CPH Exam Study Guide

A type _____ error is the probability of rejecting the null hypothesis when the null hypothesis is true.

1

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.

1

Based upon experience of the most successful and visionary organizations, for a new program what is the most important step in building an effective staff? 1. Hire people who fit the culture of the program. 2. Consistent disciplinary action to shape team performance. 3. Regularly scheduled extra-curricular team-building retreats. 4. Very detailed policy and procedure manuals.

1 According to several research studies by Jim Collins, getting the right people in the right seats is more important and effective than later efforts to motivate or discipline employees. Knowing who is right for the culture requires well-defined corporate core values. His books and monograph ("Built to Last", "Good to Great", etc.) explain this in more detail.

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

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.

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.

The five categories plotted on the bell shaped curve of the diffusion of innovations theory indicate that people adopt new products, ideas and practices at 1. Different rates 2. The same rate 3. Very high rates 4. Very low rates

1. According to Everett Rogers, people adopt new practices, products and ideas at different rates. In his theory, five adopter categories exist; innovators (2.5%), early adopters (13.5%), early majority (34%), late majority (34%) and laggards (16%). These categories can be plotted on a bell-shaped curve.

A state epidemiological unit has received several notifications about a potential influenza outbreak. The notification referred to high school students having a fever of 101.5 degrees Fahrenheit or higher accompanied by cough, sore throat, headache or muscle ache in the last week. The content of this notification illustrates which of the following epidemiological tools for effective outbreak investigation: 1. case definition 2. PICO(T) 3. PRISMA 4. syndrome identification

1. Case definition: "A case definition includes criteria for person, place, time, and clinical features. These should be specific to the outbreak under investigation" (https://www.cdc.gov/urdo/downloads/CaseDefinitions.pdf). PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analysis (http://prisma-statement.org). PICO (or PICOT) is a mnemonic used to describe the four elements of a good clinical question: patient/problem; intervention; comparison, and outcome (and time)

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)

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. NOTE: RECHECK THIS REFERENCE IN DECEMBER TO CONFIRM PUBLICATION.

The Dartmouth Atlas of Healthcare demonstrates that small area variations in Medicare expenditures across geographic areas are primarily attributable to differences in: 1.Physician practice styles 2.Consumer preferences for high-cost services 3.Age of the population served 4.Health status of the population served

1. The small area variations in Medicare expenditure that are observed in the Dartmouth Atlas of Healthcare are attributable to differences in how physicians practice medicine. The Dartmouth Atlas of Healthcare found wide variations in the frequency that various medical care treatments occurred in different areas of the United States. Additional research has shown that these variations are likely not associated with differences in health status, patient age, or consumer preferences, but rather with the practice styles noted and with the supply of physicians in different areas. Research on small area variations has supported the development of clinical practice guidelines.

A type _____ error is the probability of failing to reject the null hypothesis when the null hypothesis is actually false

2

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

2

The best multi-platform software product to support public health field investigators who want a program on their portable device capable of generating survey questionnaires and analyzing survey data is: 1. Excel 2. Epi-Info 3. R 4. SPSS

2

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

2

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

2 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 (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

Societies have fostered discrimination against certain communities in various ways. Policy makers must address this to move toward health equity. One theory, which explains the reinforcing feedback loop of poor housing quality, lesser paying jobs, poor education and poor health outcomes, may be summarized as: 1. Social Epidemiology 2. Institutional racism 3. Structural racism 4. Causative factors

2 As a result of institutional racism, racial stratification and disparities have occurred in employment, housing, education, healthcare, government and other sectors. While many laws were passed in the mid-20th century to make discrimination illegal, major inequalities still exist. Institutional racism is distinguished from the bigotry or racial bias of individuals by the existence of systematic policies and practices within institutions that effectually disadvantage certain racial or ethnic groups.

