CPH Practice Questions

In the design and implementation of public health data systems, installing security features should be: 1. inherent in privacy by design at all stages. 2. a task separately done by an expert cybersecurity team. 3. limited to firewalls and administrative control. 4. the final step before release of software systems.

1. Privacy by design is not a new principle, but under GDPR became a legal requirement. See explanatory websites like that of the UK Information Commissioner's Office

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

1. See Biermann O, Policy dialogues: facilitators' perceived role and influence, International Journal of Health Governance 2018;23(2) [in press, pages not yet assigned]

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. While courts may use these as an indication of the standard of practice within a professional community, these are guidelines rather than standards and are voluntary rather than enforceable. The quality of evidence can range from randomized controlled clinical trials, to observational studies, to anecdotal reports or even simply consensus among experts. Different groups often publish their own guidelines on a topic, sometimes citing the same evidence and sometimes not including the same evidence, so there also may be conflict between clinical practice guidelines published by different organizations. Ultimately, their best use is to frame patient-centered care discussions between patients and their doctors in shared decision-making based on patient preferences and best available evidence

In order to effectively evaluate organizational performance, performance indicators must be: 1. approved by all organizational staff 2. publicly reported 3. benchmarked against previously agreed upon standards 4. clear in the organizational mission statement

3. Measurable performance indicators are useless unless they are benchmarked against previously agreed upon performance standards.

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

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.

Which of the following pairs of values are most likely to conflict during a response to a public health emergency? 1. Truth-telling versus community welfare 2. Beneficence versus justice 3. Individual autonomy versus community welfare 4. Community welfare versus justice

3. Responses to public health crises are likely to entail some restriction of individual freedom as a trade-off to ensure the health, safety, and well-being of the broader community.

Total coliform and E. coli counts are performed in routine monitoring of drinking water reservoirs because: 1. These bacteria commonly cause gastrointestinal infection in humans. 2. They are a more easily grown indicator of Legionella 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. 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 or domestic animals, others in humans. They all are heterotrophic (meaning that they require nutrients in growth media) and are monitored by plate counts as an indicator of sanitary quality of 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, etc. Reference CDC, EPA or NIH websites for more information (e.g. https://www.ncbi.nlm.nih.gov/books/NBK234164/).

Facilitation takes work and in a meeting of multiple stakeholders it becomes important for the facilitator to prioritize his or her role. Above all the facilitator should: 1. Be neutral 2. Focus on the content 3. Take notes 4. Listen to the active speakers

A facilitator's job is to encourage participants of a meeting to contribute ideas not to be weighing in on people's ideas as this may be polarizing.

All written intervention messages (whether printed, computer-delivered, or Internet-based) must: 1. Start with the most important information first 2. Include graphics, pictures, and the like to attract people's attention 3. Be at a reading level suitable to the target population 4. Be no longer than four sentences long

A written intervention could potentially fill the need of being at a reading level suitable to the target population through providing more appealing graphics and updated to reflect panel recommendations. To develop easy-to-read materials and graphics, readability tests (as a communication research methods) can help determine the reading level required to understand material and can help writers be conscientious about the careful selection of words and phrases.

Which method is the most accurate exposure assessment in workers?

Biomonitoring of chemicals or metabolites of the chemicals in blood and urine

disinfection methods is most commonly used in US drinking water supply systems?

Chlorination

The probability of an event occurring assuming that another event has occurred is called a: 1. Joint probability 2. Simple probability 3. Conditional probability 4. Marginal probability

Conditional probability is the probability of an event occurring assuming that another event has occurred.

If two copies of a mutant allele are necessary to cause symptoms of a disease to appear in the phenotype, what type of genetic disease is this? 1. Recessive 2. Sex-linked 3. Autosomal 4. Dominant

Correct answer: 1 A recessive condition is one in which an individual needs to be homozygous for a mutation in order to show symptoms.

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

Correct answer: 4 The researcher must seek assent from the participant and permission 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 Department of Health and Human Services' 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." In most cases, people under the age of 18 can only provide assent because they have not yet reached the legal age at which they can offer consent. Institutional review boards (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

When beginning work with a coalition of community groups to improve health outcomes in the community, a key first step would be to: 1. Develop a shared vision 2. Develop an evaluation plan 3.Develop a data collection plan 4.Develop a logic model

Developing a shared vision is important in make sure the coalition of community groups is on the same page. A shared vision allows the different coalition groups to come to a consensus on the definition of the health need or issue they are working on.

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

From the perspective of hospitals, the No. 1 cost category in hospital budget is employees' wages and benefits. Cuts in personnel or staffing willleave public health departments unable to respond to crisis.

Historically, which of the following had the greatest impact on average life expectancy? 1. Vaccinations for infectious diseases 2. Improvements in sanitation and hygiene 3. Advances in medical care technology 4. Increased application of health education

Historically, improved sanitation and hygiene have had the greatest impact on lengthening life expectancies. The sanitarian movement, led by Edwin Chadwick in Great Britain in the last half of the 1 the century, brought about improvements in municipal sanitation systems and promoted public hygiene. Thomas McKeown and other public health investigators have demonstrated that declines in mortality during the 20th century occurred before the advent of vaccinations, antibiotics, and other modern medical treatments. Thus, these declines can be attributed to the efforts of the sanitarian movement.

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.

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. They are complex, what a public health scientist would call 'multifactorial." Frequently they arise out of the near-universal dread of the new and frightening." (Kruvand, 2011; Mayhall, 2012).

