CPH Exam 90 Questions with Verified Answers,100% CORRECT

CPH Exam 90 Questions with Verified Answers Host, agent and environment - CORRECT ANSWER The epidemiologic triangle (triad) describes the occurrence of disease as an interaction between what three factors? -0.9 ...

CPH Exam 90 Questions with Verified Answers Host, agent and environment - CORRECT ANSWER The epidemiologic triangle (triad) describes the occurrence of disease as an interaction between what three factors? -0.9 An odds ratio of -0.9 most strongly indicates a computational error because an odds ratio is calculated using probabilities, which cannot be negative. An odds ratio is the probability that an event will occur divided by the probability that it will not occur. Since probabilities cannot be negative, a negative odds ratio would indicate computational error. - CORRECT ANSWER 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 1) Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease - CORRECT ANSWER 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 4) Proportionate mortality ratio Proportionate mortality ratio is calculated as the number of deaths due to a specific disease within a population divided by the total number of deaths in the population. In this case, we would calculate the total number of deaths due to heart disease divided by the total number of deaths within the population of interest. - CORRECT ANSWER 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 *Case control*, also known as case-referent studies, estimate the magnitude of an association between and exposure and an outcome. In case control studies, subjects are selected because they have the outcome of interest. - CORRECT ANSWER 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 Product, price, place, and promotion - CORRECT ANSWER The four P's of public health marketing services include: 1) Take into account characteristics of the target population As defined by Kreuter and Wray, targeted communication is intended to reach a segment of the population that shares specific characteristics, while *tailored communication* is intended to reach a specific individual. Both strategies increase the effectiveness of interventions and are premised on acquiring in-depth familiarity with the audience before the message is created, tested, and disseminated. Otherwise, the message will be meaningless to the target population. - CORRECT ANSWER 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 1) indication of the best diagnostic and treatment practices based on the best available evidence. - CORRECT ANSWER 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) enforceable 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. 1) To promote the agency and engage in advocacy - CORRECT ANSWER 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 3) They provide strategic leadership in leading local and international solutions In an ever interconnected world where diseases have no borders, cutting edge public health research has to be disseminated with local stakeholders as well as international communities. * Please note leadership is a communication act. - CORRECT ANSWER 5.For the first time scientists in the United States conducted a longitudinal study that followed children with Zika for one year. They found that even children who appeared with no deformities at birth developed specific developmental delays. Which communication criteria do Zika scientists meet when they share their research findings with their communities and global constituencies? Select the BEST answer. 1) They practice transparency in advancing Zika research 2) They demonstrate beneficence, a core public health ethical principle 3) They provide strategic leadership in leading local and international solutions 4) They demonstrate their competence in Zika research 1.An analysis to justify and allocate resources In this scenario, you compared the programs and analyzed the data trends to justify and allocate resources to one program. - CORRECT ANSWER New to your leadership position, you realize that two of the programs you manage have similar functions, and work with the same population in the same area. Data trends over the past 5 years suggest that the health condition has improved significantly. You decide that only one program is needed to provide the necessary services to the community. This is an example of: 1.An analysis to justify and allocate resources 2.Applying a health equity and social justice lens 3.Strategic planning 4.Community Health Needs Assessment 40° - 140° F (4° - 60° C) - CORRECT ANSWER The "danger zone," in which bacteria multiply in food fast enough to become a hazard, is: Justice, beneficence, and respect for people Justice, beneficence, and respect for people are the three principles set forth in the 1979 Belmont Report. 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. - CORRECT ANSWER What are the three ethical principles outlined in the Belmont Report? 2. 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. https://www.americannursetoday.com/on-the-cusp-how-to-implement-a-comprehensive-unit-based-safety-program/ - CORRECT ANSWER A distinctive foundation of the Comprehensive Unit-based Safety Program (CUSP) developed at Johns Hopkins and promoted by the Agency for Healthcare Research and Quality creates a culture of safety by focusing on: 1. detecting and reporting sentinel events 2. open attitudes and mutual respect 3. using standardized checklists 4. assuring professional expertise 3. One Health Veterinary Public Health focuses on the intersection of humans and animals. Environmental health focuses on "the relationships between people and their environment; promotes human health and well-being; and fosters healthy and safe communities" (APHA, n.d.). Population health has been defined as "the health outcome of a group of individuals, including the distribution of such outcomes within the group" (CDC, 2018). On the other hand, *One Health* focuses on the interface of humans, the environment, and animals. http://www.onehealthinitiative.com/about.php - CORRECT ANSWER Which of the following approaches recognize that health of people is interconnected with health of animals and environment; and collaborate with physicians, veterinarians, ecologists, epidemiologists, and other related healthcare providers to monitor and control public health threats and to learn about how diseases spread among people, animals, and the environment? 