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

2 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 management/leadership theory which posits that when staff are able to grow and develop staff performance results are better, is an example of: 1. Situational Leadership Theory 2. Douglas McGregor Theory Y 3. Contingency Leadership Theory (CLT) 4. Path-goal Theory

2 Path-goal theory of leadership maintains that the leader can affect the performance, motivation, and satisfaction of followers Contingent Theory involves the adoption of management style to meet the needs of all personnel Douglas McGregor Theory Y assumption that employees are highly motivated to do the work Douglas McGregor Theory X employees are generally not satisfied with work and are motivated by salary alone

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

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

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 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.

Which of the following water-borne disease organisms is very difficult to kill by chemical disinfection of drinking and/or recreational water supply systems and has caused major US disease outbreaks? 1. Vibrio cholerae (causes cholera) 2. Cryptosporidium (causes Cryptosporidiosis) 3. Giardia lamblia (causes Giardiasis) 4. Escherichia coli (causes acute gastroenteritis)

2. Protozoa of the genus Cryptosporidium are highly resistant to chlorine disinfection, and are responsible for numerous and increasing waterborne disease outbreaks. The largest waterborne disease outbreak in US history, which occurred in Milwaukee, Wisconsin in 1993, was caused by contamination of the city's drinking water with this organism; over 400,000 residents became ill. Contact with contaminated recreational waters, such as in swimming pools, is a particularly common source of exposure. Giardia is another chlorine-resistant parasite, but it has not been associated with large-scale outbreaks.

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.

3

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 "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

Which of the following statements regarding disease measures is correct? 1. Incidence equals duration times prevalence 2. Prevalence is a rate 3. Cumulative incidence is a proportion 4. Incidence density is a proportion

3 Cumulative incidence is a proportion because it expresses the number of people who develop a condition as the numerator and the number of people at risk for the condition in the denominator, thus fulfilling the requirements of a proportion. Proportions are a type of ratio in which the numerator is included the denominator. A rate, conversely, expresses the number of cases of a disease as a numerator and the total units of time as the denominator. Prevalence is expressed as incidence times duration, thus it is also a proportion. The numerator for incidence density is "number of cases" and the denominator is "person-time," thus representing a rate and not a proportion.

What level of government typically provides the oversight and guidance to prioritize public health needs and resources that focuses program planning and evaluation? 1. Public Health Department Program Management 2. Public Health Department chief executive officer 3. Board of Health 4. Legislature

3 Local or state boards of health play a key role with responsibilities and authorities defined by statute. This includes oversight, guidance and in some cases actual policy- and rule-making. A public health department's top administration is accountable to its respective board of health.

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

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.

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.

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 instructors.

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.

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

3. Selecting a policy, program or initiative that has the least direct cost without doing any estimation of possible benefit(s) might satisfy those who only believe in small government, but answer (C) is weak justification. Cost-benefit at least considers whether fiscal value of benefits could outweigh costs; cost-effectiveness identifies which of several options produces the most benefit for the least expenditure; and cost-utility analysis adds weighting of financial benefit in terms of perceived desirability of such benefits to recipients.

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

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

To help lay, professional and policy audiences understand the rationale for a program proposal, it is best to: 1. provide everyone with the same report, written in plain language aimed for a Grade 10 reading level. 2. recognize that policy or professional audiences prefer to see benefit or risk projections as ratios, lay audiences prefer them expressed as number-needed-to-treat or harm. 3. present a comprehensive literature review, summarize all the numbers in one table and let the facts speak for themselves. 4. tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience.

4

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

4

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.

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

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.

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.

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".

For a disease such as liver cancer, which is highly fatal and of short duration, which of the following statements is true? 1. Mortality rates will be much higher than incidence rates 2. Incidence rates will be much lower than prevalence rates 3. Incidence rates will be much higher than mortality rates 4. Incidence rates will be approximately equal to mortality rates

4. Incidence rates measure the number of new cases of a disease that emerge in an at-risk population within a window of time. When expressed as a fraction, the numerator is the number of new cases that emerge. The denominator is the number of people in the at-risk population during that same window of time. Mortality rates measure the number of deaths in a population within a specific window of time. The numerator is the number of deaths that occur and the denominator is the number of people in the population during that window of time. Highly fatal diseases, such as liver cancer, have a short duration because as new cases are added to a population, they are quickly resolved through death. Thus, the numerator for both measures of incidence and mortality will be roughly the same if the window of time is the same.