Data for which personally identifiable information was not collected, or has been encrypted or removed are known as: 1. Confidential 2. Secure 3. Anonymous 4. Coded

In public health surveillance, data anonymization ensure all personally identifiable information is not collected, or has been encrypted or removed so as to not compromise individual privacy

Terms that means that a tumor has spread to other locations within the body

Metastatic

High level of nitrates in groundwater are of particular concern in rural communities that rely on well water because:

Nitrates can cause "Blue-Baby Syndrome" in infants

Characteristics, attributes or exposures such as hypertension, unsafe sex, alcohol consumption, unsafe water that can increase the likelihood of developing disease or injury are known as

Risk factors

Exposures to negative situations such as a parent who smokes, sedentary lifestyle, high levels of alcohol consumption, and unprotected sex can increase the likelihood of developing disease or injury and poor health outcomes. Such exposures are often referred to as: 1. Risk factors 2. Environmental factors 3. Socioeconomic factors 4. Community factors

Risk factors are attributes or habits that increases an individuals likelihood of developing a certain disease

Drug therapy for individuals who have screened positive for tuberculosis (TB) infection, but do not have any TB symptoms, is considered which type of prevention for TB disease? 1. Primary 2. Secondary 3. Tertiary 4. Quaternary

Secondary prevention includes early detection and treatment.

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:

Sludge

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

Strategic planning is an organizational management activity that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholders are working toward common goals, establish agreement around intended outcomes/results, and assess and adjust the organization's direction in response to a changing environment.

Informed consent should avoid inclusion of: 1.risks and benefits 2.technical jargon 3.contact information 4.purpose

Technical jargon is generally not included in informed consent because it may not be understandable to the participant

CHIP is a federal program that has been important for public health because: 1. It remedies the state differences in health insurance that characterize Medicaid 2. It covers preventive services for children who otherwise might not have access to them 3. It provides block grant funding that supports state public health programs 4. It increases funding for school health initiatives

The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

As identified in the seminal 1988 Institute of Medicine report on the future of public health, which of the following is not one of the three core functions of the roles and responsibilities of public health agencies? 1. Assessment 2. Financial performance management 3. Policy development 4. Assurance

The Institute of Medicine report identified three core functions of public health agencies: assessment of health status, policy development, and assurance that necessary services are provided. Financial performance management is an important organizational activity, but is not explicitly identified in the Institute of Medicine report.

Policy analysis when designing public health programs is: 1. involves a straightforward statistical analysis of health and public polling data. 2.a subjective political task accomplished by legislative debate and trade-offs. 3. complex, involving data collection and clarification of objectives. 4. impossible to define because different policy areas require different approaches.

The modified Bridgman and Davis framework for policy development shows policy analysis to consist of three elements: collect relevant data and information, clarify objectives and resolve key questions, then develop options and proposals. It identifies policy analysis as a step between identifying issues and undertaking consultation before moving on to making decisions. In the book "Social Policy, Public Policy: From Problem to Practice" (Edwards et al., Allen & Unwin Publishers, 2001), the authors explain the importance of addressing such analysis questions as "Where did the data and research come from and what was its significance in affecting the identification of the problem, the issues and the options? How did key players interact and how were areas of disagreement identified? At what stage were options developed and by whom and in what forums? Were criteria used to assess the options, and if so, what were they? What can be understood about bureaucratic politics from these events?"

In the planning process, the group being served is referred to as the: 1. Pilot population 2. Key informants 3. General population 4. Priority population

The priority population is the people for whom the program is intended. In the past, this has also been called the target popluation.

Income, interpersonal stress, and education level are all examples of ____________, which determine the overall health, and quality of life of our communities. 1. Physical determinants 2. Spatial determinants 3. Environmental determinants 4. Social determinants

The social determinants of health determine the quality of life and overall health for individuals.

Concern of live, attenuated vaccines

They can cause disease in an immunocompromised individual

Which of the following statements best characterizes research findings about trait-based approaches to leadership theory? 1. Intelligence, high energy, and initiative are necessary 2. Personality traits are irrelevant 3. No one set of traits has been established as necessary 4. Leaders are born, not made

Trait-based approaches to leadership theory are concerned with traits that distinguish leaders from other people and the magnitude of the differences between the two groups. Early trait-based approaches posited that leaders possessed innate heritable qualities that differentiated them from the general population. Later research on leadership emphasized behavior rather than traits. More recent literature focuses on a combination of traits and behaviors, but has not explicitly identified a set of traits, innate or otherwise, that constitute a leader.

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

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

The following test would be used to compare mean ages between groups: 1. Chi-square goodness of fit test 2. Chi-square test of independence 3. Two independent samples t test 4. Fisher's exact test

Two independent samples t test: The outcome of interest is age, which is a continuous variable, and interest lies in comparing mean ages between two independent groups (participants assigned to the placebo as compared to participants assigned to the experimental group). The two independent samples t test is used to compare means of a continuous variable between two independent groups.

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

West Nile virus neuro-invasive disease (WNVND) is common throughout the US, particularly in the warm months when mosquito populations are highest and people spend more time outdoors. Malaria, Dengue Fever, and Yellow Fever rarely occur in the US.

That individuals are motivated to satisfy or pursue food, drink, or shelter before focusing on esteem or self-actualization is an example of which model? 1. Hierarchy of needs (Maslow) 2. Expectancy theory (Vroom) 3. Two-factor theory (Herzberg) 4. Theory X/Theory Y (McGregor)

1. Hierarchy of needs expresses the basic logic of Abraham Maslow's need-based model of human motivation. This model posits that needs must be met in the following order: physiological needs; safety-security; belongingness; esteem; then self-actualization.

Municipal sewage is typically processed to remove organic material before disposing the treated water. In large cities, this treatment generally consists of: 1. Biological treatment in an aerated activated sludge system, followed by settling to remove sludge solids, then chlorination prior to discharge. 2. Chemical treatment by coagulation and flocculation, followed by settling to remove solids, then chlorination prior to discharge. 3.Filtering through sand beds to remove organic solids, followed by chlorination prior to discharge. 4. Super-chlorination to destroy organic materials, followed by discharge.