1.Veterinary Public Health 2.Environmental Health 3.One Health 4.Population Health Volume, velocity, variety, variability and veracity https://www.sciencedirect.com/science/article/abs/pii/S1047279715000861 - CORRECT ANSWER "big data" is distinct from other data in terms of its: 3.personnel - CORRECT ANSWER 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 4.Results in plans that may be immediately necessary but may overlap or leave gaps 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. - CORRECT ANSWER An incremental approach to program planning in public health: 1.Uses multiple sources and methods to collect similar information 2.Provides an intensive, detailed description and analysis of a single project 3.Produces a plan where the specification of every step depends upon the results of previous steps 4.Results in plans that may be immediately necessary but may overlap or leave gaps Formative As per CDC, 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. NOT: Process, Outcome, Impact https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf • Process/implementation evaluation determines whether program activities have been implemented as intended. • Outcome/effectiveness evaluation measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve. • Impact evaluation assesses program effectiveness in achieving its ultimate goals. - CORRECT ANSWER A(n) *_________ evaluation* determines whether to expand a component of a current intervention 1. Donabedian's model is correct. 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. https://www.nejm.org/doi/10.1056/NEJMp1605101 - CORRECT ANSWER The logic model that has been the dominant paradigm representing types of information that may be collected to draw inferences about quality of care provided by a healthcare system has been: 1. Donabedian's model 2. Shewart's PDCA 3. Theory of Change 4. Web of Causation 1. The least-squares method is one approach to determining the slope and intercept of the best-fitting line. Simple linear regression involves a dependent variable (y) and one or more independent variables (x 1 , x 2 , etc.). Regression analysis involves finding the "best" mathematical model (within some restricted class of models) to describe y as a function of the x's or to predict y from the x's. The regression line is the presentation of the regression equation. Residuals are used to determine the best-fitting line, and residuals are the difference between the observed and expected values along the regression line. A line satisfies the least-squares property if the sum of the squares of the residuals is the smallest sum possible. - CORRECT ANSWER In simple linear regression, what is a method of determining the slope and intercept of the best-fitting line? 1.Least squares 2.R-square 3.Minimum error 4.Likelihood error Birds (mosquitos are the vector) 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. - CORRECT ANSWER What is the "reservoir host" for West Nile Virus? 1.develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner's office. Since the upper chain of state health command has ordered dental service closure, consultation with the Commissioner's office will be needed to assure compliance with legislative directives and fidelity to state health department policy. The likelihood of support from the state-level is greater if it is well-defined and sustainable options are presented. - CORRECT ANSWER In a state with a state-directed public health organization, the State Commissioner of Health has notified health districts to close health department dental programs in response to a state legislature vote to defund and discontinue health department dental services. The district health department has identified dental services as a leading community health need. To help assure continued access to services, the best first step is to: 1.develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner's office. 2.develop agreements with local providers or organizations for the provision of dental services. 3.Continue the dental program in-house at the local health department, since it was already financially sustainable and heavily utilized. 4.ensure implementation of contracts and other agreements with community partners to provide community dental services. Physician practice styles The small area variations in Medicare expenditure that are observed in the Dartmouth Atlas of Healthcare are attributable to differences in how physicians practice medicine. 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. - CORRECT ANSWER The Dartmouth Atlas of Healthcare demonstrates that small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in: 1.value the policy dialogue process over its outcome. https://www.emeraldinsight.com/doi/abs/10.1108/IJHG-12-2017-0063 Biermann, O., Kuchenmüller, T., Panisset, U., & Leys, M. (2018). Policy dialogues: facilitators' perceived role and influence. International Journal of Health Governance, 23(2), 120-133. - CORRECT ANSWER Effective policy dialogue facilitators: 1.value the policy dialogue process over its outcome. 2.value an outcome over the policy dialogue process. 3.rarely engage in preparatory stages before panels meet. 4.moderate rather than interpose with questions. 2.Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use, but they cannot specify their own preferred airline for business travel. The frequent flyer miles and/or bonus miles awarded to an employee as a result of state-reimbursed travel may be used for personal use by the employee. - CORRECT ANSWER Can a state public health agency authorize its employees to use or donate frequent flyer miles for personal travel that were acquired during state business travel? 