CPH Exam

Which of the following terms means that a tumor has spread to other locations within the body?

Metastatic

degrees of freedom

(#row-1)(#columns-1)= (r-1)(c-1)

inequity

- unfair and unjust - unnecessary and avoidable

universal intervantions

designed for all segments of population (large audience)

cost

resources require to provide good/service

rate ratio

(rate of outcome in exposed, E+)/ (rate of outcome in unexposed, E-) = the rate of outcome in exposed is X times the rate of outcome in E- Ex) RR= 50/20= 2.5 the rate of outcome in the exposed is 2.5 times the rate of the outcome in the unexposed

external validity

the extent to which the results of a study are applicable to broader populations (generalizability); do the study results apply to other patients? - Representative sample drawn from population (usually randomly) - Individuals have equal chance to participate in the study - High participation rate - Inference is made back to the population- but still may not apply to other populations

Environmental Impact Statement (EIS)

a document that describe the impacts (positive/negative results from activity) on the environment (natural and physical/relationship of people within; includes land, water, air, structures, living organisms, environmental values at the site, and the social, cultural, and economic aspects) as a result of a proposed action; also describes impacts of alternatives as well as plans to mitigate (lessen/remove) the (negative) impacts. -The National Environmental Policy Act (NEPA) specifies this must be prepared; must include discussion of a proposed action and the range of reasonable alternatives/sufficient information for reviewers to evaluate the relative merits of each alternative - Council for Environmental Quality (CEQ) regulations provide the recommended format and content

civil law

actions intended to protect the public health and welfare

Absolute measures of impact (AMIs)

address questions about public health impact of an exposure; excess risk in exposed individuals in reference to the population (if this many people smoke, we need this many more resources)

1964 Surgeon General's Report

alerted the nation to the health risk of smoking; Luther Terry issued report

Public health professional oath

protect/promote PH of public integrity, trust of public ethical responsibilities service fundamentals protect disenfranchised

stakeholders

providers, payers (insurers), employers, patients different views/interests when developing developed resources = greater share

Power

(1- β=1-type II error) rate at which test correctly rejects how often don't you make a type 2 error; HA (alternative) is true= REJECT H0

Microbial Waterborne Disease

(1880s) typhoid killed 100/100,000 in US annually; (1885) 90,000 people were victims in Chicago, caused Chicago to divert sewage from Lake Michigan; (today) 3 mil young children die of waterborne diarrheal diseases, directly related to lack of adequate sewage disposal facilities

direct age adjustment

(direct standardization) is used to remove the effects of age structure on mortality rates in 2 different populations --> apply actual age-specific rates (states) to standard population (US population)

strategies for ensuring program sustainability

- Build community and organizational capacity in management, advocacy, fundraising, training, etc. - Utilize simple, user-friendly materials and tools - Involve community members in every step of the program - Develop, implement, and institutionalize cost-recovery mechanisms - Develop, implement and institutionalize quality assurance and self assessment tools - Build on pre-existing structures - Develop program leaders and "champions" - Encourage cross-community learning

Interpretation of RR/OR (point estimate)- 2 x 2 contingency table

1= no association > 1 = positive association (if do have risk factor, odds of outcome increase) < 1 = negative association (if have risk factor, odds of outcome is lower)

Scores of a certain exam for a group of students were normally distributed with a mean of 100 and standard deviation 20. Based on the information provided what is the percentage of students who scored between 80 and 120? 1) 0.5 2) 0.68 3) 0.75 4) 0.95

2) 0.68 Based on the (68-95-99 percent rule) of normally distributed data that states that 68% of values are within 1 standard deviation, 95% are within 2 SD, and 99% are within 3 SD

population attributable risk

= Risk in population - unexposed looking at entire population, how much excess is there due to this exposure; should resources be allocated for controlling exposure, or instead to exposures causing greater health problems in the population

Institutional Review Board (IRB)

A committee at each institution where research is conducted to review every experiment for ethics and methodology; created after Tuskegee experiments Human subjects research is research involving a living individual about whom an investigator (whether professional or student) conducting research obtains data through intervention or interaction with the individual, or Identifiable private information. This type of research requires obtaining either a waiver or an approval from an IRB prior to the initiation of the study.

Learning organizations theory

A description of organizations that facilitate learning by its members and continuously transforms itself. Systems thinking approaches are the conceptual basis for understanding the organization in its environment, and provides a basis for other key characteristics, namely a process of learning (personal mastery), the challenging and building of mental models, and the development of a shared vision and team learning.

value-based insurance design (VBID)

A feasible and effective approach to better aligning expenditures with patient-centered outcomes structures consumer cost sharing around the idea of clinical nuance, which recognizes that the value of medical services depends on who receives it, who provides it, and where it is provided. This nuanced strategy supports the goals of equity by reducing financial barriers to specific services for targeted populations who need them most. This approach can also be used to deter the use of services when there is low or no expected clinical benefit to the patient. addresses financial barriers to treatment, and there are myriad other access barriers that contribute to health inequities.