1. The aerated activated sludge secondary treatment process effectively removes organic materials from municipal sewage. A mix of aerobic biological organisms termed "activated sludge" consume the organic materials. Sludge is removed from the treated water by gravitational settling, and the water is disinfected by chlorination before discharge (e.g. to a receiving river). The chemical coagulation / flocculation / settling process is used to treat water destined for the drinking water supply system, and is usually required when the water is taken from a surface water source such as a lake or river. Filtering through sand beds is also used to treat drinking water, but not municipal sewage. Super-chlorination is not an effective treatment for municipal sewage

To evaluate public health performance, we consider capacity, process, and outcomes. Which of the following represents an example of an "outcome?" 1. An increase in the types of vaccines offered to protect against common childhood diseases 2. Decrease in number of children age 0-2 with vaccine preventable disease 3. Routine health care 4. Increase in number of patients seen in the mobile immunization van

2. Outcomes in program management and performance respond to the question of what impact will the planned program activity have? Or what change may we expect due to the program? The outcome may be short term/ mid term/ or long term. The increase in vaccination meets this criteria. Answer A and D are examples of program activities or OUTPUTS.

A key characteristic of action research or community based participatory research (CBPR) include: 1. Securing local community IRB approvals for the project and informed consent 2. Embracing the community as a full and equal research partner 3. Presenting a well thought out research and analysis plan to the community 4. Partnering with law makers to ensure health improvements in the community

2. CBPR or Community Based Participatory Research is a research tool where the target community is an equal partner in the research study. This includes involvement from defining the research question(s) to data collection, to data analysis, to sharing results. The community is considered an equal in the project and shares key stakeholder status, leading to improved health outcomes. While this model allows for increased community involvement in the project, often allowing community members to serve as researchers, the process is slower than other conventional types of research. Despite the growing interest in CBPR and its promise for enhancing the effectiveness of interventions, there remains the challenge to better understand the characteristics of partnerships and participation by community members, public health professionals, and researchers to most effectively produce health outcomes. The literature of CPBR has documented systemic outcomes such as policy changes, practice and program changes for greater sustainability and equity, and community capacity and empowerment outcomes, all of which contribute to health outcomes (5,9,24). NIH has also touted the benefits of community participation in research design, enhanced recruitment and retention into studies, development of culturally appropriate measures, and assurance of cultural centeredness and intervention feasibility.

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. 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

The exposure standard for lead in children has been lowered over the years because even small amounts can result in: 1. Childhood cancers, such as leukemia 2. Impaired cognitive development 3. Impaired formation of bone mineral 4. Reduced rate of growth

2. Current evidence suggests that any exposure to lead carries some risk of impaired cognitive development in children.

When making decisions, public health leaders face the ethical challenge of: 1. Ignoring the rights and liberties of those individuals affected by disease 2. Creating maximum benefit for all while minimizing individual harm 3. Maximizing resource expenditures 4. Demanding trust from health care providers serving patients

2. Ethical decision making in public health involves the common need to weigh the concerns of both the individual and the community. The need to exercise power to ensure health and at the same time to avoid the potential abuses of power are at the crux of public health ethics. The 12 principles of ethical practice in public health provide guidance to public health professionals for ethical practice with respect to health, community, and bases for action. These ethical principles align with those identified in the Belmont Report of respect for persons, beneficence, and justice but provide a more specific application to public health practice.

Determining whether to continue or modify but not terminate a program is a reasonable objective of a: 1. formative evaluation 2. summative evaluation. 3. qualitative evaluation. 4. quantitative evaluation

2. Formative evaluations are done to identify program strengths and weaknesses in order to guide improvement. Summative evaluations are conducted as a pass or fail examination that can lead to program termination. Qualitative, quantitative, or a mix of both methods can be used in either of these.

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. 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

The first step in the policy process typically is: 1. Undertake Consultation 2. Problem definition 3. Policy analysis 4. develop options and proposals

2. Problem definition is typically the first step in the policy process. The second step is agenda setting. The next step is policy making. The fourth step is budgeting. The fifth step is implementation and the final step of the policy process is evaluation.

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

2. 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 privately address the issue is best. More information can be found in these articles:

A supervisor of a small community health clinic serving a largely multi-national immigrant community assigns their project manager the responsibility of developing a new process to ensure complaints and conflicts are addressed promptly and respectfully for each patient. This is prompted by a recent complaint that a staff member was rudely addressing a limited English-speaking patient and her family when trying to communicate a diagnosis. In order to create a new process that takes into account the cultural and communication needs of the patients, the program manager must: 1. Create a new conflict process based solely on examples from other clinics. 2. Select a group of patients to provide input on how complaints should be resolved. 3. Wait until a new complaint occurs to observe the existing process. 4. Ask their coworkers how they personally deal with complaints and conflicts in the office.

2. The other answers are partly correct, as observation and assessment are part of developing a new process or policy, however, they do not take into account the culture of the organization and its patients or its existing policies. The correct answer is consistent with the National Culturally and Linguistically Appropriate Services (CLAS) Standards which are designed to advance health equity and eliminate health disparities through governance, communication, and engagement.

A primary technique for preventing food-borne disease in cafeteria-type food service establishments is: 1.Encouraging customers to wash their hands before eating 2.Maintaining warm foods at a sufficiently high holding temperature 3.Weekly application of pesticides to control cockroaches 4.Annual physical examinations of food service workers

2.Maintaining warm foods at a sufficiently high holding temperature: Microbial food contaminants such as Salmonella, Campylobacter, and E. coli may multiply rapidly at warm temperatures (between about 41-140F or 5-60C). Maintaining warm foods above 140F (60C) will kill actively growing bacteria.

