CPH Exam 90 Questions with Verified Answers
Host, agent and environment - CORRECT ANSWER The epidemiologic triangle (triad) describes the occurrence
... [Show More] 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 [Show Less]