LaLonde Report

Canada, predated Healthy People reported, shifted focus to chronic disease approach vs. infectious disease approach, health promotion activity apart of public health agenda

To compare educational attainment, measured with the categories, "some high school," and "High school degree, GED, or more," which of the following tests would be appropriate?

Chi-square test of independence appropriate test to compare the proportions of participants in each category of educational attainment, which is expressed as an ordinal variable.

McGregor's Theory X of Human Motivation

Classical approach- employees are generally not satisfied with work and are motivated by salary alone employees are generally not satisfied with work and are motivated by salary alone employees motivated exclusively by salaries (minimum amount of work); don't need additional training beyond function; little prep (one job); easily replaced

Delany Amendent

Food Additive Amendment (1958) use of animal to human data- carcinogen if causes cancer in any animal specifics at any level of exposure (sues smaller doses now)

Type II error (β)

HA (alternative) is true= Do not reject H0 CORRECT= Reject H0 (null) when HA (alternative) is true; Do not reject H0 when H0 is true

health informatics

HIPAA confidentiality ability to access information

Interpretation RR/OR CI (precision)

If value of 1 is included in CI, then RR/RR is not significant, otherwise it is significant OR = 1.5 with 95% CI = [1.2, 2.1] is signicant at  alpha= 0.05. RR = 1.2 with CI = [0.7, 1.3] is not because it contains 1.

The exposure standard for lead in children has been lowered over the years because even small amounts can result in:

Impaired cognitive development

Innovation (or change management) history

Innovation or change management history aims to generate knowledge about a system by compiling a systematic history of key events, intended and unintended outcomes, and measures taken to address emergent issues. It involves in-depth interviews with as many key stakeholders as possible to build an understanding of the performance of the system from a number of different points of view.

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:

Institutional racism refers to the unjust and discriminatory mistreatment of an individual or group of individuals by society and its institutions as a whole, through unequal selection or bias, intentional or unintentional; as opposed to individuals making a conscious choice to discriminate.

Passive (corrective)-avoidant leadership

Laissez-faire and Passive management by exception Takes corrective action only after a problem becomes significant and obvious (retrospective).

Count data, such as the number of events occurring in a specified period of time, are often described by which probability distribution?

Poisson

Type I Error (α)

Reject H0 (null), when H0 is true Significant level of the test, standard value is α=0.05; Okay with making type I error 5% of time when null hypothesis is true CORRECT= Do not reject H0 (null) when H0 is true; Reject H0 when HA (alternative) is true

relationship between sensitivity and specificity

Sensitivity and specificity measure the ability of a test to correctly identify diseased and non-diseased people - lowering criterion of positivity results in increased sensitivity - making criterion of positivity more stringent increases the specificity, but at the expense of decreased sensitivity - goal is to have high sensitivity and high specificity, but this is often not possible/feasible

Income, interpersonal stress, and education level are all examples of ____________, which determine the overall health, and quality of life of our communities.

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

Process mapping

Stock and flow diagrams are quantitative system dynamics tools used for illustrating a system that can be used for model-based policy analysis in a simulated, dynamic environment. Stock and flow diagrams explicitly incorporate feedback to understand complex system behavior and capture non-linear dynamics.

SWOT assessment

Strengths Weaknesses Opportunities Threats

Declaration of Helsinki

The World Medical Association's international ethical guidelines for medical professionals researching human subjects

Punctuated equilibrium (in social theory)

Theory inspired from evolutionary biology to explain long periods of stasis interrupted by rapid and radical change, particularly as applied to the evolution of policy change or conflict.

Rocky Mountain, spotted fever and Lyme disease are examples of diseases transmitted by:

Ticks Other tick-borne diseases in the US include erlichiosis, Q-fever, relapsing fever, tularemia, and tick paralysis.

Can federal environmental laws allow States to make parallel environmental laws?

Yes, if no less stringent than federal standards 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.

May a state officer or employee of a regulatory agency concurrently conduct an outside (private) business or accept outside employment?

Yes, provided the outside business activity is unrelated to the area that he or she regulates. A state officer or employee may conduct an outside (private) business or accept employment when there is no conflict of interest.

information bias

an error that arises from systematic differences in the way information on exposure/disease is obtained from the study groups; results in participants who are incorrectly classified as either exposed/unexposed or as diseased or not diseased; occurs after subjects have entered the study 1. interview bias 2. recall bias 3. misclassification

ecological study

at least one variable, which can be the exposure or the outcome, is measured at the group level and not the individual level

Water purification

basic steps of raw water treatment 1. Sedimentation- incoming raw water maintained in a "quiet pond" for settling out 2. Coagulation- hydrate aluminum sulfate is added to the water to cause the suspended solids to form flocs which precipitate 3. Filtration- through beds of sand, Arthracite or Diatomaceous Earth 4. Disinfection- Chlorine, Ozone, or UV light; disinfection is utilized to kill pathogens in the water

concordant pairs

both case and control exposed or both not exposed

Proportionate mortality ratio

calculated as the number of deaths due to a specific disease within a population divided by the total number of deaths in the population. - of all deaths, the proportion caused by a certain disease - can determine leading causes of death; "one of every four deaths in the U.S. id due to cancer" (1/4; 25%) - doesn't tell us the risk of dying from disease

discordant pairs

case exposed/control unexposed or cases unexposed/ control exposed

Veterans Act (1924)

codifies and extends federal responsibilities for health care services to veterans, who receive aid if they are injured in the line of service.