Assume that a linear regression analysis is performed with predictor variables age and socio-economic status, and the correlation coefficient r is 0.4. What percent of the variation in the outcome is explained by age and socio-economic status? 1. 0.25 2. 0.16 3. 0.4 4. 0.6

2.The percentage of the variation explained by a predictor variable is given by the square of the correlation coefficient.

Administrative law judges, who adjudicate conflicts involving the decision-making of units of government agencies: 1. have at the federal and state level full judicial power, like all trial judges. 2. are elected as non-partisan candidates within congressional districts. 3. ensure compliance with constitutional requirements of due process. 4. are in all respects the same as "hearing officers" within government agencies.

3. Administrative law judges are to ensure compliance with constitutional requirements of due process.

After identifying and appointing expert members to inter-professional teams for implementing health initiatives, the administration: 1. has shifted all responsibility to the team. 2. role should only consist of receiving periodic progress reports. 3. should plan to confirm the team norms and dynamics are productive. 4.can announce that the initiative was successfully launched.

3. Authority can be delegated, but responsibility can only be shared. Waiting for progress reports without ensuring healthy team dynamics is unwise. There are different ways that teams can operate successfully (i.e. talented members can work in a decentralized self-reliant manner under delegation-style leadership on a team [as in baseball or track], or in a centralized cooperative manner under directive-style leadership in a team [as in crew or football], or in a fluid, spontaneous innovative manner supported by extensive communication as a team [as in hockey or basketball]. There is no single best way that teams should operate. Announcing success at this stage would be premature.

An understaffed city health department submits an annual budget to it's city leadership; including a request for an additional 6.0 FTE positions. This budget includes the funding request but no accompanying narrative and was submitted despite the City Manager's request for each department to avoid any funding increases in their requests. When asked about this, the department responds by: 1. Submitting another budget with no new positions. 2. Asking another department to decrease their budget by 6.0 FTE positions. 3. Provide information to justify the increased number of positions. 4. Reaching out to the media to gain citizen support for the new positions.

3. Being able to defend a programmatic or organizational budget requires management to provide justification for expenses based on the true needs of the organization or the individuals they are serving.

Public health departments can use health profession students (eg. medicine, nursing, other allied health specialties) in projects to assess community health needs: 1. if those students are formally employed by that 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 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. 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 instructor

In part due to the public attention focused on environmental pollution by Rachel Carson's book "Silent Spring," as well as studies such as those showing a drastic decline in the American Bald Eagle population, a ban was issued on the use of: 1. Chlorofluorocarbon (CFC) refrigerant gases 2. Leaded gasoline 3. DDT pesticide 4. Asbestos insulation materials

3. DDT is essentially non-toxic to humans and was widely used in past years as a general purpose pesticide. However, it was shown to "bio-accumulate" through the food chain of birds and to cause thinning of the birds' egg shells, resulting in broken eggs and a severe decline in some species including Bald Eagles, falcons, and pelicans. "Silent Spring" raised public awareness of bio-accumulation, which led to the EPA to ban its use in 1972.

As a first step in public health emergency preparedness, jurisdictions should: 1. Ask a local government leader what will be expected of them. 2. Outsource public health emergency preparedness responsibilities. 3. Self-assess their ability to address resource elements for each preparedness capability and then assess their ability to demonstrate the functions associated with each capability. 4. Design and conduct at least one table-top exercise.

3. State and local public health departments are key responders in emergency situations that impact the public's health. To assist public health departments with emergency preparedness, the Centers for Disease Control and Prevention has articulated 15 public health preparedness capabilities. Each capability has several associated functions and performing each function requires specific resource elements. The resource elements fall into three categories: Planning, Skills and Training, or Equipment and Technology As a first step, jurisdictions are encouraged to self-assess their ability to address the prioritized planning resource elements of each capability and then to assess their ability to demonstrate the functions and tasks within each capability. CDC has defined successful accomplishment of prioritized resource elements as the following: a public health agency has either the ability to have (within their own existing plans or other written documents) or has access to (partner agency has the jurisdictional responsibility for this element in their plans and evidence exists that there is a formal agreement between the public health agency and this partner regarding roles and responsibilities for this item) the resource element.

In the funding applications that state public health departments typically submit every year, program and organizational budget requests: 1. are not included, only research project funding is described. 2. are justified by reasonable numbers on accounting spreadsheets. 3. need explanation in a budget narrative. 4. tend to always be funded.

3. State public health departments typically conduct needs assessments and program evaluations, but do not perform academic research projects and their financial accounting systems are not set up to hold research funds in anticipation of future project expenses. Dollar figure request items shown need to be explained in a section typically called the budget narrative. Since funding success depends upon political will and is competitive against applicants from other programs, it is important to defend a budget request in clear and meaningful language.

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. 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.

Which statement is correct about scatterplots? 1. They are the preferred graphical method for displaying any type of data. 2. They are the preferred method to compare the means in biariate data. 3. They are useless when the relationship between two variables is nonlinear. 4. They are useful for initial exploration of relationships in bivariate data.

4. A typical scatterplot graph is a plot of paired (x,y) data with a horizontal x-axis and a vertical y-axis. It has many applications, and is useful as a first step to investigate the relationship between two variables (or more than two by use of 3-dimensional scatterplots or a scatterplot matrix). It can also help identify outliers within data sets. Curve-fitting techniques, such as LOWESS (locally-weighted scatterplot smoothing) and other tools, can be applied to derive even more information from these graphs.

Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities are commonly referred to as: 1. Health behavior factors 2. Risk markers 3. Needs assessment 4. Determinants of health

4. All biological, environmental, behavioral, organizational, and political, and social factors that contribute to health status for individuals, groups, communities and beyond, are all referred to as determinants of health.

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

4. 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.