1.Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use or to specify their preferred airline for business travel. 2.Yes, there is no ethical violation in allowing a government employee to keep frequent flyer miles for personal use, but they cannot specify their own preferred airline for business travel. 3.No, this would violate the "de minimis" use of government resources so any frequent flyer miles acquired during business travel must be retained by the government agency. 4.No, this would violate several ethical constructs, so any participation in frequent flyer programs during government service must be prohibited. Summative 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. https://www.nsf.gov/pubs/2002/nsf02057/nsf02057.pdf https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/eval_planning.pdf https://www.cdc.gov/healthcommunication/pdf/evaluationplanning.pdf - CORRECT ANSWER A __________ evaluation designed to present conclusions about whether a program should be sustained, changed, or eliminated? 4.a 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). - CORRECT ANSWER Enrollment for a new public information session advertised exclusively through the agency's website was much lower than expected. A small quick survey of the target audience found that very few remember seeing the ad. This suggests that: 1.an agency website redesign is indicated 2.the ad is not motivating those who read it. 3.websites are not the best way to reach this audience. 4.a formal review of communication strategy is indicated. 2.Fisher's exact test Fisher's exact test is often used to test for association between two categorical variables when there are small cell counts (viz. expected cell counts are less than or equal to 5) in a table. Links http://doi.org/10.5395/rde.2017.42.2.152 http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/methodsinbiostatisticsii/coursePage/index/ References Field, A. (2009). Discovering Statistics Using SPSS. London, UK: SagePublications. Kim, H.-Y. (2017). Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test. Restorative Dentistry & Endodontics, 42(2), 152-155. http://doi.org/10.5395/rde.2017.42.2.152 Caffo, B. (2006). Lecture Number 21: Fisher's Exact Tests, Chi-Squared Tests. Retrieved from: Methods in Biostatistics II, Johns Hopkins School of Public Health Open Courseware website: http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/methodsinbiostatisticsii/coursePage/index/ - CORRECT ANSWER An investigator would like to assess the association between two categorical variables, but the expected value of at least one cell was less than five. Which statistical test would be most appropriate in this situation? 1.Scheffe's test 2.Fisher's exact test 3.McNemar's test 4.Student t-test 1.Nominal Nominal variable are categorical without an inherent order. https://stats.idre.ucla.edu/other/mult-pkg/whatstat/what-is-the-difference-between-categorical-ordinal-and-interval-variables/ - CORRECT ANSWER In a randomized trial where infants are assigned to receive one of two types of feeding formulas (soy-based or cow's milk formula), formula-type is measured using which measurement scale? 1.Nominal 2.Ordinal 3.Interval 4.Ratio 2.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. https://www.nejm.org/doi/full/10.1056/NEJM199410133311527 https://www.cdc.gov/parasites/crypto/index.html - CORRECT ANSWER Which of the following water-borne disease organisms is very difficult to kill by chemical disinfection of drinking and/or recreational water supply systems and has caused major US disease outbreaks? 1.Vibrio cholerae (causes cholera) 2.Cryptosporidium (causes Cryptosporidiosis) 3.Giardia lamblia (causes Giardiasis) 4.Escherichia coli (causes acute gastroenteritis) 2.Sample mean is approximately normally distributed. The Central Limit Theorem states that if sample size is large enough, then distribution of the sample means can be approximated by a normal distribution, even if the original population is not normally distributed. In other words, the distribution of the sample means approaches a normal distribution as the sample size increases. - CORRECT ANSWER The Central Limit Theorem states that the: 1.Sample mean statistic is not always an unbiased estimator. 2.Sample mean is approximately normally distributed. 3.Population from which a sample is drawn is normally distributed. 4.Population standard deviation is approximately normal. 4.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. Reference: "Social Policy, Public Policy: From Problem to Practice by Meredith Edwards with Cosmo Howard & Robin Miller, 2001. Allen & Unwin. https://www.healthaffairs.org/do/10.1377/hblog20170522.060211/full/ - CORRECT ANSWER Which of the following practices enhances equity across populations when making health policy decisions in a community? 1.Requiring randomized control evidence of effectiveness 2.Allocating resources based on population size 3.Collecting health-related data about the individuals in the community 4.Including diverse constituencies in the decision-making groups 2.