charges

consumer asked to pay (surplus revenue/ profit); for profit to investors

National Research Act

creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Commission goal: ID basic ethical principles guiding the conduct of research with human subjects.

contingency table

data organized test for proportions want to know if the frequency of categories of one variable depend on the categories of another; if the distribution of a categorical dependent variable differs based on levels of a categorical independent variable Ex) 3x3 contingency table - ethnicity (white, black, other) vs. hemoglobin levels (categorized <10, 9-9.9, <9), is race and hemoglobin levels independent/not associated (H0) or dependent/ associated (HA)?

long-term outcomes

decreased rates of disease, disability, death, or disparity

chi-square test for independence

determine if there is a significant relationship between two nominal (categorical) variables. The frequency of each category for one nominal variable is compared across the categories of the second nominal variable

variable cost

difference in price depending

hypergeometric distribution

discrete probability distribution that describes the probability of successes in draws, without replacement, from a finite population of size that contains exactly objects with that feature, wherein each draw is either a success or a failure (trials are not independent)

RE-AIM Model

encourages translating an effective program to practice 1. Reach (of program)- how do I reach the targeted population intervention? 2. Effectiveness (of program)- how do I know my intervention is effective? 3. Adoption (by large number of diverse settings)-How do I develop organizational support to deliver my intervention? 4. Implementation (with fidelity)- How do I ensure the intervention is delivered properly? 5. Maintenance (through institutionalization or by becoming part of organizational policies and practices)- How do I incorporate the intervention so it is delivered over the long term?

Toxic Air Contaminants (TAC); Hazard Air Pollutants (HAPs)

everything else emitted into air that's not a CPA and for which there's some regulatory concern

independent variable

exposure/factor of interest; control variables

Confounding variable

extraneous variable that distorts the true effect of the independent variable (exposure) on the dependent variable (outcome)

2+ DV, 0 IV, interval & normal

factor analysis

false positive

falsely identify healthy people as diseased; poor specificity

wants

form that a human needs takes as shaped by cultural and individual personality (ie bread)

six stigma road map

goal no more 3.5 mil deficits per million opportunities 1. define- build project from nonconformance feedback, audits 2. measure 3. analyze 4. improve/design (define, measure, analyze, improve, control) 5. control/verify (define, measure, analyze, design, verify)

The local health jurisdiction is seeking governmental funding to address breast cancer which has a lower incidence rate in group X than in group Y, though group X has a higher mortality rate. This is an example of:

health disparity the difference in health status between two groups.

managed care

health maintenance organization flat fee for entire continuum of care, minimize cost, promoting good health

Asbestos

human carcinogen; for lung cancer, the effect of tobacco smoking in combination with asbestos exposure appears to be synergistic by approximately 5-fold - Sources: heating insulations, acoustic insulation, floor/ceiling tiles, shingles - Can get into deep lung, penetrate, reside there

demands

human wants backed by buying power (ie money) ; what willing to pay for

interaction model

in regression model, include multiplicative term (independent variable x gender)

Key informant interviews

in-depth interviews with people who have informed perspectives about the topic or community you're working with.

short-term outcomes

increased knowledge, improved attitudes and beliefs, and increased skills

Autocratic leadership

individual control over all decisions and little input from group members; typically make choices based on their ideas and judgments and rarely accept advice from followers; absolute, authoritarian control over a group.

outcome evaluation

investigates effect of the program on short-term outcomes, intermediate outcomes, and long-term outcomes

internal validit

is the extent to which the results of the study accurately reflect the true situation of the study population, is influenced by: bias/ random error

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)

Social Cognitive Theory (SCT)

learning process as determinant of health; individuals learn from own experiences and by watching behaviors and attendant behavior consequences of others reciprocal determinism- behavioral, interpersonal+ environmental events/factors interact as determinants of each other

retrospective study

looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study

Nominal variables

lowest level of information; categorical variables values have no inherent order, values only used to distinguish categories e.g. sex- male female; race/ethnicity- white, black, Hispanic

Environmental Tobacco Smoke (ETS)

major source of indoor air contaminants; 4,000 chemicals (toxic/carcinogenic) in vapor/particle phases - "Sidestream" smoke and exhaled "mainstream" smoke (secondhand smoke) - EPA lists as known

relative measures of impact (RMIs)

measure of proportion of risk that can be attributed to exposure

Lucrezia Borgia

mother of toxicology dangerous poisons in jewelry

2+ DV, 2+ IV, interval & normal

multivariate multiple linear regression

benign tumor

not malignant and so does not grow in an uncontrolled manner or invade nearby tissues.