Select the qualitative method that collects data through a simultaneous conversation with a group of people. 1. key informant interviews 2. discourse analysis 3. surveys 4. focus groups

4. Focus groups are group interviews where a facilitator guides the questions and discussion. Key informant interviews are in-depth interviews with people who have informed perspectives about the topic or community you're working with. Discourse Analysis "is the study of social life, understood through analysis of languages in its widest senses (including face-to-face talk, non-verbal interaction, images, symbols and documents)" (Shaw & Bailey, 2009). Surveys "is the collection of information from a sample of individuals through their response to questions) (Check & Shutt, 2012).

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? 1. Mean and range 2. Median and standard deviation 3. Mean and standard deviation 4. Median and range

4. Median and range: Because the data are skewed and have an outlier, the median and range would best summarize the data because these measures of center and dispersion are most resistant to the effect of outliers, meaning that they do not increase or decrease greatly when data values not change when an observation lies outside the overall pattern of a distribution.

Under which circumstance would there be no ethical violation for an officer or employee of a governmental regulatory agency to accept food or beverage paid for by others? 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 or 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. Modest items of food and non-alcoholic refreshments such as soft drinks, coffee, and donuts, not offered as part of a meal are excluded from the definition of a gift and may be accepted pursuant to certain specific regulatory exclusions.

Which of the following is the least acceptable method for making drinking water available in an emergency situation? 1 Using a tank truck 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 is the least acceptable method of making water available during an emergency. River water is a type of surface water, which is more vulnerable to contamination than groundwater, which can be pumped from underground aquifers. Surface water can easily be contaminated by chemical pollutants discharged from a drainage pipe (point source) or agricultural runoff (nonpoint source) or micro-organisms that live in the water or enter the water through point sources or nonpoint 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

Which of the following is defined as a community's ability to survive, adapt and thrive? 1. Community capital 2. Community development 3. Community organization 4. Community capacity

4. The more skills, assets, and strengths that a community has, the better prepared it is to achieve its goals.

Which method is used for controlling confounding by demographic variables like age in the analysis stage of epidemiologic studies? 1. Restriction 2. Matching 3. Randomization 4. Stratification

4.Stratification: During the analysis stage of a study, stratification can control for a third variable, such as age, confounding the observed relationship between an exposure, such as smoking, and an outcome, such as lung cancer. As the name implies, stratification involves creating strata, or groups, based on the third variable and comparing the rates of the outcome between the exposed and unexposed in each strata. For example, to control for confounding by age, we could compare the rates of lung cancer among smokers and non-smokers aged 30 - 39, 40 - 49, and 50 - 59.

May a state officer or employee of a regulatory agency concurrently conduct an outside (private) business or accept outside employment? 1.Yes, provided the outside business activity is unrelated to the area that he or she regulates. 2.No, any outside business engagement gives the appearance of unacceptable conflict of interest. 3.Perhaps, but only if the outside business engagement is approved by the agency's head. 4.There is no clear ethical standard - this is more a question of ability to manage both schedule

Correct answer: 1 A state officer or employee may conduct an outside (private) business or accept employment when there is no conflict of interest.

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

Correct answer: 1 After combining the data values from 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.

What is the next step when a baby has a positive result during newborn screening? 1. Follow-up testing to confirm the diagnosis 2. Evaluating the specimen handling 3. Referral to a specialist physician 4. Offering genetic counseling to the family

Correct answer: 1 Any positive result of a newborn screening test must be confirmed by additional diagnostic testing before any other steps are taken. Screening tests are different from diagnostic tests. The purpose of newborn screening is to identify indicators or risk factors of a disease in infants who otherwise seem healthy. Diagnostic tests determine whether a specific disease is absent or present. Screening tests tend to be highly sensitive in order to minimize the possibility of false negatives whereas diagnostic tests tend to be highly specific, minimizing the possibility of false positives.

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

Correct answer: 1 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

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

Correct answer: 1 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.

Which leadership theory advances the notion that one's task-relationship orientation can only be modified within certain limits and that structural and power factors will dictate whether you have a good leadership "fit?" 1. Contingency 2. Path-Goal 3. Transactional 4. Transformational

Correct answer: 1 Contingency Theory views effective leadership as contingent on matching a leader's style to the right setting. After the nature of a situation is determined, the fit between leader's style and the situation can be evaluated. Situational factors include leader member relations, task structure (degree to which tasks are clearly defined) and position power within the organization.

Waterborne diseases can result from fecal contamination. Which of the following would be classified as a waterborne disease? 1. Cryptosporidium parvum 2. Flavivirus 3. Plasmodium spp. 4. Borrelia burgdorferi

Correct answer: 1 Cryptosporidium parvum, colloquially referred to as crypto, is a waterborne disease that is a major cause of gastroenteritis worldwide. It is a protozoan parasite that is resistant to chlorination, making its control difficult. Flavivirus is a genus of viruses that includes mosquito-transmitted diseases such as Yellow Fever that are classified as water-related because part of disease's vector's lifestyle occurs in water. Plasmodium spp. is a family of parasites that causes malaria, which, like flavivirus, is water-related. Borrelia burgdorferi is a bacterial species that causes Lyme disease, the vector for which is the deer tick.

Which term below refers to the concept of confirming conclusions from qualitative data through multiple data sources, multiple methods, multiple theories, or multiple data collectors. 1. Triangulation 2. Systematic Review 3. Data Cleaning 4. Meta-analysis

Correct answer: 1 Data triangulation is when a finding or piece of data is verified with several different data sources or research methods. Triangulation adds credibility to findings (K4Health, n.d.).