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

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.

U.S. mandates Creutzfeld-Jacob disease, a prion disease to be nationally notifiable from all the states. What kind of infectious agent is a prion? 1.A bacterium 2.A virus 3.A protozoan 4.A protein

4. Prions are the infectious agents that cause spongiform encephalopathies such as "Mad Cow Disease" and new variant Creutzfeld-Jacob disease (nvCJD). They are simple proteins that adopt a different three-dimensional shape in diseased individuals. The Prion and Public Health Office within DHCPP fulfills CDC's responsibilities as the lead agency for monitoring the occurrence of human prion diseases in the United States. The office coordinates CDC's activities and programs related to prion diseases as well as to select neurological diseases and syndromes of unknown etiology.

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

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.

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 acidity of the food 4. does not change

4. Viruses can only grow in living cells and will not multiply under these circumstances.

According to the transtheoretical model of change, as individuals go from pre-contemplation to maintenance, "con" behavioral beliefs decrease and "pro" behavioral beliefs increase. This process is best described as which of the following? Adecisional balance Bself-liberation Creinforcement management Dself-efficacy

A

An appropriately tailored intervention message most importantly should: A) Take into account characteristics of the target population B) Be designed through community organizational strategies C) Meet the criteria established by the funding agency D) Be designed and tested by colleagues and experts in the field

A

Most funding for nursing home care in the United States comes from which of the following sources? AMedicaid BMedicare Cout-of-pocket Dprivate insurance

A

Public health agencies should be aware of how to communicate the role of public health with external stakeholders. What is the role of public health agencies when communicating with external stakeholders? A) To promote the agency and engage in advocacy B) To promote favorable legislation C) To provide STI tests and keep the public safe D) To provide vaccinations

A

Researchers are seeking a spokesperson for a health communication campaign to promote breast cancer screening for low-income women. To ensure the strongest effect of the campaign on the target group, the researcher should select a spokesperson who shares which of the following characteristics with the target group? Apersonal attitudes Bethnic background Clevel of knowledge Dsocioeconomic status

A

The best use of clinical practice guidelines is as an: A) indication of the best diagnostic and treatment practices based on the best available evidence. B) enforceable standard of care against which deviations should be detected and corrected. C) 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.

A

The management of a health care facility requires staff to adhere to ethical principles and provide culturally appropriate care. The institutionalization of these values is most likely to influence which of the following aspects of health care provided by this facility? Aacceptability Baccessibility Caccountability Dadequacy

A

The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is to: A) Subject a proposed major project or action to a comprehensive environmental review study B) Ensure that an important industrial project or action is constructed C) Ensure that the environment is protected at all cost D) Achieve sustainable development while relieving communities concerns

A

Which of the following historical events raised awareness of the need for the protection of research subjects and resulted in the 1947 creation of the International Code of Ethics for research? ANazi human experimentation BWillowbrook hepatitis studies Cpublication of the Belmont Report DTuskegee Syphilis Study

A

A study is conducted to compare colorectal screening rates in white and African-American men. Researchers contact 50 white men and 50 African-American men older than 50 years of age by telephone and ask them if they have undergone colorectal screening. Fifty-five percent of white men and 49% of African-American men report undergoing appropriate screening. Which of the following tests is the most appropriate method of analysis of the survey data? Apaired t-test BPearson chi-square (X2) test Ctwo-sample t-test DSpearman correlation test

B

Approximately how many local health departments are there in the United States? A890 B3,000 C10,600 D59,000

B

HACCP is a food safety system employed to: A) Detect bacterial contamination in food after it happens B) Identify and control problems that may cause foodborne illness before they happen C) Isolate and identify bacterial pathogens from a foodborne illness outbreak D) Set temperature limits for food containing eggs

B

Literacy advocates in the U.S. recommend that for health promotion materials to be effective, they should be written at which of the following reading levels? A2nd-4th grades B6th-8th grades C10th-12th grades Dcollege level