dependent variables

outcome of interest

fixed cost

paying same every time

capital budget

plans for the acquisition of high-value, long term (>1 yr) assets ex) construction/remodeling; new (big) equipment

fixed/closed population

population with permanent membership ex) people present at Hiroshima, passengers on an airplane, Nurses health study

dynamic/open population

population with transient membership (can grow) ex) population of Omaha, Nebraska

Secondary prevention strategies

prevention services delivered at the earliest stages of disease to identify and detect disease and provide prompt treatment. Ex) screening for cancers, heart disease, diabetes, lead exposure, TB, HIV, mental illness, and substance abuse

financial management

resources available to organization for implementation info used to improve decision making; management of sources/ uses of resources within an organization

Consolidated Omnibus Budget Reconciliation Act of (COBRA, 1985)

signed into law by President Ronald Reagan, mandates an insurance program giving some employees the ability to continue health insurance coverage from their workplace after leaving the job. In addition, hospice care is made a permanent part of Medicare and extended to states for Medicaid.

Total Quality Management (TQM)

structured approach to overall organizational management. The focus of the process is to improve the quality of an organization's outputs, including goods and services, through continual improvement of internal practices.

ecological fallacy

suspected risk factor and disease are associated at population level but not at the individual level

screening

the application of one or more tests to determine those likely to have the disease from those unlikely to have the disease; two-step process (screening followed by diagnosis) Ex) mammography- breast cancer, fecal occult blood test- colon cancer, pap smear- cervical cancer, x-ray- lung cancer, BP-HTN, blood sugar- diabetes, prostate specific antigen- prostate cancer - not error free; fail to identify some individuals with disease/falsely identify some without disease as needing further testing

Hemolytic Uremic Syndrome

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.

percentile

the kth percentile is the value where k% of all other values fall below Ex) if you score in the 90th percentile on a test, that means you did better than 90% of people who took the exam 1st quartile= 25th percentile 2nd quartile= 50th percentile (median) 3rd quartile= 75th percentile

randomized community trial

type of experimental study where the intervention is allocated to entire communities. This type of trial can be randomized or nonrandomized.

Criteria Air Pollutants (CAP)

typical components of smog and include chemicals emitted in large quantities and from many sources (CO, Pb, NO2, O3, PM, SO2); pollutants which EPA established National Ambient Air Quality Standards (NAAQS) *worry about the most

chi-square goodness of fit test

want to know if distribution is normal; does the sample you have come from hypothesized distribution (eg. Normal distribution, normality assumption necessary for validity) used to determine whether observed sample frequencies differ significantly from expected frequencies specified in null hypothesis. Ex) is a 6-sided dice fair? Count the number of 1s, 2s, etc. observed, compare observed and expected (assuming a fair die) using chi-square test For continuous data, divide data into intervals then compare observed and expected using chi-square test

dose response curve for acute toxicity

x-axis= dose y-axis= response (% mortality) range= difference between LD0 and LD50 (target)

decision making functions of management

1. Planning- deciding in advance what is to be done 2. Organizing- developing intentional patterns of relationships among people and other resources (those involved with provisions) 3. Staffing- acquiring, maintaining, and retaining human resources (replacing based on retirement) 4. Directing- (implementation) initiating work in organization 5. Controlling- regulating activities in accordance with peers

Formative evaluation

To "test" various aspects of the program. Does it make sense and is it applicable? Typically takes place prior to program implementation or early on in the process; done to identify program strengths and weaknesses in order to guide improvement. The goal is to provide feedback on strengths and areas of improvement for the program, or program materials, as well as explore overall applicability and feasibility of the project. Ex) Determining whether to continue or modify but not terminate a program is a reasonable objective Ex) Focus Groups with target audience for a program that is in development at a local community center A brief "pen and paper" survey of participants in a pilot educational program on sexual health for teens to understand what program features they liked and what could be improved. One-on-one interviews with current users of a prescription drug to review an informational brochure on medication compliance for content, applicability and ability to produce a call to action Qualitative, quantitative, or a mix of both methods can be used in either of these.

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(n):

Negative feedback loop

intermediate outcomes

behavior change

health disparities

higher burden of illness, injury, or mortality experienced by one group or population relative to another poorer health outcomes for groups experiencing discrimination/ exclusion because of: - gender - age - race/ethnicity - education/income - geographic location - disability - sexual orientation

Relability

overall consistency of a measure; are similar results produced under similar conditions - Measure has high reliability if similar results are produced under similar conditions - High reliability does not necessary mean the measure is accurate, i.e. not necessarily valid

correlation coefficient (R)

parameter that represents the strength of linear relationship between two continuous variables (ranges between -1 and 1) - Positive= variables are positively correlated (upward trend; as one variable increases, other increases) - Negative= variables are negatively correlated (downward trend; as one variables increase, other decreases) - If 0= variables are uncorrelated (no association)

Agent-based modeling (ABM)

ABMs are used to create a virtual representation of a complex system, modeling individual agents who interact with each other and the environment. Although the interactions are based on simple, pre-defined rules, in a complex system these simulations allow for the identification of emergence and self-organization

Health Impact Pyramid

CDC Factors that affect health 1. Socioeconomic factors 2. Changing the context (to make individual's default decisions health) 3. Long-lasting protective interventions 4. Clinical interventions 5. Counseling and education

Biochemical Oxygen Demand (BOD)

most common measurement of pollutant organic material in water; when bacteria act upon organic sewage, large amounts of dissolved O2 is used up; this can result in fish kills and drastic alteration in aquatic environment - Low BOD- good water quality - High BOD- polluted conditions

risk difference

most often referred to as "attributable risk"; refers to the amount of risk attributable to exposure of interest Ex) in the birth cohort analysis, where exposure= prenatal care in the first 5 months--> RD= R1 (exposure)- R0 (non-exposure)= excess risk of preterm birth attribute to prenatal care (exposure)

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

1) Contingency 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.

