CPH Exam Practice Questions

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 chemicals, followed by discharge

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 "active 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 water is taken from the surface water such as a lake or river. Filtering through sand beads to remove organic solids is also used to treat drinking water, but not municipal sewage. Super-chlorination is not effective for treating municipal sewage.

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

1) Capacity building Capacity building in an organization are categorized by efforts of the organization to enhance ability to competently achieve its (operational, programmatic, financial) goals now and into the future (https://www.cdc.gov/publichealthgateway/funding/rfaot13.html)

In a state with a state-directed pubic 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 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

1) Develop a list of possible 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.

A researcher has implemented an intervention. The program activities included STD counseling for the members of a community-based organization. One outcome measure would be best addressed by which of the following questions? 1) Did STD counseling result in changes in knowledge among the target population? 2) When did the program activities take place? 3) What are the barriers to implementation of program activities? 4) What is the number of people who received counseling?

1) Did STD counseling result in changes in knowledge among the target population? This helps to measure the effectiveness of the intervention. 4) is not specific enough because it only covers the number of people who received counseling - but did they find the intervention effective? Outcomes in program management and performance respond to the question of what impact will the planned program activity have? Or what change may we expect due to the program? The outcome may be short term/ mid term/ or long term.

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

1) 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. (http://sphweb.bumc.bu.edu/otlt/mph-modules/ProgramEvaluation/ProgramEvaluation2.html)

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) Nitrated 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 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 tissue due to oxygen deficiency (cynaosis), hence the name "Blue Baby Syndrome"

River water pollution due to storm water runoff from chemically fertilized farms fields is an example of: 1) Non-point source pollution 2) Point-source solution 3) Accidental and unforeseeable pollution 4) Unpreventable and inconsequential pollution

1) Non-point source pollution Fertilized or fleshly plowed farm field, an animal feed lot, or an agricultural waste storage area (e.g. for manure from poultry feed 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. https://www.youtube.com/watch?v=RVkHwV39BFs

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

1) Sanctioning (punishing) individuals for mistakes is the most appropriate method for ensuring effective quality of care This is the only correct response because the current quality management paradigm considers the primary source of errors, waste, and other indicators of poor quality to be poor system design and ineffective processes rather than individual incompetence or carelessness. Deming and others regard the sanctioning of individuals for poor quality to be misplaced and likely to aggravate the problem. Focus on errors in the system - not the individual.

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 is constructed 3) Ensure the environment is protected at all costs 4) Achieving sustainable development while relieving community concerns

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.

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

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

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

1) West Nile Virus (Neuro-Invasive) (https://www.cdc.gov/westnile/index.html)

A public health department government employee manages that department's non-infectious conditions epidemiology program. The program's recent report on traffic accident deaths has attracted attention. Mothers Against Drunk Drivers, a non-profit incorporation, has asked that person to simultaneously take a leadership role in MADD's program to oversee fund-raising activities and promote compliance with laws about drinking and driving. Would it be ethical for this person to accept MADD's offer of simultaneous employment? 1) Yes, provided the outside activity is not operated within the government agency, and the employee does not incur conflicts of interest, divulge confidential information nor receive special privileges or benefits. 2) Yes, because this is a non-profit corporation it is not subject to the same restrictions that apply to for-profit businesses, so the employee is completely free to engage in activities complimentary to promoting state laws. 3) No, because there is potential to influence legislation this type of non-profit corporate engagement is contrary to the ethical requirement that government employees refrain from political activities. 4) No, for ethical reasons government employees generally are banned from simultaneously taking senior leadership positions in outside businesses during the course of their government employment.

1) Yes, provided the outside activity is not operated within the government agency, and the employee does not incur conflicts of interest, divulge confidential information nor receive special privileges or benefits. Government employees still have constitutional rights as individuals, so generally can exercise those rights so long as there are no conflict of interest implications that lead to the appearance of bias or abuse of privilege in their role as a government official. At the state and federal level, there are executive ethics boards that adjudicate such matters. It is prudent to check the applicable board for its policies and prior decisions whenever a government employee is considering taking an action but is uncertain about it being permissible.