B

Which of the following is the equation for Return on Investment (ROI)? A. Cost of Investment / Financial Return B. (Financial Return - Cost of Investment) / Cost of Investment C. (Financial Return + Cost of Investment) / Financial Return D. Financial Return / Cost of Investment

B

Which of the following statements best describes an intent-to-treat analysis? A. dermal absorption of particulates and gaseous emissions B. inhalation of particulates and gaseous emissions C. ingestion of agricultural products that have accumulated settled particulates D. ingestion of drinking water that has accumulated settled particulates

B

Which of the following terms best describes the power of a local jurisdiction to independently regulate public health, safety, and welfare? Aunionism Bhome rule Cpreemption Dself-administration

B

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? A) Environmental equity B) Environmental justice C) Environmental pollution D) Environmental democracy

B

______ 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

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: A) Positive feedback loop B) Outflow effect C) Negative feedback loop D) Inflow effect

C

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with states to implement national environmental standards such as NAAQS? A) By creating a memorandum of understanding focusing on cost-sharing of environmental burdens B) By establishing air quality monitoring stations C) By using a State Implementation Plan (SIP) approved by the EPA D) By funding risk assessment studies that provide a basis for the NAAQS for any criterion pollutant

C

Can federal environmental laws allow States to make parallel environmental laws? A) Yes, if more stringent than federal standards B) Yes, if less stringent than federal standards C) Yes, if no less stringent than federal standards D) No, states may not make their own environmental laws where federal laws exist

C

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. A) They practice transparency in advancing Zika research B) They demonstrate beneficence, a core public health ethical principle C) They provide strategic leadership in leading local and international solutions D) They demonstrate their competence in Zika research

C

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

C

It is expected that the program will continue serving 250 community members. To maintain program fidelity, which of the following is the best option for making the budget cuts? AAsk the community to provide meeting space as an in-kind contribution. BRequire participants pay for the workbook costs to indicate their commitment. CReduce FTE support for personnel because less material development time is necessary. DRemove the incentives for participants because the ongoing program has been effective.

C

On the basis of the present evidence, the greatest reduction in injuries and death related to motor vehicles in the United States is most likely to be a result of which of the following? Aincrease in law enforcement and highway patrol officers Bstricter motor vehicle inspection laws Cmodifications to vehicles and highway systems Dstiffer penalties for drunk drivers and repeat speeders

C

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: A) Police powers prohibit states from defining standards of care and required the federal government to do so B) Standards of care are implied by police powers but implementation is left to the states C) Police powers permit each state the right to define and delegate authority and responsibility for public health services D) States use police powers to fund public health services only through property taxes, and these vary from state to state Explanation

C

The theory of reasoned action is a model of health behavior targeted at which of the following levels? Acommunity Bglobal Cindividual Dorganizational

C

Which of the following is the most important limitation in the use of vital statistics data for public health research? ABirths and deaths that occur outside of institutions are not recorded. BData collected vary substantially from state to state. CData files are not readily available to people collecting data outside the agency. DVariables of research interest may not be collected.

C

Which of the following organizations accredits local public health departments? AAmerican Public Health Association BCenters for Disease Control and Prevention CPublic Health Accreditation Board Dstate licensing boards

C

Which of the following types of leadership would be most helpful in an organization experiencing rapid change? Aservant BTheory X Ccontingency Dtransactional

C

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: A) Hazardous waste B) Suspended Solids C) Biochemical Oxygen Demand (BOD) D) Sludge

D

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

D

To ensure successful collaboration and partnership, as well as effective use of resources, a public health professional needs to identify key stakeholders in a new project. Which of the following will determine if an organization is truly one of the key stakeholders for this initiative? AThe organization regulates the public health professional's work. BThe organization previously partnered with the public health professional. CThe public health professional's relationship with the organization is static. DThe public health professional can clearly identify what is needed from the organization.