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. https://www.cdc.gov/tuskegee/timeline.htm - CORRECT ANSWER To learn more about the "natural course" of syphilis, from 1932-1972, the US Public Health Service left infected study participants (comprised of poor black men) untreated. This resulted in pain, blindness, infertility, and death, as well as transmission of the disease to partners and children. The Tuskegee Syphilis Study, is a sentinel public health event because of these ethical violations and resulted in: 1.The Nuremberg Code 2.The Belmont Report 3.Rose-Welch Report 4.The Legal Epidemiology Competency Model 3.Heterosexual male-female intercourse The general pattern of transmission began through homosexual male-male intercourse, then spread through shared needles in unsafe injection drug abuse, and heterosexual male-female intercourse. Encouragement of safe sex practices, provision of harm reduction safe injection site programs and development of anti-retroviral therapies effective at suppressing viral loads all play a role in curtailing the spread of human immunodeficiency virus (HIV) infection. Public health interventions must adapt to changing demographics and epidemiology during challenges like this. http://hivinsite.ucsf.edu/InSite?page=kb-01-03 - CORRECT ANSWER Over the history of the HIV infection pandemic, in its initial phase, transmission in populations started with a sharp rise through homosexual male-male intercourse and in its late phase the steepest rise tended to be through: 1.Homosexual male-male intercourse 2.Homosexual female-female intercourse 3.Heterosexual male-female intercourse 4.Transfusion of contaminated blood 1) 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. - CORRECT ANSWER 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 Justice, beneficence, and respect for people Justice, beneficence, and respect for people are the three principles set forth in the 1979 Belmont Report. 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. - CORRECT ANSWER What are the three ethical principles outlined in the Belmont Report? Theory of Planned Behavior (TPB) and Theory of Reasoned Action (TRA) are theories that both focus on the relationship between behavior and beliefs, attitudes, and intentions. However, TPB includes one additional construct, *perceived behavior control*, which describes the belief individuals have about controlling a particular behavior. See pg 18 here: https://cancercontrol.cancer.gov/brp/research/theories_project/theory.pdf - CORRECT ANSWER The Theory of Planned Behavior was built on the Theory of Reasoned Action. Which component was added? 2.Behavioral intention The Theory of Reasoned Action, which is similar to the Theory of Planned Behavior, holds that behavioral intention is the most important driver of behavior. Behavioral intention describes an individual's self-perceived likelihood of performing a specific behavior. It is influenced by one's attitude towards the behavior and the subjective norms regarding the behavior. The TRA helps to explain why social marketing campaigns should provide information as well as aim to influence attitudes and perceived norms regarding a behavior. Perceived benefits are associated with the Health Belief Model, perceived outcome expectations are associated with Social Cognitive Theory, and stages of change are a feature of the Trans-theoretical Model. https://cancercontrol.cancer.gov/brp/research/theories_project/theory.pdf - CORRECT ANSWER According to the theory of reasoned action (TRA), the most important determinant of behavior is a person's: 1.Perceived benefits 2.Behavioral intention 3.Perceived outcome expectations 4.Stages of change A. health disparity. - CORRECT ANSWER Variation in rates of medical procedures by race, even when controlling for insurance status, income, age, and severity of conditions, is an example of A. health disparity. B. racism. C. inadequate access to health care. D. a high rate of uninsured individuals. A. the individual's BMI and the mean and standard deviation of the specific population - CORRECT ANSWER Body mass index (BMI) is sometimes reported as age- and gender-specific z-scores. Such scores are best described as a function of which of the following? A. the individual's BMI and the mean and standard deviation of the specific population B. the individual's BMI and the mean and standard deviation of an entire population C. the individual's BMI, the mean of the specific population, and the standard deviation of an entire population D. the individual's BMI, the mean of an entire population, and the standard deviation of the specific population C. elevated blood lead concentration - CORRECT ANSWER A 22-year-old Latina woman brings her 13-month-old daughter to a health department clinic for routine well-child care. Both are enrolled in the Medicaid program. They live in an inner-city apartment building that the mother describes as "old and run down." The infant's diet consists of table foods; the principal protein sources are eggs, peanut butter, cheese, and canned tuna. Screening of the infant for which of the following conditions is recommended by the Centers for Disease Control and Prevention (CDC)? A. allergies and asthma B. pesticide exposure C. elevated blood lead concentration D. mercury poisoning 2. 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. - CORRECT ANSWER Societies have fostered discrimination against certain communities in various ways. Policy makers must address this to move toward health equity. One theory, which explains the reinforcing feedback loop of poor housing quality, lesser paying jobs, poor education and poor health outcomes, may be summarized as: 1.Social Epidemiology 2.Institutional racism 3.Structural racism 4.Causative factors *Epi-Info* is a public domain product widely used by public health agency field staff. Unlike the other statistical analysis software listed, it is unique in supporting creation of questionnaires and transferring data from those questionnaires directly into the data tables for analysis. - CORRECT ANSWER The best multi-platform software product to support public health field investigators who want a program on their portable device capable of generating survey questionnaires and analyzing survey data is: 1.Excel 2.Epi-Info 3.R 4.SPSS 2.perspective outside an organization. In "The Effective Executive" (Harper & Row Publishers, 1967), Drucker comments that "...the organization is an abstraction... Specifically, there are no results within the organization. All the results are on the outside. The only business results, for instance, are produced by a customer who converts the costs and efforts of the business into revenues and profits through his willingness to exchange his purchasing power for the products or services of the business... Similarly, a hospital has results only in respect to the patient. But the patient is not a member of the hospital organization. For the patient, the hospital is 'real' only while he stays there. His greatest desire is to go back to the 'nonhospital' world as fast as possible." - CORRECT ANSWER From Peter Drucker, often identified as the founding father of the science of management, it is clear that efficiency is most meaningful measured in terms of the: 1.perspective within an organization. 