Public Health Assessment

Developed by the Agency for Toxic Substances and Disease Registry (ATSDR) for evaluating the public health implications of exposures to environmental contamination. Evaluates data and information on the release of hazardous substances into the environment in order to assess any past, current, or future impact on public health, develop health advisories or other recommendations, and identify studies or actions needed to evaluate and mitigate or prevent human health effects

needs assessment

Investigates the extent of the problem, its consequences, and subgroups of people or places affected by the problem. methods: - key informant interviews - community forum - agency records - community indicators from public datasets - community surveys

The Tuskegee Syphilis Study

To learn more about the "natural course" of syphilis, from 1932-1972, the US Public Health Service left infected study participants (comprised of poor black men) untreated. This resulted in pain, blindness, infertility, and death, as well as transmission of the disease to partners and children this is a sentinel public health event because of these ethical violations and resulted in The Belmont Report The US PHS were found to be in violation of various ethical considerations: the participants were deceived about the rationale and process of the study; there was no informed consent; treatment was withheld. The study went on for 40 years, when these egregious actions were brought to light. In response to this, the National Research Act of 1974 and the Belmont Report which identifies basic ethical principles that should underlie human subjects research.

criminal law

conduct prohibited by government because it threatens and harms public safety and welfare

Relief of Sick and Disabled Seaman (1798)

marks the beginning of federal involvement in health care; treatment for marines for infectious disease (hospital services)

standardized mortality ratios (SMR)

observed deaths/expected deaths

selected interventions

targets sub group with higher than average risk + target

Informed consent should avoid

technical jargon

Chi-square (X2) test

used to test for proportions (frequency of categories); statistic computed from observed and expected counts; interpret is there is an association between independent and dependent variables

Cost-effectiveness analysis

- Estimates costs and outcomes of interventions. - Expresses outcomes in natural units (e.g., cases prevented, lives saved) - Compares results with other interventions affecting the same outcome.

z-score / test

(standardized score) used with normal distribution z= (x-μ (observation-mean))/(σ (std.deviation)) Equality of binomial proportions (z-test)- if you have proportions Standard normal variable- can transform any normal variable into standard normal variable normal distribution with mean 0 and variance 1 (standard normal distribution); use when you don't know variance for hypothesis testing sample z-test- statistical method testing the difference in population means between two groups when population variance is KNOWN

health

(who) state of complete physical, mental and social well-being and not merely absence of disease/infirmity

Health Insurance Portability and Accountability Act (HIPAA, 1996)

- Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs - Reduces health care fraud and abuse - Mandates industry-wide standards for health care information on electronic billing and other processes - Requires the protection and confidential handling of protected health information - Promotes medical savings accounts and improves access to long-term care services and coverage

code of ethics for public health

- clarifies distinctive elements of PH and ethical principles that follow - makes clear to population and communities the ideals of PH institutions that serve them - serves goal to guide PH institutions and practitioners - standard to which held accountable - relatively brief; not designed to provide means of untangling convoluted ethical issues communicate to general population ideas, set goals, minimum means to help standardize work through complex issues

inequality

- difference in condition, rank - lack of equality as of opportunity, treatment or status

limitations of clinical trials

- ethical considerations (can't randomize all exposures, i.e making one group drink alcohol) - select population (generalizability) - duration (disease progression) - adherence/compliance (drop out; required effort)

limitations of cohort studies

- expensive - slow to find answers (time-consuming); time to disease after exposure - associations may be due to confounding (true with any observational study) - exposures assessed at baseline may be incomplete (didn't collect information on other factors) - disease with long pre-clinical phase may not be detected (people may already have disease but we think they do not have the disease; people who shouldn't be in the study are in the study; any cases not included in the first year) - sensitive to follow-up bias (loss of diseased subjects; loss to follow-up); quit, don't want to be in the study; can't analyze data; disease out of study

septic system

- liquid wastes deliberately discharged into the ground 1. Septic tank- buried in ground, connected by a pipe (30% of US households; Salmonellosis, Hepatatis A, and Typhoid Fever have been traced to well water contaminated by sewage) 2. Soil absorption field/sand filter - sewage tank is partially decomposed by bacteria - solids settle to the bottom of the tank; lighter solids grease and gas rise to the top; liquid passes to absorption field via perforated pipes - every 3-5 years, one must have the solids pumped