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

1) cultivate a new group of leaders Succession planning: a "deliberate and systematic effort by an organizations to ensure leadership continuity in key positions, retain, and develop intellectual and knowledge capital fo the future, and encourage individual advancement"

A researcher has implemented an intervention. The program activities include STD counseling for the members of a community-based organization. One outcome measure would be best addressed by which of the following questions? 1.) Did STD counseling result in changes in knowledge among the target population? 2.) When did the program activities take place? 3.) What are the barriers to implementation of program activities? 4.) What is the number of people who received counseling?

1.) Did STD counseling result in changes in knowledge among the target population? Outcome evaluation measures the program effects on the target population.

National Physical Activity Guidelines for Americans suggests adults need to participate in at least 150 minutes per week in moderate intensity physical activity for substantial health benefits. A study was designed to test whether there is the difference in mean time (in minutes) spent in moderate intensity physical activity in adults with no, mild, moderate and severe depression. Time spent in moderate intensity physical activity is a continuous measure which can be assessed using an accelerometer. Which among the following is the most appropriate statistical technique to test the difference in time spent in moderate intensity physical activity between adults with no, mild, moderate and severe depression? 1) Spearman correlation 2) ANOVA 3) t-test 4) chi-square test

2) ANOVA ANOVA compared two or more independent groups (in this case it will be 4 types of adults i.e. those with no, mild, moderate or severe depression) on the measure of the dependent variable (time spent in moderate intensity physical activity) at a selected probability level. (https://www.spss-tutorials.com/anova-what-is-it/)

What is the usual statistical distribution used in carrying out a comparison of means from 3 normally distributed independent populations? 1) An F-distribution provided all samples are the same size 2) An F-distribution provided all populations have the same variance 3) Three t-distributions comparing each group with the other two groups 4) A Chi-square distribution provided all samples are the same size

2) An F-distribution provided all populations have the same variance (normally distributed, but not all samples have to be the same size) The F-distribution can be conducted as a basis for ANOVA even if samples have different sizes. Using multiple t-tests will inflate the Type 1 error rate.

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

2) Consulting stakeholders to decide what best serves public interest 10 Essential Services of Public Health: https://www.cdc.gov/publichealthgateway/publichealthservices/pdf/Ten_Essential_Services_and_SDOH.pdf

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

2) Consulting stakeholders to decide what best serves public interest The three force functions of public health have been named as: Assessment, Promotion, and Protection. Under this framework, 10 "essential public health services" have been identified. The correct answer here, describes the core function of policy development, where broad-based consultations with stakeholders occur to weigh available information and decide which interventions are most appropriate and ensure that the public interest is served by measures that are adopted. The other two core functions are assessment, which emphasizes collecting and analyzing information about health problems, and assurance, which seeks to promote and protect public interests through programs, events, campaigns, regulations, inspections and other strategies, and making sure that necessary services are provided to reach agreed upon goals. https://www.networkforphl.org/_asset/dd8lf6/Public-Health-Core-Functions-and-10-Essential-Services.pdf

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

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

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) SAS 4) R Statistics

2) Epi-Info Epi-Info is a public domain product widely used by public health agency staff. Unlike the other statistical analysis software listed, it is unique in supporting creation of questionnaires and transferring data for those questionnaires directly into the tables for analysis. (https://www.cdc.gov/epiinfo/index.html)

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

2) Interested in capturing the context of program participation and the participants' stories Quantitative evaluation methods can be useful in the other scenarios. Qualitative methods place emphasis on lived experiences and are especially useful for capturing context and complexity.

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

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

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

2) Prepare by developing a "feedback sandwich" approach with two corrective statements surrounding a reinforcing statement. The ability to give constructive feedback is a critical skill for all professionals. As a result, specific approaches need to be used to ensure that the person receiving the feedback understands and makes adjustments to their practice. A "feedback sandwich" is one method, however, it consists of two reinforcing statements surrounding a corrective statement. Generally, feedback should focus on the specific situation to be addressed and not every single performance issue. The best time is addressing each situation right after each occurrence, but when that is not possible, planning for a specific time and place to address the issue is best.

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

2) Societal Values The Constitution does not provide explicit direction when it comes to balancing individual rights and promoting the common good. Public health policy and regulation, although based on scientific evidence and general moral considerations is not likely to be adopted where there is not general consensus and support by the public it serves to protect. The definition: "Public Health is what we, as a society, do collectively to assure the conditions in which people can be healthy" suggest the need for cooperative actions built on overlapping values and trust.