2.perspective outside an organization. 3.financial costs and efforts of the organization 4.units of time. 2.It covers preventive services for children who otherwise might not have access to them The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. - CORRECT ANSWER CHIP is a federal program that has been important for public health because: 1.It remedies the state differences in health insurance that characterize Medicaid 2.It covers preventive services for children who otherwise might not have access to them 3.It provides block grant funding that supports state public health programs 4.It increases funding for school health initiatives 1.Non-point source pollution A non-point water pollution source such as a fertilized or freshly plowed farm field, an animal feed lot, or an agricultural waste storage area (e.g. for manure from poultry feeding operation) requires a different control approach compared to point sources such as factory smokestacks or waste discharge pipes. Area sources are sometimes quite difficult to manage due to their size. - CORRECT ANSWER River water pollution due to storm water runoff from chemically fertilized farm fields is an example of: 1.Non-point source pollution 2.Point source pollution 3.Accidental and unforeseeable pollution 4.Unpreventable and inconsequential pollution 3.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. - CORRECT ANSWER Which of the following components of a strategic planning process in a public health agency has logical priority over the others? 1.Preparing an action plan for eradicating giardiasis in the municipal water system 2.Developing the operating budget and staffing plan for the agency 3.Reviewing (and revising) the vision and mission statements for the agency 4.Setting strategic goals for a three-year cycle 1.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. - CORRECT ANSWER Which leadership theory advances the notion that one's task-relationship orientation can only be modified within certain limits and that structural and power factors will dictate whether you have a good leadership "fit?" 1.Contingency 2.Path-Goal 3.Transactional 4.Transformational 4.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. - CORRECT ANSWER The primary purpose of strategic planning is to: 1.assign tasks and responsibilities to individuals based on expertise 2.determine the organization's annual budget allocation 3.maximize return on investment for programming 4.determine the direction an organization will pursue 3. 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. - CORRECT ANSWER From a political perspective, which type of analysis provides the weakest identification of social and economic impact? 1. Cost-benefit analysis 2. Cost-effectiveness analysis 3. cost-minimization analysis 4. cost-utility analysis Health Belief Model stages of change (particularly within Strong and Weak principles) - CORRECT ANSWER (Perceived) Susceptibility, cues-to-action and barriers are classic _____ constructs. By adding "decisional balance", we evolve into the ______ theory. B. Pearson chi-square (X2) test - CORRECT ANSWER A study is conducted to compare colorectal screening rates in white and African-American men. Researchers contact 50 white men and 50 African-American men older than 50 years of age by telephone and ask them if they have undergone colorectal screening. Fifty-five percent of white men and 49% of African-American men report undergoing appropriate screening. Which of the following tests is the most appropriate method of analysis of the survey data? A. paired t-test B. Pearson chi-square )(2 test C. two-sample t-test D. Spearman correlation test D. (100,000 × $1.50) / 90,000 - CORRECT ANSWER A county public health department has prepared the annual operating budget for its childhood vaccination program. It forecasts that 90,000 children will be vaccinated, requiring a total of 48,000 hours of nursing labor at an average cost of $25 per hour and 100,000 doses of vaccination at an average cost of $1.50 per dose. Fixed costs of the vaccination program, such as administration and overhead, are estimated at $50,000. Which of the following calculations is most appropriate to obtain the forecast vaccination expense per child? A. (48,000 × $1.50) / 90,000 B. (90,000 × $1.50) / 48,000 C. (100,000 × $1.50) / 48,000 D. (100,000 × $1.50) / 90,000 B. home rule - CORRECT ANSWER Which of the following terms best describes the power of a local jurisdiction to independently regulate public health, safety, and welfare? A. unionism B. home rule C. preemption D. self-administration C. drug-resistant tuberculosis cases. - CORRECT ANSWER A local health department establishes a program with community outreach and clinical components that is intended to reduce the number of drug-resistant tuberculosis cases. A measure of the program's outcomes is the number of A. clinical visits for drug-resistant tuberculosis. B. community education sessions. C. drug-resistant tuberculosis cases. D. patients receiving follow-up care for drug-resistant tuberculosis. A. decisional balance (*transtheoretical model*) - CORRECT ANSWER According to the transtheoretical model of change, as individuals go from pre-contemplation to maintenance, "con" behavioral beliefs decrease and "pro" behavioral beliefs increase. This process is best described as which of the following? A. decisional balance