D

Which of the following essential public health services is an assurance practice? A. analyzing the determinants of identified health needs B. investigating the occurrence of health effects and hazards in the community C. building constituencies in the community D. informing and educating the public

D

Which of the following most accurately describes an organizational design that applies to independent units that are joined by a shared administrative overlay, such as a county government? Aadhocracy Bmachine bureaucracy Cprofessional bureaucracy Ddivisionalized bureaucracy

D

The four P's of public health marketing services include:

Product, price, place, and promotion

Data _______ is when a finding or piece of data is verified with several different data sources or research methods. ________ adds credibility to findings

Triangulation

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 ________ in clear and meaningful language.

budget request

Compulsory vaccination poses a potential ethical dilemma primarily because of which of the following? A. the scope of authority of legislators vs. the medical credentials of lobbyists B. the benefit of the vaccine vs. the risks associated with the vaccine C. the patient's right to refuse treatment vs. the right for a society to protect itself D. the universal availability of a vaccine vs. the financial incentives within the supply chain

c

_________ is the proportion of cases of a disease or condition that are fatal within a specified period of time.

case fatality ratio

______ is the mortality rate from a specified cause for a population

cause-specific mortality rate

Cultural ________ is defined as the ability of public health professionals to effectively deliver services that meet the social, cultural, and linguistic needs of individuals.

competence

Government employees still have constitutional rights as individuals, so generally can exercise those rights so long as there are no _________ implications that lead to the appearance of bias or abuse of privilege in their role as a government official.

conflict of interest

______ the number of deaths in a given period divided by the population exposed to risk of death in that period

crude mortality (death) rate

epidemiological triad

host, agent, environment

Live attenuated vaccines are prepared by growing live pathogens under conditions that induce mutations in the pathogen that reduce its virulence, but not its ________. There is a small, but definite, risk that the pathogen can undergo reversion mutations.

immunogenicity

________ 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 ________ approaches is that they do not necessarily reflect program-based allocation of resources or organizational priorities among programs.

incremental budgeting

_______ analysis is a method for analyzing results in a prospective randomized study where all participants who are randomized are included in the statistical analysis and analyzed according to the group they were originally assigned, regardless of what treatment (if any) they received.

intention to treat

Environmental _____ encompasses equity, as well as equality and fairness

justice

Ingestion of _____-polluted water by infants under 6 months of age can cause the formation of potentially fatal levels of methemoglobin in their red blood cells. Methemoglobin restricts the ability of the cells to carry oxygen to the tissues, and although adults are generally ________, "methemoglobinemia" can be fatal to the infants. Methemoglobinemia produces a characteristic blue tint in the tissues due to oxygen deficiency (cyanosis), hence the name "Blue-Baby Syndrome."

nitrate, unaffected

An _______ is the probability that an event will occur divided by the probability that it will not occur. Since probabilities cannot be ______, a negative odds ratio would indicate computational ______.

odds ratio, negative, error

______ powers may be used by states to promote laws in the interests of the general welfare and health of society. States retain discretion over the content and scope of such laws, provided they are not found to violate constitutional rights, and this leads to differences in how such policies are implemented at the state and local level.

police

_______ is typically the first step in the policy process. The second step is ______. The next step is ______. The fourth step is ______. The fifth step is _______ and the final step of the policy process is _______

problem definition, agenda setting, policy making, budgeting, implementation, evaluation

________ 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

proportionate mortality ratio

A test with 95% ______ and 90% ______will, from a population with the disease, detect the disease in 95 people out of 100.

sensitivity, specificity

_______ is the proportion of truly diseased people in the screened population who are identified as having the disease by the screening test. Probability of correctly diagnosing a case or the probability that any given case will be identified by the test, _______________

sensitivity, true positives

_______ is the proportion of truly non-diseased people who are so identified by the screening test. Probability of correctly identifying a non-diseased person with the screening test, _________

specificity, true negatives

According to the ______ theory, _______ feedback loops are patterns of interaction where results to a change in an original element dampens or buffers its effect. ______ 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.

systems, negative, positive

_____ Leadership occurs where a leader influences another through a reciprocal relationship or an exchange of things of value to advance both of their agendas.

transactional

_____ communicates what your organization believes are the ideal conditions for your community. An organization's __________ describes what the group is going to do, and why it's going to do that. _______ refer to specific measurable results for the initiative's broad goals. ______ and quantities provide means of measurement and comparison for goals and objectives.

vision, mission statement, objectives, numbers