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

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

Which of the following is consistent with broadly accepted theory of adult learning? 1) Adults are busy, so unlikely to want participation in planning and evaluation of instruction 2) They tend to be most interested in learning things of immediate relevance and practical value 3) Activities promoting memorization are preferable to trial-and-error experiential learning 4) Adult learning preference is content-oriented rather than problem-centered

2) They tend to be most interested in learning things of immediate relevance and practical value Malcolm Knowles put forward a set of assumptions and principles for adult learning (andragogy) as a maturation continuum in pedagogy-andragogy ranging from teacher-directed to student-directed learning. This is an important framework to consider when designing educational programs for mature individuals.

To work effectively, a public health specialist should be able to meet the social, cultural, and linguistic needs of individuals within the community. This is termed cultural: 1) awareness 2) competence 3) feasibility 4) measures

2) competence Cultural Competence: the ability of public health professionals to effectively deliver services that meet the social, cultural, and linguistic needs of individuals. Learning to communicate w/ patients, families, communities, and fellow professionals in a culturally competent manner helps to reduce disparities and promote enhanced health and wellness. Ample evidence exists documenting the role of cultural competence in addressing health disparities. The ability to practice in a culturally competent manner within the frame of reference of one's patient(s) and/or the community of interest improves the delivery of appropriate care and enhances the likelihood that programs, services, and policies will be relevant to diverse populations. The benefit is twofold: an improvement in health outcomes and a corresponding reduction in health disparities.

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

2) open attitudes and mutual respect CUSP tools support change at the unit level to create a culture of safety. 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. https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html 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.

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

2) which data elements to remove to create de-identified data sets The Safe Harbor convention defines which data elements to remove from personal health records to create de-identified data sets for public use. Safe Harbor has been in place for decades, and more recently has proven inadequate. Other legislation, like HIPAA in the US, not Safe Harbor, defines the covered entities with which personal health data may be shared directly.

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

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.

Which of the following is the most accurate exposure assessment in workers? 1.) Determination of the chemical in the air 2.) Biomonitoring of chemicals or metabolites in blood or urine 3.) Determination of the chemical on the skin 4.) Estimation of the exposure by taking an occupational history

2.) Biomonitoring of chemicals or metabolites in blood or urine Biomonitoring gives the best estimate for individual exposure. This approach involves collecting bodily fluids or other biological samples and analyzing them for the presence of a contaminant, the metabolite of the contaminant, or a biological response. Biomonitoring proves that absorption of a contaminant has occurred and accounts for absorption through all routes of exposure. Because individuals naturally vary in their ability to metabolize a compound, biomonitoring can indicate which individuals are most susceptible to deleterious health effects from an exposure. Other approaches to estimating an individual's exposure, such as measuring a contaminant's presence in the air, determining a contaminant's presence on the skin, or completing a job-exposure matrix will not yield information about uptake, metabolism, and individual susceptibilities.

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

3) -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.

When considering a contingency table test with six rows and six columns, which of the following is the correct number of degrees of freedom for the test? 1) 6 2) 12 3) 25 4) 36

3) 25 The degree of freedom in a contingency table is given by (r-1)(c-1) where r and c are the number columns and rows. Thus we have (6-1)(6-1) = 25.

If two events are mutually exclusive, to determine the probability that one or the other happened: 1) Double their probabilities 2) Add their conditional probabilities 3) Add their individual probabilities 4) Multiply their individual probabilities

3) Add their individual probabilities mutually exclusive (disjoint): describes events which cannot occur at the same time, such as a screening test indicating that someone is both positive and negative for a condition The special addition rule of probability holds that for two mutually exclusive events, the probability that one or the other of the events has occurred is equal to the sum of of the probabilities of each event. Since we are concerned with the probability of either event occurring, conditional probability, which relates to the probability of one event occurring given that the other event has already occurred, is not relevant. Similarly, multiplying the probabilities of the two events would express the probability of both independent events occurring. Doubling their probabilities would also not be relevant.

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 Study

3) Case Control Or 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.

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

3) Cost minimization analysis Selecting a policy, program, or initiative that has the least direct cost w/o doing any estimation of possible benefit(s) might satisfy those who only believe in small government. Cost-benefit: considers whether fiscal value of benefits could outweigh costs Cost-effectiveness: identifies which of several options produces the most benefit for the least expenditure Cost-utility: adds weighing of financial benefit in terms of perceived desirability of such benefits to recipients

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

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

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

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." The decision is being made by the local health department (internal) after they evaluate their budget. They are asking area managers to review and compare the LHD's community needs assessment (external).