Which of the following is an expected benefit of consolidating independent hospitals and provider groups into an integrated health care system? 1. Economies of scale in production 2. Lower costs of integration 3. Ease of accommodating diverse organizational cultures 4. Immediate gains in administrative efficiency

Correct answer: 1 Growth through mergers and acquisitions are typically justified on the basis of economic efficiencies achieved through enhanced economies of scale, an increase share of the relevant market by the integrated system, and greater revenues. However, the demands of implementation and maintaining a larger integrated system increase the administrative burden (and associated overhead costs). Accommodating different organizational cultures is a challenge faced by management in most corporate mergers and often is recognized as a root cause of failed mergers and acquisitions

Healthcare facilities share patient data through Health Information Exchange networks. Which of the following pairs address the definition of a covered entity among data recipients, and procedures for creating public use data sets de-identified of personal health information? 1. Health Insurance Portability and Accountability Act (HIPAA) and Safe Harbor conventions 2. Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA) 3. Safe Harbor conventions and the Consolidated Omnibus Budget Reconciliation Act (COBRA) 4. Health Information Technology for Economic and Clinical Health Act (HITECH) and Affordable Care Act (ACA)

Correct answer: 1 Healthcare facilities are legally required to report certain patient-identified data to regional and national public health agencies. National agencies, in turn, share certain data internationally with their counterparts. As this communication becomes more automated, various laws, regulations, and conventions were implemented to safeguard patient's personal health information. Choice A is correct in this example from the United States of America. HIPAA, and its regulatory interpretation through related Privacy and Security rules (see https://www.hhs.gov/hipaa/for-professionals/index.html for more information), define as "covered entities" the data recipients subject to privacy protection provisions specified in the Act, including requiring patient permission. HIPAA includes an exemption for public health reporting of limited data sets, which eliminates the requirement that patients grant permission on data sharing of certain information. Patient permission is also not required for sharing identifiable personal health information with public health agencies for certain essential public health activities such as investigations of child abuse or a person at risk of contracting or spreading a disease. Safe Harbor conventions have defined which data elements to delete to create de-identified patient data sets. The other federal Acts deal with other issues of access to healthcare insurance (ACA, COBRA) and promotion of electronic reporting systems (HITECH). Safe Harbor is international in its roots; ACA, COBRA, HIPAA and HITECH are unique to the United States. It is important to understand related laws and regulations in different countries because data travelling through the internet crosses jurisdictions where different approaches to privacy protection and national security can create conflicts. For example, federal and provincial Information and Privacy Commissioners in Canada required that health information of Canadians be stored in Canadian archives due to concerns about the U.S. Patriot Act. See Birnbaum D, Antonio MG, Loewen E, Gretsinger K and Lacroix P, Revisiting Public Health Informatics: Patient Privacy Concerns, currently under review (likely to be published in 2018) by the International Journal of Health Governance.

Measuring inputs, throughputs, outputs and outcomes of health systems is, to an increasing extent, relying on "big data" which is distinct from other data in terms of its: 1. Volume, velocity, variety, variability and veracity 2. Terabyte file size, proprietary ownership, encryption and cost 3. Storage in data warehouses isolated from internet access 4. Importance, validation, curation and credibility

Correct answer: 1 In 2015, Brownson et al. identified "big data" among the important "macro trends" impacting public health (Brownson, R.C., Samet, J.M., Gilbert, F., Chavez, G.F., Davies, M.M., Galea S., Hiatt, R.A., Hornung, C.A., Khoury, M.J., Koo, D., Mays, V.M., Remington, P. and Yarber, L. (2015). Charting a future for epidemiologic training. Annals of Epidemiology, 25, 458-465, available at http://www.annalsofepidemiology.org/article/S1047-2797(15)00086-1/fulltext). The implications of "big data" are discussed in the book Big Data, Big Challenges: A healthcare perspective (Househ M, Borycki E, Kushniruk A, eds., Springer, scheduled to be published in 2018). Volume, velocity, variety, variability and veracity distinguish "Big Data" from other data

Mortality rates by sex in the United States generally show the following sex differences in age-specific mortality rates: 1. Males have higher rates than females 2.Females have higher rates than males 3. Males have the same rate as females 4. Males have the same rate as females only in the first years of life

Correct answer: 1 Males generally have higher all-cause age-specific mortality rates than females from birth to age 85 and older. This trend occurs in many countries outside the United States, as well.

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.

Correct answer: 1 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.

The following test would be used to compare the frequency of diabetes between groups: 1. Chi-square goodness of fit test 2. Chi-square test of independence 3. Two independent samples t test 4. Analysis of variance

Correct answer: 2 A chi-square test of independence is appropriate because it can compare the proportions of participants in each category. The outcome of interest is diabetes status, a dichotomous variable, and interest lies in comparing diabetes between groups.

A distinctive foundation of the Comprehensive Unit-based Safety Program (CUSP) developed at Johns Hopkins and promoted by the Agency for Healthcare Research and Quality creates a culture of safety by focusing on: 1. detecting and reporting sentinel events 2. open attitudes and mutual respect 3. using standardized checklists 4. assuring professional expertise

Correct answer: 2 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.

In a box-and-whisker plot, if the median is displaced to near the left-edge of the box, the data distribution is best described as: 1. Symmetric. 2. Right skewed 3. Left skewed 4. Bimodal.

Correct answer: 2 For a right skewed distribution, the mean is typically greater than the median. The right hand side tail of the distribution will also be longer than the left

HACCP is a food safety system employed to: 1. Detect bacterial contamination in food after it happens 2. Identify and control problems that may cause foodborne illness before they happen 3. Isolate and identify bacterial pathogens from a foodborne illness outbreak 4. Set temperature limits for food containing eggs

Correct answer: 2 Hazard Analysis and Critical Control Points (HACCP) is a systematic, science-based approach to identify and control problems that may cause foodborne illness before they happen. The first step is to conduct a hazard analysis to identify all biological, physical, and chemical hazards associated with a food product. Next is to identify critical control points in food production where a measure can be applied to prevent, reduce, or eliminate a food safety hazard. Each measure applied at a critical control point must be grounded in an empirical parameter (such as setting limits on acceptable moisture level). Finally, there must be robust monitoring to assess whether the measures taken at each critical control point are effective and if corrective actions are necessary

In some cases of food bourne illness, Hemolytic Uremic Syndrome is caused by which organism? 1. Listeria 2. E. coli strain 0157:H7 3. Cryptosporidium 4. Salmonella

Correct answer: 2 Hemolytic Uremic Syndrome is the fatal condition that arises in a minority of cases of food-poisoning caused by E. coli O157:H7, often caused by eating contaminated foodstuffs.