Kaplan Meier estimator/curve

- method used in practice survival curves are estimated as a step function (step curve) - anytime there is step down, it means at least one event occurred at that time - 100 percent incident free/event free, at certain point someone experiences the event, then percentage of people who are incident free drops down over time, this continues until end of study - step is higher when more than one person experiences the event - If everyone experiences the event, step curve will end at 0 - estimated curve usually does not decrease all the way down to zero, because the data are censored before every subject experience the event

case control vs. cohort studies

- more efficient for rare disease (cohort more efficient with rare exposures) - can evaluate multiple exposures - less expensive (asking someone to think back in time whether than having to follow them throughout many years) - can get answers more quickly - challenges of control selection (how to select the correct control group) - challenges of retrospective exposure assessment (self-report data; report bias/forgetfulness)

environmental prevention measures

- promotion of safe household water storage and better hygienic measures - use of clearer and safer fuels - increased safety of built environment - more judicious use and management of toxic substances in home/workplace - better water resource management

confidence interval (CI)

- represents a range of values around an estimate of population parameter, which indicates amount of uncertainty associated with estimated population parameter - Narrow= pretty good idea of what mean value is - CI and hypothesis test have equivalent information; use same data with the same concepts; i.e. if the null value (H0) is in the CI, then the test will not reject (not significant) - Ex) if 95% CI for mean = [10, 15], any value between 10 and 15 are 'good' estimates for the population mean (can't definitively say CI estimate actually contains the true population mean/parameter of interest) if we were to repeatedly construct similar CI's using different samples from the same population, about 95% of those intervals will cover the true parameter (sampling from same population can create different group of people and different CIs)

primary sewage treatment

- sewage has human feces, urine, laundry waste, bathing, garbage grinding, and dishwashing water (often contains sand, gravel, baseballs, leaves, sticks, dead rats, etc.) - Publicly Owned Treatment Plant (POTW) - removal of larger suspended solids through screening and sedimentation - grinders to reduce solids to uniform size - sedimentation tanks- solids and sludge dried and disposed - removes 50-65% of suspended solids; BOD is reduced by 25-40%

strengths of cohort studies

- used to define incidence/ natural history - known temporal sequence (exposure came first; disease itself didn't change behavior) - efficient in investigating rare exposures; can narrow focus on certain people of interest - permits study of multiple exposures AND outcomes

operating budget: 1) revenue 2) expenses 3) surplus/profit 4) deficit/loss

1) forecast of resource inflows into the organization 2) resources that an organization uses up carrying on activities 3) excess of revenues over expenses 4) excess of expenses over revenues

National Ambient Air Quality Standards (NAAQS)- 2 types of standards established by Clean Air Act

1) "Primary" standards- sets limits to protect public health, including the health of "sensitive" populations such as asthmatics, children, and the elderly 2) "Secondary" standards- set limits to protect public welfare, including protection against decreased visibility and damage to animals, crops, vegetation, and buildings

1) right censored 2) left censored 3) interval censored

1) (most survival data) we know when the survival time starts, but do not know when or if the event occurs (can only analyze data until end of study) 2) data occur when the start of the survival period is unknown (e.g. the survival time of an HIV patient may start at infection, but the person cannot enter the study until he/she first test positive); starting observing them but time of event could have happened before 3) data occur when the exact time of the event is unknown within the interval, this occurs in studies where subjects are monitored continuously (don't have clear count when event occurred; lost track of actual time)

1 DV, 1 IV with 2 levels (independent groups) 1) interval & normal 2) ordinal/interval 3) categorical

1) 2 independent sample t-test 2) Wilcoxon-Mann Whitney test 3) Chi square test/ Fisher's exact test

A short narrative or statement that describes the general focus and purpose of a program is called: 1) A mission statement 2) A long-term goal 3) A long-range plan 4) An objective

1) A mission statement A mission statement is correct because it takes into account a "short narrative or statement" and is focused on the intent of the program. A goal is more global and broader in its expectations, and a program objective is specific and measurable.

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

1) Be neutral 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.

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

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

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

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) Economies of scale in production 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. that the cost per unit decreases as more units are produced. fixed costs can be spread over more units, reducing per unit costs. Higher volumes also permit greater specialization of staff

The incidence of bacteria that are resistant to antibiotics is: 1) Increasing 2) Decreasing 3) Staying the same 4) Difficult to measure

1) Increasing The spread of antibiotic-resistant bacterial infections is a major Public Health concern in the 21st century

High level of nitrates in groundwater are of particular concern in rural communities that rely on well water because: 1) Nitrates can cause "Blue-Baby Syndrome" in infants 2) Nitrates are potent carcinogens in adults 3) The well water will be undrinkable due to taste, odor, and color problems 4) The well water will form nitric acid and become corrosive to metal pipes in the water system

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

The sensitivity of a particular screening test for a disease is 95%, and the specificity is 90%. Which of the following statements is correct? 1) Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease 2) Of 100 people sampled from a population with the disease, the test will correctly detect 90 individuals as positive for the disease 3) If a person tests positive, the probability of having the disease is 0.95 4) If a person tests positive, the probability of having the disease is 0.90

1) Of 100 people sampled from a population with the disease, the test will correctly detect 95 individuals as positive for the disease A test with 95% sensitivity and 90% specificity will, from a population with the disease, detect the disease in 95 people. Sensitivity is the proportion of truly diseased people in the screened population who are identified as having the disease by the screening test. It measures the probability of correctly diagnosing a case or the probability that any given case will be identified by the test (e.g., true positives). Specificity is the proportion of truly non-diseased people who are so identified by the screening test. It is a measure of the probability of correctly identifying a non-diseased person with the screening test (e.g., true negatives).