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

3) Negative feedback loop Patterns of interaction where results to a change in an original element dampens or buffers it effect. Positive feedback loops are on the other hand, are patterns of interaction where results to a change in an original element magnifies (reinforces/amplifies) its effect, thus moving a state away from its equilibrium state.

Which of the following approaches recognize that health of people is interconnected w/ health of animals and environment; and collaborate w/ 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

3) One Health One Health focuses on the interface of humans, the environment, and animals. 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" Population Health: "the health outcome of a group of individuals, including the distribution of such outcomes within the group"

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

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

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

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

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

3) Process Evaluation Waiting until a program or intervention has completed to begin evaluation misses opportunities to conduct activities related to a process evaluation. Process evaluation is concerned with how the program is delivered. It deals with issues such as when program activities occur, where they occur, and who delivers them. In other words, process evaluation asks whether the program is being delivered as intended. An effective program may not yield desired results if it is not delivered properly. Outcome and impact evaluations typically occur after a program or intervention concludes and assess its impact on participants and the broader community, respectively. Summative evaluations assess the extent to which a program has achieved its goals.

Which of the following components of a strategic planning process in a public health agency has logical priority over the others? (Key words: Strategic Planning Process) 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

3) Review (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.

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

3) Tertiary Prevention and Harm Reduction Strategy This example is based on language from an actual order issued by the Virginia State commissioner of Health on November 11, 2016.

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 ints 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

3) 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 HIV infection. Public health interventions must adapt to changing demographics and epidemiology during challenges like this.

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

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.

Administrative law judges, who adjudicate conflict 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 w/ constitutional requirements of due process 4) are in all respects the same as "hearing officers" within gov. agencies

3) ensure compliance w/ constitutional requirements of due process Administrative law judges are to ensure compliance w/ constitutional requirements of due process

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

3) when supervised by their clinical instructors in actions within the scope of that profession's practice Community health projects frequently engage medical, nursing or other allied health profession students. Fellowship programs follow graduation. Students ready for such activities typically already have received training in clinical procedures, and act under supervision of their school's instructors.

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

3.) Reviewing (and revising) the vision and mission statements for the agency Based on the strategic planning process specifically, 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.

The Greenhouse Gas of primary concern in global warning is: 1) Chloroflurocarbons 2) Carbon Monoxide 3) Sulfur Dioxide 4) Carbone Dioxide

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

Which of the following processes from the Transtheoretical Model refers to substituting healthy behaviors for unhealthy ones? 1) Stimulus Control 2) Consciousness raising 3) Reinforcement Management 4) Counter-Conditioning

4) Counter-Conditioning (Use Substitutes) Within the Transtheoretical Model, stage movement is accompanied by one or more processes of change. Counter-conditioning, that is substituting healthy behaviors for unhealthy ones, is active during action and maintenance.

Which of the following factors is the least essential requirement for effective public health emergency preparedness? 1) Identifying surge capacity in the public health infrastructure 2) Developing channels for real-time interagency communication 3) Training key decision-makers and first responders for coordinated action 4) Developing and testing emergency preparedness plans on a monthly basis

4) Developing and testing emergency preparedness plans on a monthly basis The time period between developing and testing emergency preparedness plans varies based on state, local, and national laws and organization practice.

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

4) Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event Modest items of food and non-alcoholic refreshments such as soft drinks, coffee, and donuts, not offered as par

Which of the following survey items best assesses an individual's SES 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

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.

A 911 emergency operation center is flooded with calls at certain times of the day. What is the distribution that is most often used to assess this data? 1) Normal 2) Binomial 3) Hypergeometric 4) Poisson

4) Poisson The Poisson distribution is used to model data that represent the number of occurrences of a specific event in a fixed period of time.