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

Correct answer: 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 is are being met. Needs assessment help to identify the gap between what is and what should be

To inform a policy decision so that an intervention will result in the largest possible number of persons benefitted, which of the following statistics provides the most useful indication of the magnitude of exposure to a factor and subsequent development of disease? 1. Likelihood ratio 2. Absolute risk difference 3. Relative risk ratio 4. Prevalence rate

Correct answer: 2 Relative risk is the ratio of the probability of an event occurring in an exposed group to the probability of that event occurring in a comparison, non-exposed group. Dividing one group's rate by another in this manner is useful for identifying risk factors, but the ratio can be large whether the number of persons in each group is big or small, so relative risk is not a good estimator of caseload. Absolute risk difference is simply the difference in outcome rates, subtracting one group's rate from the other. It is a more useful indicator of caseload for managers and policy-makers. Likelihood ratios are more commonly used in relation to interpreting diagnostic tests. Prevalence rates alone can be more cumbersome and are not as informative as incidence rates for diseases that are not chronic. Studies have shown that people have more difficulty making accurate decisions when presented with ratios rather than risk differences (see Gigerenzer et al., "Helping Doctors and Patients Make Sense of Health Statistics", Psychological Science in the Public Interest, 2007;8(2):53-96; see Fahey et al., "Evidence-based Purchasing: Understanding the Results of Clinical Trials and Systematic Reviews", BR MED J 1995;31:1056-60).

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.

Correct answer: 2 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.

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

Correct answer: 2 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.

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

Correct answer: 2 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 United States, not Safe Harbor, defines the covered entities with which personal health data may be shared directly.

Which statement best describes the p-value? 1. The probability that the null hypothesis is true 2. The probability of rejecting the null hypothesis when it is true 3. The probability that a replicating experiment would not yield the same conclusion 4. The probability of rejecting the null hypothesis when it is false

Correct answer: 2 The definition of a p-value is the probability that a test statistic would be as extreme as, or more extreme than, observed if the null hypothesis were true. P-value is a statement of the probability that the difference was observed by chance if the groups were really alike, as stated under the null hypothesis.

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.

Correct answer: 2 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.

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

Correct answer: 2 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

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

Correct answer: 2 The three core functions of public health have been named as assessment, policy development and assurance, sometimes referred to 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.

If the chances of a second event occurring are the same as the chances of the first event occurring, regardless of the first event's outcome, then the two events are: 1. Equally likely 2. Independent 3. Indeterminate 4. Dependent

Correct answer: 2 Two events A and B are independent if the occurrence of one does not affect the probability of the occurrence of the other. An example of independent events would be pulling a 3 of hearts from a deck of cards and then pulling an ace from the same deck, after replacing the 3 of hearts. If A and B are not independent, they are considered dependent. An example of a dependent event would be pulling a 3 of hearts from a deck of cards and, without replacing the 3 of hearts, then pulling an ace from the same deck.

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.

Correct answer: 3 "In the context of public health assessment is the beginning of the continuum of problem identification, priority setting, strategic planning, intervention and evaluation. Assessment can be either internal, addressing processes within an organization, or external, addressing processes within the community."(p. 412).

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

Correct answer: 3 According to the systems theory, negative feedback loops are patterns of interaction where results to a change in an original element dampens or buffers its effect. Positive feedback loops on the other hand, are patterns of interaction where results to a change in an original element magnifies (reinforces) its effect, thus moving a system away from its equilibrium state.

If all of the numbers in a list increase by 2, then the standard deviation is: 1. Increased by 2 2. Increased by 4 3. Unchanged 4. Cannot be determined without the actual list of number

Correct answer: 3 Adding a constant number to a set of observations will not change the standard deviation of the set. Standard deviation is a measure of dispersion, meaning it expresses how spread out data are. Adding 2 to every observation will not change how widely spread the dataset is. It would however, increase the measures of central tendency, such as mean or median.

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

Correct answer: 3 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.

Can federal environmental laws allow States to make parallel environmental laws? 1. Yes, if more stringent than federal standards 2. Yes, if less stringent than federal standards 3. Yes, if no less stringent than federal standards 4. No, states may not make their own environmental laws where federal laws exist

Correct answer: 3 The Federal government conducts or funds research to determine appropriate environmental and health standards and then makes those the minimum standards. By not allowing states to set less stringent standards, the environment and public health are better protected.

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

Correct answer: 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 human immunodeficiency virus (HIV) infection. Public health interventions must adapt to changing demographics and epidemiology during challenges like this.

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

Correct answer: 3 This example is based on language from an actual order issued by the Virginia State commissioner of Health on November 11, 2016.

Given popularity of the phrase "evidence-based decisions", a member of a program advisory committee wants the next meeting's agenda to include a recent evaluation study published by an independent academic researcher. That study concludes that a government-guaranteed minimum annual income is the best solution to homelessness. The committee advises a program whose mandate is to oversee the operation of a health insurance program for children in families with income level lower than the federal poverty line. Should the study be added to the agenda? 1. Add the item - government programs are obliged to follow the lead of their advisory committee. 2. Add the item - decisions must follow the evidence if evidence points to a different allocation of resources. 3. Refrain from adding the item - one member is not a quorum. 4. Refrain from adding the item - it is not germane to program decision needs.