B. self-liberation C. reinforcement management D. self-efficacy C. interaction - CORRECT ANSWER A study of national patterns of smoking prevalence finds that the prevalence of women smokers is higher in countries with higher national income per capita, but lower in countries experiencing rapid economic growth. Among men, the prevalence of smoking is lower in countries with higher national per capita income, but higher in countries experiencing rapid economic growth. This finding is an example of which of the following phenomena? A. bias B. confounding C. interaction D. error D. ozone - CORRECT ANSWER Which of the following is a priority air pollutant regulated by the National Ambient Air Quality Standards (NAAQS)? A. asbestos B. carbon dioxide C. methane D. ozone 3.DDT pesticide DDT is essentially non-toxic to humans and was widely used in past years as a general purpose pesticide. However, it was shown to "bio-accumulate" through the food chain of birds and to cause thinning of the birds' egg shells, resulting in broken eggs and a severe decline in some species including Bald Eagles, falcons, and pelicans. "Silent Spring" raised public awareness of bio-accumulation, which led to the EPA to ban its use in 1972. https://www.epa.gov/ingredients-used-pesticide-products/ddt-brief-history-and-status - CORRECT ANSWER In part due to the public attention focused on environmental pollution by Rachel Carson's book "Silent Spring," as well as studies such as those showing a drastic decline in the American Bald Eagle population, a ban was issued on the use of: 1.Chlorofluorocarbon (CFC) refrigerant gases 2.Leaded gasoline 3.DDT pesticide 4.Asbestos insulation materials 3. 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."(p. 412). https://www.malph.org/sites/default/files/files/Health%20Improvement/Strategic%20Plans/Key%20Components%20to%20a%20Strategic%20Plan.pdf - CORRECT ANSWER A local public health department (LHD) must make significant budget cuts. Area managers are directed to review and compare current services, service utilization and cost to areas of need identified a recent community health needs assessment completed by the LHD. This approach, as a prelude to decision-making, is based on: 1. Internal assessment and strategic goals 2. External assessment and department policy review 3. Internal assessment and external assessment 4. Strategic planning and maximizing program efficiency. 1.Nitrates can cause "Blue-Baby Syndrome" in infants Ingestion of nitrate-polluted water by infants under 6 months of age can cause the formation of potentially fatal levels of methemoglobin in their red blood cells. Methemoglobin restricts the ability of the cells to carry oxygen to the tissues, and although adults are generally unaffected, "methemoglobinemia" can be fatal to the infants. Methemoglobinemia produces a characteristic blue tint in the tissues due to oxygen deficiency (cyanosis), hence the name "Blue-Baby Syndrome." https://archive.epa.gov/region5/teach/web/pdf/nitrates_summary.pdf - CORRECT ANSWER 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 1.Biological treatment in an aerated activated sludge system, followed by settling to remove sludge solids, then chlorination prior to discharge. The aerated activated sludge secondary treatment process effectively removes organic materials from municipal sewage. A mix of aerobic biological organisms termed "activated sludge" consume the organic materials. Sludge is removed from the treated water by gravitational settling, and the water is disinfected by chlorination before discharge (e.g. to a receiving river). The chemical coagulation / flocculation / settling process is used to treat water destined for the drinking water supply system, and is usually required when the water is taken from a surface water source such as a lake or river. Filtering through sand beds is also used to treat drinking water, but not municipal sewage. Super-chlorination is not an effective treatment for municipal sewage. http://www.nesc.wvu.edu/pdf/WW/publications/pipline/PL_FA97.pdf - CORRECT ANSWER Municipal sewage is typically processed to remove organic material before disposing the treated water. In large cities, this treatment generally consists of: 1.Biological treatment in an aerated activated sludge system, followed by settling to remove sludge solids, then chlorination prior to discharge. 2.Chemical treatment by coagulation and flocculation, followed by settling to remove solids, then chlorination prior to discharge. 3.Filtering through sand beds to remove organic solids, followed by chlorination prior to discharge. 4.Super-chlorination to destroy organic materials, followed by discharge. 2.Absolute risk difference Relative risk 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 relative risk is not a good estimator of caseload. *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. Likelihood ratios are more commonly used in relation to interpreting diagnostic tests. Prevalence rates alone can be more cumbersome and are not as informative as incidence rates for diseases that are not chronic. Studies have shown that people have more difficulty making accurate decisions when presented with ratios rather than risk differences (see Gigerenzer et al., "Helping Doctors and Patients Make Sense of Health Statistics", Psychological Science in the Public Interest, 2007;8(2):53-96; see Fahey et al., "Evidence-based Purchasing: Understanding the Results of Clinical Trials and Systematic Reviews", BR MED J 1995;31:1056-60). - CORRECT ANSWER To inform a policy decision so that an intervention will result in the largest possible number of persons benefitted, which of the following statistics provides the most useful indication of the magnitude of exposure to a factor and subsequent development of disease? 