impact evaluation
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.)
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.
- Ecological Study
- Community Based Participatory Research
- Theory of Reasoned Action
- Randomized Community Trial
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)
______ 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
Ecological Study
is a theory that “explores the relationship between behavior and beliefs, attitudes, and intentions”
Theory of Reasoned action
is a type of experimental study where the intervention is allocated to entire communities. This type of trial can be randomized or nonrandomized.
(Randomized) Community Trial
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?
- Recessive
- Sex-linked
- Autosomal
- Dominant
Recessive
A recessive condition is one in which an individual needs to be homozygous for a mutation in order to show symptoms.
When comparing dichotomous variables with less than five expected observations per cell, the correct statistical test would be a:
- t-test
- rank sum test
- Fisher’s Exact test
- Chi-square test
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.)
used for continuous data
T-test
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:
- The Nuremberg Code
- The Belmont Report
- Rose-Welch Report
- The Legal Epidemiology Competency Model
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)
The difference between primary and secondary prevention of disease is:
- Primary prevention focuses on control of causal factors, while secondary prevention focuses on control of symptoms
- Primary prevention focuses on control of acute disease, while secondary prevention focuses on control of chronic disease
- Primary prevention focuses on control of causal factors, while secondary prevention focuses on early detection and treatment of disease
- Primary prevention focuses on increasing resistance to disease, while secondary prevention focuses on decreasing exposure to disease
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)
To help lay, professional and policy audiences understand the rationale for a program proposal, it is best to:
- provide everyone with the same report, written in plain language aimed for a Grade 10 reading level.
- 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.
- present a comprehensive literature review, summarize all the numbers in one table and let the facts speak for themselves.
- tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience.
tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience.
Using a qualitative evaluation method would be most useful in which of the following scenarios? The researcher is:
- primarily concerned with the generalizability of the results.
- interested in capturing the context of program participation and the participants’ stories.
- concerned with ease of analysis and interpretation of data
- comparing outcomes for a group participating in a program to the outcomes for a similar group not receiving the program
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.)
Activists criticized America’s public health policy response during initial years of its AIDS epidemic on the grounds that:
- Absence of universal health care insurance prevented victims from accessing expensive treatment
- Government indifference and political infighting resulted in apathy toward a suffering gay community.
- Too much money was being spent on treatment, not enough on prevention to stop the epidemic.
- Too much resource was being spent on urging people to change risk behaviors, not enough on medication.
Government indifference and political infighting resulted in apathy toward a suffering gay community.
The primary purpose of strategic planning is to:
- assign tasks and responsibilities to individuals based on expertise
- determine the organization’s annual budget allocation
- maximize return on investment for programming
- determine the direction an organization will pursue
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.)
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):
- Capacity building
- Efficiency Study
- Continuous Quality Improvement
- Feasibility Study
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)
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?
- Price
- Promotion
- Place
- Process
Process
The four P’s of social marketing is Price, Promotion, Place, and Product.
What term reflects the meaning of external validity of study findings as used in an evidence-based critical appraisal?
- Generalizability
- Bias
- Confounding
- Surrogate end points
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.)
A systematic error where something else other than the predictor variable influences the response variable.
Bias
Presence of a factor that influences both the intervention and the outcome of research.
Confounding
An outcome that substitutes for a direct measurement of a clinical outcome. This may correlate with the real clinical outcome.
Surrogate end points
Data for which personally identifiable information was not collected, or has been encrypted or removed are known as:
- Confidential
- Secure
- Anonymous
- Coded
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)
The “Greenhouse Gas” of primary concern in global warming is:
- Chlorofluorocarbons
- Carbon monoxide
- Sulfur dioxide
- Carbon dioxide
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.)
Which statement best describes the p-value?
- The probability that the null hypothesis is true
- The probability of rejecting the null hypothesis when it is true
- The probability that a replicating experiment would not yield the same conclusion
- The probability of rejecting the null hypothesis when it is false
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.)
Public health departments can use health profession students (eg. medicine, nursing, other allied health specialties) in projects to assess community health needs:
- if those students are formally employed by that health department under a national fellowship program that puts selected applicants into mentorship placements.