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

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

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

4) Reciprocal transfer of knowledge and skills among all collaborators and community partners An appropriate approach focuses on the true meaning of engagement; that is, members of the community taking the lead to address what the community needs to become empowered, and public health workers assisting them in a bi-competent manner. 3) may seem similar, but more paternalistic and assuming that the community members don't have self-determination (may have other barriers they need to overcome)

An incremental approach to program planning in public health is: 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 up on the results of previous steps 4) Results in plans that may be immediately necessary but may overlap or leave gaps

4) Results in plans that may be immediately necessary but may overlap or leave gaps The incremental approach to program (a little bit more is added each time) planning may address an immediate need (ex: Closing bathhouses in the early days of HIV/AIDS epidemic) it may also leave gaps (ex: 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.

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

4) Sludge The secondary biological treatment process used by most large municipalities produces substantial quantities of settled solids, termed "sludge", composed largely of masses of bacteria. About half of this organic-rich material is recycled each year as fertilizer, but its use is strictly regulated by the EPA because some sludge may contain potentially harmful concentrations of heavy metals and other toxic substances.

A consecutive series of 1,000 women newly identified with breast cancer included 235 who currently smoked cigarettes. From this information one can correctly conclude that in this series of woman... 1) Smoking cigarettes increases the incidence of breast cancer by 23.5% 2) Smoking cigarettes increases the prevalence of breast cancer by 23.5% 3) The incidence of smoking cigarettes at cancer diagnosis was 23.5% 4) The prevalence of smoking cigarettes at cancer diagnosis was 23.5%

4) The prevalence of smoking cigarettes at cancer diagnosis was 23.5% This is cross sectional sampling of women w/ breast cancer, so we can estimate prevalence. Incidence cannot be estimated from cross-sectional data. To estimate risk we would need to follow the same group of women over time.

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

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

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 that ad. This suggest 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

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). (which rules out answer choices 1-3)

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

4) determine the direction an organization will pursue Strategic Planning: an organizational management activity, 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 outcome/results, and assess and adjust the organization's direction in response to a changing environment By this point, the organization's managers should have already assigned tasks and responsibilities to individuals

A researcher is calculating the infant mortality rate of several states. Which of the following methods is appropriate to use during this analysis to adjust for racial differences in infant mortality rates among the states? A) Direct standardization B) Linear Regression C) Logistic Regression D) Life Table Analysis

A) Direct Standardization The direct method of standardization requires that the age-specific rates for all populations being studied are available and that a standard population is defined. Logistic Regression: used to describe data and to explain the relationship between one dependent binary variable and one or more nominal, ordinal, interval or ratio-level independent variables. Linear Regression: used when your response variable is continuous Life Table Analysis: tool to analyze occurrences of an event through time, presents the proportion surviving, the cumulative hazard function, and the hazard rates of a large group of subjects followed over time

The sensitivity of a particular screening test for a disease is 95%, and the specificity is 90%. Which of the following statements is most correct? (A) Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease (B) Of 100 people sampled from a population with the disease, the test will correctly detect 90 individuals (C) If a person tests positive, the probability of having the disease is 0.95 (D) If a person has the disease, there is a 5% chance that the test will be negative (E) If a person does not have the disease, there is a 5% chance that the test will be positive

A) Of 100 people samples from a population with the disease, the test will correctly detect 95 individuals as positive for the disease. Sensitivity is the proportion of truly diseased people in the screened population who are identified as diseased by the screening test. It is a measure of the probability of correctly diagnosing a case or the probability that any given case will be identified by the test (e.g., true positives). Specificity is the proportion of truly non-diseased people who are so identified by the screening test. It is a measure of the probability of correctly identifying a nondiseased person with the screening test (e.g., true negatives).

In addition to ozone and particulates, which of the following is most likely to aggravate asthma? A) Sulfur dioxide B) Carbon Monoxide C) Asbestos D) Nitrogen

A) Sulfur Dioxide Sulfur dioxide causes a range of harmful effects on the lungs, as the EPA's most recent review of the science concluded... (https://www.lung.org/our-initiatives/healthy-air/outdoor/air-pollution/sulfur-dioxide.html)

An investigator measures a continuous variable on four independent groups of people and would like to know whether the means of each group differ. Which statistical method should the investigator use to answer this question? 1) Logistic Regression 2) Cox Regression 3) Chi-square test of association 4) Analysis of variance (ANOVA)

ANOVA is the only choice that is appropriate for continuous outcome variables. Logistic regression is used for nominal or ordinal outcomes Cox regression is used for survival outcomes Chi-square tests are used for categorical variables