Correct answer: 4 Advisory committees are, by definition advisory rather than supervisory. Their meetings benefit from an agency clearly defining the questions on which it needs advice. Unless evidence being presented to inform policy discussion addresses those questions and its limits to interpretation are made clear, then it is a distraction rather than an asset. See Justin Parkhurst's 2017 book "The politics of evidence: from evidence-based policy to the good governance of evidence".

The "Greenhouse Gas" of primary concern in global warming is: 1. Chlorofluorocarbons 2. Carbon monoxide 3. Sulfur dioxide 4. Carbon dioxide

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

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.

Correct answer: 4 Effectiveness of communication strategies should be conducted, gaps identified and corrected. Google Analytics, for example, can be helpful to evaluate the frequency, duration, number of pages viewed, and domains from which a website has been visited. Surveys of target audiences, as well as focus groups, can help to understand linguistic and format preferences, as well as other influences on individual's perceptions. Here, there is enough information to detect a problem but not enough to diagnose its root cause(s).

To report on a program to local officials about the degree to which the program meets its ultimate goal and provides evidence for use in policy and funding decisions, what is needed? 1. Feasibility study 2. Cost analysis study 3. Process evaluation 4. Impact evaluation

Correct answer: 4 In order to plan the evaluation in accord with the most appropriate evaluation method, it is necessary to understand the difference between evaluation types. There are a variety of evaluation designs, and the type of evaluation should match the development level of the program or program activity appropriately. The program stage and scope will determine the level of effort and the methods to be used. An Impact Evaluation is defined as occurring during the operation of an existing program at appropriate Intervals such as at the end of a program. The Impact evaluation will reveal information about the degree to which the program meets its ultimate goal and provides evidence for use in policy and funding decisions

The primary disadvantage of incremental program budgeting is: 1. It makes comparison from one year to the next difficult 2. It requires the justification of all dollars allocated 3. It requires far more time and effort than zero-based budgeting (ZBB) 4. It may not reflect the current programmatic priorities of the organization

Correct answer: 4 Incremental budgeting does allow for easy year-to-year comparisons (A), does not require last-dollar justification (B), and requires a considerably lower investment than fully implemented zero-based budgeting (ZBB). The major deficiency of traditional incremental budgeting approaches is that they do not necessarily reflect program-based allocation of resources or organizational priorities among programs.

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

Correct answer: 4 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.

Which of the following survey items best assesses an individual's socioeconomic status in terms of increasing validity and response rate? 1. Income in the past month 2. Highest level of education attained 3. Eligibility for public assistance 4. Perception of economic insecurity

Correct answer: 4 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.

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

Correct answer: 4 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.

Social marketing is the use of marketing principles to influence human behavior in order to improve health. Which one below is NOT one of the 4 P's of social marketing? 1. Price 2. Promotion 3. Place 4. Process

Correct answer: 4 The four P's of social marketing is Price, Promotion, Place, and Product.

Which of the following strategic planning tools is in the form of a 2x2 table? 1. Gantt chart 2. Network diagram 3. Precede Proceed model 4. SWOT chart

Correct answer: 4 There are two planning tools that take the form of a 2x2 table: the Johari Window and the SWOT chart (also called SWOT matrix or SWOT analysis). SWOT stands for Strengths, Weaknesses, Opportunities and Threats. They are useful at the initial planning stage. The Precede Proceed model is a more complex model for cost-benefit evaluation, developed by Lawrence Green in 1974. Network diagrams and Gantt charts take the form of a railroad-type map and a matrix; they are used in program management to ensure a project stays on schedule.

Which statement best describes the role of public health professionals in government employ with respect to authoring manuscripts about their work for publication in peer-review journals? 1. Since, as government employees, they cannot sign copyright releases to publishers they cannot submit manuscripts as authors. 2. The role of government health departments does not include research nor writing for journals. 3. Conflict of interest and ethics rules allow public health department employees to write for government publications but not for-profit journals. 4. It is challenging to find the time and gain necessary internal clearances, but sharing lessons learned through such publication is an important aspect of professionalism.

Correct answer: 4 While it is true that professionals in government employ are not free to sign copyright over to a publisher, publishers offer licensing agreements in lieu of copyright agreements specifically to enable government employees as authors. Historically, universities have supported their academic public health professionals to obtain grants, conduct research and submit resultant papers for publication whereas the main mission of public health departments has been service. Finding the time to do background research, having limited access for review of previous publications, writing, gaining internal approvals, then dealing with manuscript submission, have been a challenge for public health department professionals. However, this is changing as more realize that peer-review journals are an important communication channel to share lessons learned among the global community. (D) is correct.

Which of the following are the three ethical principles outlined in the Belmont Report? 1. Beneficence, liberty, and risk reduction 2. Justice, beneficence, and respect for people 3. Quality, respect for people, and ethical treatment 4. Justice, respect for people, and integrity

Justice, beneficence, and respect for people 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.

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 or proportion of LEP residents within each district, 2. The frequency with which LEP individuals come into contact with VDH programs, 3.The nature and importance of the program, activity or service provided by the recipient to its beneficiaries, and, 4. The resources available to the grantee/recipient and the costs of interpretation/ translation services (http://www.vdh.virginia.gov/omhhe/CLAS/language-needs-assessment/)." 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

cultural competence

defined as the ability of public health professionals to effectively deliver services that meet the social, cultural, and linguistic needs of individuals. Learning to communicate with patients, families, communities, and fellow professionals in a culturally competent manner helps to reduce disparities and promote enhanced health and wellness. (Gebbie et al., 2003) Ample evidence exists documenting the role of cultural competence in addressing health disparities (Betancourt et al., 2003; Brach & Fraser, 2000; Goode et al., 2006). 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.