1.Likelihood ratio 2.Absolute risk difference 3.Relative risk ratio 4.Prevalence rate 1. Assessment 2. Policy development 3. Assurance - CORRECT ANSWER As identified in the seminal 1988 Institute of Medicine report on the future of public health, the three core functions of the roles and responsibilities of public health agencies are...? 3.By using a State Implementation Plan (SIP) approved by the EPA The Constitutional division of powers between the Federal and State governments means that both levels of government must operate with mutual respect, recognizing that cooperation rather than conflict better serves the public interest. The natural continuum of the environment cuts across geopolitical boundaries and rightly elicits the concerns of both Federal and State governments. 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. - CORRECT ANSWER 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 2.Chi-square test of independence 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. - CORRECT ANSWER The following test would be used to compare the frequency of diabetes between groups: 1.Chi-square goodness of fit test 2.Chi-square test of independence 3.Two independent samples t test 4.Analysis of variance 3.ensure compliance with constitutional requirements of due process. Administrative law judges are to ensure compliance with constitutional requirements of due process. - CORRECT ANSWER Administrative law judges, who adjudicate conflicts involving the decision-making of units of government agencies: 1.have at the federal and state level full judicial power, like all trial judges. 2.are elected as non-partisan candidates within congressional districts. 3.ensure compliance with constitutional requirements of due process. 4.are in all respects the same as "hearing officers" within government agencies. 2.Douglas McGregor Theory Y Path-goal theory of leadership maintains that the leader can affect the performance, motivation, and satisfaction of followers Contingent Theory involves the adoption of management style to meet the needs of all personnel *Douglas McGregor Theory Y assumption that employees are highly motivated to do the work * Douglas McGregor Theory X employees are generally not satisfied with work and are motivated by salary alone - CORRECT ANSWER A management/leadership theory which posits that when staff are able to grow and develop staff performance results are better, is an example of: 1.Situational Leadership Theory 2.Douglas McGregor Theory Y 3.Contingency Leadership Theory (CLT) 4.Path-goal Theory 4.Perception of economic insecurity Of all the options, perception of economic insecurity (e.g., concern about food insecurity) best assesses an individual's current economic status while reducing non-response due to concern about stigma. Respondents are least likely to respond to income and public assistance questions, while educational attainment does not accurately reflect one's economic situation. - CORRECT ANSWER Which of the following survey items best assesses an individual's socioeconomic status in terms of increasing validity and response rate? 1.Income in the past month 2.Highest level of education attained 3.Eligibility for public assistance 4.Perception of economic insecurity Social cognitive theory - CORRECT ANSWER Which interpersonal-level health behavior theory includes reciprocal determinism as a key element (idea that there is dynamic interaction between the person, behavior, and environment? 2.Reciprocal determinism Reciprocal determinism comes from social cognitive theory (SCT) and refers to the interrelationship between a person, their environment, and their behavior. In other words, behavior both influences, and is influenced by, the social and physical environment. https://www.uky.edu/~eushe2/Bandura/Bandura1978AP.pdf - CORRECT ANSWER Which of the following terms from the social cognitive theory refers to the dynamic interaction among the person, environment, and behavior? 1.Behavioral norms 2.Reciprocal determinism 3.Decisional balance 4.Tridirectional dependence Diffusion of innovation - CORRECT ANSWER Which organizational/community-level theory includes stages of awareness, interest, evaluation, trial, and adoption? D. poor-quality exposure information that introduces random error into the exposure classification - CORRECT ANSWER Assume that the true odds ratio between an exposure and a disease is 2.7. Which of the following results in an observed odds ratio that is weaker than the true odds ratio? A. decreased ability to diagnose disease in unexposed individuals compared with exposed individuals B. failure of the unexposed individuals to participate in the study C. lower prevalence of exposure in control participants than in the total control population D. poor-quality exposure information that introduces random error into the exposure classification D. relatively inelastic - CORRECT ANSWER Which of the following best describes the elasticity of demand for health care in the United States? A. perfectly elastic B. perfectly inelastic C. relatively elastic D. relatively inelastic B. decreasing the variability of the estimate - CORRECT ANSWER A health behaviors survey conducted in a large urban area includes a question about whether a person is a smoker. The company conducting the survey decides to increase the size of its random sample of survey participants from 1,500 people to approximately 20,000 people. This change will most likely have which of the following effects? A. increasing the standard error of the estimate B. decreasing the variability of the estimate C. no effect on survey statistics because the population size is the same D. increasing the confidence interval width for the parameter C. Public Health Accreditation Board - CORRECT ANSWER Which of the following organizations accredits local public health departments? A. American Public Health Association B. Centers for Disease Control and Prevention C. Public Health Accreditation Board D. state licensing boards C. personal protective equipment (e.g., hearing protection) - CORRECT ANSWER Which of the following strategies is placed last in the hierarchy of controls for protecting the health