On the basis of the present evidence, the greatest reduction in injuries and death related to motor vehicles in the US is most likely to be a result of which of the following? A) Stricter motor vehicle inspection laws B) Modifications to vehicles and highway systems C) Increase in law enforcement and highway patrol officers D) Stiffer penalties for drunk drivers and repeat speeders

B) Modifications to vehicles and highway systems

A researcher is designing a new questionnaire to examine patient stress levels on a scale of 0 to 5. What type of outcome variable is being collected? A) Ratio B) Nominal C) Interval D) Ordinal E) Binary

B) Ordinal

The Central Limit Theorem states that: A) The sample mean is unbiased B) The sample mean is approximately normal C) The parent population of the sample distribution is normally distributed D) The sample SD is approximately normal E) Both statements A) and C) can be deduced from the Central Limit Theorem

B) The sample mean is approximately normal The Central Limit Theorem states that if the sample size is large enough, the 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

Assume that a researcher has measured weight in a sample of 100 overweight adults before and after a diet and exercise program conducted at the local health department's weekly Eat Health - Be Fit community program. To determine whether the mean weight decreased six weeks after the exercise program compared to the initial baseline measures, the researcher should: A) Compute the correlation coefficient, r, and determine the association between being overweight and the community program B) Conduct a t-test for independent samples C) Conduct a t-test for dependent samples D) Conduct a chi-square test for association E) Not estimate the decrease because there was no control group for the program

C) Conduct a t-test for dependent samples A t-test is a hypothesis test to compare population means and proportions. In this case, the sample is dependent because the tests are performed on the same individuals in the sample.

Which of the following is the largest source of radiation dose to the general public nation wide? A) Medical use of x-rays B) Nuclear Power Plants C) Radon Gas D) Nuclear weapons testing fallout

C) Radon Gas

An epidemiologist attempts to predict the weight of an elderly person from demispan. She randomly chooses 70 elderly subjects in a particular geographic area and records their weight and demispan measurements in the form of (x i , y i ) for i = 1...70. Given that the value of the Pearson correlation coefficient is zero, what can be deduced? 1) There is no relation between weight and demispan B) There is an almost perfect relationship between weight and demispan C) There could be some nonlinear relationship between weight and demispan D) There is a strong negative relationship between weight and demispan E) All pairs of values of weight and demispan are practically identical

C) There could be some nonlinear relationship between weight and demispan

Which of the following statistical tests is NOT considered a nonparametric test? A) Kruskal-Wallis Test B) Wilcoxon's rank-sum test C) Tukey's test D) Mann-Whitney test

C) Tukey's test

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

Churches and other nonprofit interest groups that launched the environmental fairness movement in the 1980s articulated their mission using the term "Environmental Justice." The overarching premise is fairness in the distribution of the burden of pollution across all population groups regardless of race, ethnicity or socio-economic status. The term "Environmental equity" is not the best answer because while it may be a component of environmental justice, it is more limited. Environmental justice encompasses equity, as well as equality and fairness. The term "Environmental pollution" is only vaguely expressive of the message, but does not capture concern with how exposure to environmental pollution is distributed across a population. The term "Environmental democracy" is completely wrong because it is not about majority rule. If it were a matter of majority rule, than minority health could be in serious jeopardy. Environmental equity is an outcome of Environmental justice. https://www.mobilizegreen.org/blog/2018/9/30/environmental-equity-vs-environmental-justice-whats-the-difference

Which measure of mortality would you calculate to determine the proportion of all deaths that is caused by heart disease? A) Case Fatality Ratio B) Randomized Clinical Trial C) Crude Mortality Rate D) Proportional Mortality Ratio

D) Proportional Mortality Ratio the proportion of deaths in a particular population over a specified period of time attributable to a specific disease

Which of the following organizations accredits local public health departments? A) CDC B) APHA C) State Licensing Boards D) Public Health Accreditation Board

D) Public Health Accreditation Board

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

D) Relatively Inelastic: relatively large changes in price cause relatively small changes in quantity In other words, quantity is not very responsive to price. More specifically, the percentage change in quantity is less than the percentage change in price.

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

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."