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

Policy

1. Formulation 2. Implementation 3. Modification (address concerns)

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

1) Sanctioning individuals for mistakes is the most appropriate method for ensuring effective quality of care This is the only correct response because the current quality management paradigm considers the primary source of errors, waste, and other indicators of poor quality to be poor system design and ineffective processes rather than individual incompetence or carelessness. Deming and others regard the sanctioning of individuals for poor quality to be misplaced and likely to aggravate the problem.

The objective of the National Environmental Policy Act of 1969 and its equivalent at the State level is to: 1) Subject a proposed major project or action to a comprehensive environmental review study 2) Ensure that an important industrial project or action is constructed 3) Ensure that the environment is protected at all cost 4) Achieve sustainable development while relieving communities concerns

1) Subject a proposed major project or action to a comprehensive environmental review study Before the National Environmental Policy Act, there was no requirement for a systematic study of the environmental effects of a proposed project. Thus, projects could be executed with little or no regard to the environmental effects. Poor environmental stewardship was apparent in many cases, for example, in disposal of hazardous waste and groundwater contamination. The significant environmental movement of the 1960s pressured Congress to pass the National Environmental Policy Act to promote developments that are in harmony with environmental protection. This approach is executed by ensuring that the environmental effects of a proposed major Federal action or project are studied, understood, and mitigated as much as possible and that better alternatives to a proposed project are preferred.

An appropriately tailored intervention message most importantly should: 1) Take into account characteristics of the target population 2) Be designed through community organizational strategies 3) Meet the criteria established by the funding agency 4) Be designed and tested by colleagues and experts in the field

1) Take into account characteristics of the target population As defined by Kreuter and Wray, targeted communication is intended to reach a segment of the population that shares specific characteristics, while tailored communication is intended to reach a specific individual. Both strategies increase the effectiveness of interventions and are premised on acquiring in-depth familiarity with the audience before the message is created, tested, and disseminated. Otherwise, the message will be meaningless to the target population.

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? 1) To promote the agency and engage in advocacy 2) To promote favorable legislation 3) To provide STI tests and keep the public safe 4) To provide vaccinations

1) To promote the agency and engage in advocacy Longest & Rohrer (2005) recommend that public health agencies can systematically acquire information from other agencies by engaging in three of the commonest features. These involve promoting the agency, advocacy and social marketing.

Exposure assessment attempts to answer all of the following questions except: 1) Toxicity of the exposure 2) Frequency and duration of exposure 3) Population exposed 4) Route of exposure

1) Toxicity of the exposure Exposure assessment is not concerned with the toxicity of the exposure. It is concerned with a population's contact with a contaminant and aims to quantify their exposure by assessing the magnitude, frequency, and duration of an exposure; the route of exposure (e.g. inhalation, ingestion, or dermal); and which segments of the population may have been exposed.

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

1) Volume, velocity, variety, variability and veracity data sets that are too large or complex for traditional data-processing application software to adequately deal with. Data with many cases (rows) offer greater statistical power, while data with higher complexity (more attributes or columns) may lead to a higher false discovery rate. 1. Volume- ability to ingest, process and store very large datasets (generated by machine, network, human interactions on system etc.) 2. Velocity- Speed of data generation and frequency of delivery. The data flow is massive and continuous which is valuable to researchers as well as business for decision making for strategic competitive advantages and ROI. For processing of data with high velocity tools for data processing known as Streaming analytics were introduced. Sampling data helps in sorting issues with volume and velocity. 3. Variety- from different sources/types; structured (well defined class of info/rules to frame, ie MRI images, money, dates) vs. unstructured (express ideas and thoughts based on human understanding, ie picture, a voice recording, a twee) creates problems for storage, data mining and analyzing the data 4. Variability- establishing if the contextualizing structure of the data stream is regular and dependable even in conditions of extreme unpredictability; defines the need to get meaningful data considering all possible circumstances. 5. Veracity- speed of data generation and frequency of delivery. 6. Value- purpose, scenario or business outcome that the analytical solution has to address.