- provided the students interview but do not take clinical measurements or samples from individuals.
- when supervised by their clinical instructors in actions within the scope of that profession’s practice.
- but this is not often done because the health department would be responsible for all supervision and liability.
when supervised by their clinical instructors in actions within the scope of that profession’s practice.
Exposure assessment attempts to answer all of the following questions except:
- Toxicity of the exposure
- Frequency and duration of exposure
- Population exposed
- Route of exposure
Toxicity of the exposure
It can be helpful to make sure you are setting goals and objectives that are SMART. The R in SMART stands for:
- Reliable
- Resistant
- Realistic
- Rapid
Realistic.
A “SMART” goal or objective is one that is Specific, Measurable, Achievable, Realistic, and Time-bound.
In low resource countries during an outbreak, what simple, low-tech sanitation measure can dramatically reduce the spread of enteric bacteria and viruses?
- Disposing of stagnant water
- Sleeping under an insecticide-soaked bednet
- Vaccination of those individuals who work on the water supply
- Add chlorine to water storage containers
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.
May a state officer or employee of a regulatory agency concurrently conduct an outside (private) business or accept outside employment?
- Yes, provided the outside business activity is unrelated to the area that he or she regulates.
- No, any outside business engagement gives the appearance of unacceptable conflict of interest.
- Perhaps, but only if the outside business engagement is approved by the agency’s head.
- There is no clear ethical standard – this is more a question of ability to manage both schedules.
Yes, provided the outside business activity is unrelated to the area that he or she regulates.
What level of government typically provides the oversight and guidance to prioritize public health needs and resources that focuses program planning and evaluation?
- Public Health Department Program Management
- Public Health Department chief executive officer
- Board of Health
- Legislature
Board of Health
In cohort studies, which of the following is correct about the role of a suspected factor in the etiology of a disease?
- There are equal numbers of people in both study groups.
- At the beginning of the study, those with the disease and those without the disease have equal risks of having the factor.
- The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders.
- The incidence of the disease is low.
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.)
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?
- Cancer biomarkers (e.g. specific gene mutations or elevated expression levels)
- Direct to consumer family heritage genomic analysis services
- Blood typing
- Newborn Cystic Fibrosis screening
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)
Out of a population of 500,000 people, 500 were observed for two years. Five developed disease. What is the incidence density rate?
- 5/500
- 5/1000
- 5/500,000
- 500/500,000
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.
The last category in a cumulative relative frequency distribution will have a cumulative relative frequency equal to?
- 0
- 1
- The total number of individuals in the given data set
- The total number of categories in the given data se
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.
Which of the following characteristics is true for a prospective (or concurrent) cohort study, but not true for a retrospective (or historical) cohort study?
- They are good for rare exposures
- Exposed and unexposed groups are followed over time
- he disease outcome has not yet occurred when the study begins
- Incidence rates can be calculated for exposure groups
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.
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
Cumulative Incidence
new cases of disease in candidate population
divided by person-time of observation
#new cases of disease
person time of observation
Incidence Rate
Which of the following is calculated by dividing the
number of new cases of disease by the total
population at risk?
Cumulative Incidence
Relative Risk Formula
RR= a/(a+b) or Rate in exposed over
c/(c+d) or Rate in unexposed
Explain how relative risk works: ie what do the various numbers mean?
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.
Odds Ratio are most commonly used in what studies?
casecontrol studies; however they can also be used in
cross-sectional and cohort study designs as well.
Define Odds Ratio
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.
Odds Ratio Formula
OR = (a/b) / (c/d)
or ad/bc
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
The disease must be rare
making assumptions about the
individual based on finding at the level of the
population
Ecological Fallacy
Identify the Study Type
Unit of analysis: Population or groups
• Exposure status: Based on the population
• Time can vary
Ecological/Correlational
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
Cross-sectional
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
Case - control
the observational equivalent
of experimental studies but the researcher
cannot allocate exposure
Cohort Studies
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
Cohort Study