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

Language Needs Assessment includes a review of four factors: The Four Factor Analysis - to guide LHDs (recipients) in meeting these mandates and to provide recommendations for providing translated materials and interpretation services. The four factors are: 1. The Number of proportion of LEP residents within each district, 2. The frequency with which LEP individuals come into contact w/ VDH programs 3. The nature and importance of the program, activity or service provided by the recipient to its beneficiaries, and, 4. The resources available to the grantee/recipient and the costs of interpretation/translation services vs. The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (The National CLAS Standards) "aim to improve health care quality and advance health equity by establishing a framework for organizations to serve the nation's increasingly diverse communities (https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53)." To "conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities" is just 1 of 28 National CLAS Standards

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 expectation 4) Stages of change

TRA 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. https://www.youtube.com/watch?v=nZsxuD3gExE 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

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

The researcher must seek assent from the participant from at least one of the participant's parents or legal guardian. Title 45, part 46 of the code of federal regulations (45 CFR 46) delineates the Dept. of HHS' regulations for biomedical and behavior research. According to Subpart D of 45 CFR 46, assent refers to a "child's affirmative agreement to participate in research. According to Subpart D of 45 CFR 46, assent refers to a child's affirmative agreement to participate in research." In most cases, people under the age of 18 can only provide assent because they have not year reached the legal age at which they can offer consent. IRB take into account maturity level, psychological state, and age when determine whether children can assent to participate in a study. Permission refers to, "the agreement of parent(s) or guardian to the participation of their child or ward in research." For a study on diabetes in high school students that does not pose greater than minimal risk to the adolescents who participate in an interview, 45 CFR 46 states that an IRB may find that the permission of just one parent is sufficient for the adolescent to participate.

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

1) its stories have urgency, drama, and novelty Historically, public health analysts and managers tended to think in terms of data while communications specialists and reporters tended to think in terms of stories. Now, everyone recognizes that stories trump data, and tribalism trumps stories. Among useful insights and advice about working with the media, a notable professor of journalism quotes a former print media reporter's explanation of the attraction of public health stories, that "Public health stories have urgency, drama and novelty"...."multifactorial".....etc.

When performing a nonparametric Wilcoxon rank-sum test, the first step is to combine the data values in the two samples and assign a rank of "1" to which of the following: 1) the smallest observation 2) the middle observation 3) the largest observation 4) the most frequently occurring observation

1) the smallest observation After combing the data values fro the two samples, performing a Wilcoxon rank-sum test requires you to next order the values from lowest to highest, assigning a rank of 1 to the smallest observation

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

1) value the policy dialogue process over its outcome

If a food contaminated with a virus, such as hepatitis A, is left out for 4 hours in a kitchen at a temperature of 85 degrees Fahrenheit, the virus count in the food: 1) increases exponentially 2) increases slowly 3) depends on the acidity of food 4) does not change

4) does not change Viruses can only grow in living cells and will not multiply under these circumstances. Viruses can only replicate themselves by infecting a host cell and therefore cannot reproduce on their own.

A health behavior 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 1,5000 people to approx. 20,000 people. This change will most likely have which of the following effects? A) Decreasing the variability of the estimate B) Increasing the standard error of the estimate C) No effect on survey stats because the population size is the same D) Increase the CI width for the parameter

A) Decreasing the variability of the estimate As sample size increases, the range decreases, which means variability decreases.

In simple linear regression, what is a method of determining the slope and intercept of the best-fitting line? A) Least squares B) R-square C) Minimum error D) Least Error E) Regression

A) Least Squares

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) Passive B) Active C) Syndromic D) Sentinel

A) Passive Surveillance

The introduction of sewage into a stream is most likely to cause a measurable change in which of the following ways? A) Decrease in decomposing organic concentration B) Increase in biochemical oxygen demand C) Increase in dissolved oxygen concentration D) Stabilization in dissolved oxygen concentration

B) Increase in biochemical oxygen demand Biochemical Oxygen Demand: amount of dissolved oxygen needed by aerobic biological organisms to break down organic material present in a given water sample at certain temperature over a specific time

Which of the following best describes the tendency for an insured person to overuse health services because he has insurance? A) Adverse Selection B) Crowding Out C) Risk Aversion D) Moral Hazard

D) Moral Hazard

The lengths of stay for six patients were 0, 0, 1, 2, 2, and 16 days. Which is (are) the best measure(s) to summarize these data? A) Mean B) Median C) Median and SD D) Mean and SD E) Median and Range

E) Median and Range