of employees from workplace exposures? A. administrative controls (e.g., hazard communication) B. engineering controls (e.g., ventilation, isolation) C. personal protective equipment (e.g., hearing protection) D. substitution (e.g., product replacement) B. slope of the regression line formula is Alpha = Y + beta(X) - CORRECT ANSWER A study investigates the relationship of age to body mass index (BMI). A sample of individuals is selected, and age and BMI are measured. As part of the preliminary analysis, a simple linear regression of BMI on age is performed using a statistical software package. The resulting estimate of ß (beta) from the analysis output describes which of the following? A. coefficient of determination B. slope of the regression line C. estimate of the mean D. intercept of the regression line D. system dynamics - CORRECT ANSWER Which of the following is a modeling and simulation tool used to investigate stocks, flows, and feedback loops of complex problems? A. interactive planning B. operations research C. organizational cybernetics D. system dynamics A. Nazi human experimentation - CORRECT ANSWER Which of the following historical events raised awareness of the need for the protection of research subjects and resulted in the 1947 creation of the International Code of Ethics for research? A. Nazi human experimentation B. Willowbrook hepatitis studies C. publication of the Belmont Report D. Tuskegee Syphilis Study A. acceptability - CORRECT ANSWER The management of a health care facility requires staff to adhere to ethical principles and provide culturally appropriate care. The institutionalization of these values is most likely to influence which of the following aspects of health care provided by this facility? A. acceptability B. accessibility C. accountability D. adequacy D. sulfur dioxide - CORRECT ANSWER In addition to ozone and particulates, which of the following pollutants is most likely to aggravate asthma? A. arsenic B. carbon monoxide C. lead D. sulfur dioxide C. passive surveillance http://conflict.lshtm.ac.uk/page_75.htm - CORRECT ANSWER Requiring health care providers to report individual cases of disease as they are diagnosed to state or local health departments is an example of which of the following types of surveillance? A. active surveillance B. syndromic surveillance C. passive surveillance D. sentinel surveillance 1.Formative evaluation As per CDC, 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. Boston University School of Public Health. (2015). Program Evaluation for Public Health. Retrieved from: http://sphweb.bumc.bu.edu/otlt/mph-modules/ProgramEvaluation/ProgramEvaluation2.html - CORRECT ANSWER To determine whether to expand a component of a current intervention, which type of evaluation is needed? 1.Formative evaluation 2.Process evaluation 3.Outcome evaluation 4.Impact evaluation 4.Stratification During the analysis stage of a study, stratification can control for a third variable, such as age, confounding the observed relationship between an exposure, such as smoking, and an outcome, such as lung cancer. As the name implies, stratification involves creating strata, or groups, based on the third variable and comparing the rates of the outcome between the exposed and unexposed in each strata. For example, to control for confounding by age, we could compare the rates of lung cancer among smokers and non-smokers aged 30 - 39, 40 - 49, and 50 - 59. Public Health Open Courseware website: http://ocw.jhsph.edu/index.cfm/go/viewCourse/course/FundEpi/coursePage/index/ - CORRECT ANSWER Which method is used for controlling confounding by demographic variables like age in the analysis stage of epidemiologic studies? 1.Restriction 2.Matching 3.Randomization 4.Stratification 4.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. https://www.nsf.gov/pubs/2002/nsf02057/nsf02057.pdf https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/eval_planning.pdf https://www.cdc.gov/healthcommunication/pdf/evaluationplanning.pdf - CORRECT ANSWER What is an evaluation designed to present conclusions about whether a program should be sustained, changed, or eliminated? 1.Formative evaluation 2.Implementation evaluation 3.Process evaluation 4.Summative evaluation 3.Board of Health Local or state boards of health play a key role with responsibilities and authorities defined by statute. This includes oversight, guidance and in some cases actual policy- and rule-making. A public health department's top administration is accountable to its respective board of health. https://www.networkforphl.org/the_network_blog/2011/05/04/29/local_boards_of_health_and_their_role_in_the_community https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/21/09/50/the-state-health-department https://prepareiowa.training-source.org/section-ii-roles-and-responsibilities-local-board-health-member - CORRECT ANSWER What level of government typically provides the oversight and guidance to prioritize public health needs and resources that focuses program planning and evaluation? 1.Public Health Department Program Management 2.Public Health Department chief executive officer 3.Board of Health 4.Legislature Answer: Numerator is k - 1, which is 3 - 1 = 2. The denominator degrees of freedom are N - k, or 67 - 3, or 64. - CORRECT ANSWER Jackie sees a one-way ANOVA test that she performed, with samples from elementary school, middle school, and high school. If she had three sample groups, consisting of 32 elementary students, 20 middle-school students, and 15 high-school students, what are the degrees of freedom for the numerator and denominator of her one-way ANOVA table? Answer: 5 degrees of freedom: (r - 1)(c - 1) = (2 - 1)(6 - 1) = 5. - CORRECT ANSWER Jackie performed a chi-square test of independence, where she compared gender, recorded as male or female, against color of backpack, recorded as red, blue, white, black, yellow, or other. How many degrees of freedom were in her chi- square test of independence?