1) good" ozone vs. 2) "bad" ozone

1) absorbs UV-B radiation and protects the earth from excess amounts of damaging rays (blocking hole) 2) (VOC + NOx + Heat + Sunlight= Ozone) principal component of smog; it's created by a chemical reaction between oxides of nitrogen (NOx) and volatile organic compounds (VOC) in the presence of heat and sunlight; result of combustion (on ground near us)

1 DV, 1 interval IV 1) interval & normal 2) ordinal/interval 3) categorical

1) correlation/ simple linear regression 2) non-parametric correlation 3) simple logistic regression

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) develop a list of possible service venues and proposals to secure financial support, and present them to the Commissioner's office. Since the upper chain of state health command has ordered dental service closure, consultation with the Commissioner's office will be needed to assure compliance with legislative directives and fidelity to state health department policy. The likelihood of support from the state-level is greater if it is well-defined and sustainable options are presented.

1) local environment 2) global environment

1) environment on sub population closet to exposure (e.g. water/air) 2) effect of unbounded environment (e.g. air) on population anywhere

1 DV, 2 or more IVs (independent groups) 1) interval & normal 2) ordinal/interval 3) categorical (2 categories)

1) factorial ANOVA 2) ordered logistic regression 3) factorial logistic regression

3. 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) indication of the best diagnostic and treatment practices based on the best available evidence. 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 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) inherent in privacy by design at all stages. Privacy by design is not a new principle, but under Guide to the General Data Protection Regulation (GDPR) became a legal requirement.

1) for profit vs. 2) not for profit

1) investor owned; people engaged, looking for financial award by putting $ in advance for services 2) not non-profit; qualified based on mission; no financial gain, based on financial gain through investments; use their excess money to pay their members who do work for them. Non-profit= religious/ charitable welfare for society; don't pay taxes; deduction for contributions

1) negatively (left) skewed 2) positively (right) skewed

1) more observations towards end (mode), less towards beginning (mean < median) 2) - more observations towards beginning (mode), less towards end (mean > median)

1 DV, 1 or more interval IVs and/or 1 or more categorical IVs 1) interval/normal 2) categorical

1) multiple regression/ analysis of covariance 2) multiple logistic regression/ discriminant analysis

1 DV, 0 IVs (1 population) 1) interval & normal 2) ordinal/interval 3) categorical (2 categories) 4) categorical

1) one-sample t-test 2) one-sample median 3) binomial test 4) chi-square goodness of fit

1 DV, 1 IV with 2 or more levels (independent groups) 1) interval & normal 2) ordinal/interval 3) categorical

1) one-way ANOVA 2) Kruskal Wallis 3) Chi-square test

2+ DV, 1 IV with 2 or more levels (independent groups), interval & normal

1) one-way MANOVA

1 DV, IV with 2 or more levels (dependent/matched groups) 1) interval & normal 2) ordinal/interval 3) categorical (2 categories)

1) one-way repeated measures ANOVA 2) Friedman test 3) repeated measures logistic regression

1 DV, 1 IV with 2 levels (dependent/matched groups) 1) interval & normal 2) ordinal/interval 3) categorical

1) paired t-test 2) Wilcoxon signed rank test 3) McNemar

disease causation 1) sufficient cause 2) necessary cause

1) precedes the disease; if the cause is PRESENT, the disease ALWAYS occurs 2) precedes the disease; if the cause is ABSENT, the disease CANNOT occur

adult learning theory

1. Adults need to be involved in the planning and evaluation of their instruction. 2. Experience (including mistakes) provides the basis for the learning activities. 3. Adults are most interested in learning subjects that have immediate relevance and impact to their job or personal life. 4. Adult learning is problem-centered rather than content-oriented. Assumptions: 1. Self-Concept- As a person matures his/her self concept moves from one of being a dependent personality toward one of being a self-directed human being. 2. Adult Learner Experience- As a person matures he/she accumulates a growing reservoir of experience that becomes an increasing resource for learning. 3. Readiness to Learn- As a person matures his/her readiness to learn becomes oriented increasingly to the developmental tasks of his/her social roles. 4. Orientation to Learning- As a person matures his/her time perspective changes from one of postponed application of knowledge to immediacy of application. As a result his/her orientation toward learning shifts from one of subject- centeredness to one of problem centeredness. 5. Motivation to Learn- As a person matures the motivation to learn is internal

impact of toxicity effected by

1. Age- older/younger more vulnerable ; usually function of body system + ability to metabolize foreign chemicals (microsomal enzyme system) 2. Sex- physical and physiological differences; usually a function of hormone activity; castration/hormone administration can limit differences Ex) male rats are 10x more sensitive to liver damage than female rats from chronic oral exposure to DDT

CDC's 10 essential public health services

1. Assessment- monitor/ diagnosis 2. policy development- inform, educate, empower, mobilize, community partnerships, develop policies 3. Assurance- evaluate, assure competent workforce link to/provide care

ethical principles

1. Beneficence (doing good to others including moral obligation), nonmalefience (non-harming or inflicting the least harm possible to reach a beneficial outcome) 2. Justice 3. Autonomy- freedom from external control or influence; independence 4. Respect for individuals, respect for community 5. Utility- actions/behaviors are right in so far as they promote happiness or pleasure, wrong as they tend to produce unhappiness or pain

Primary drinking water contaminants

1. Chlorinated solvent- industrial pollution, degreasing and machine maintenance, manufacturing intermediates; cancer 2. Trihalomethanes (THMs)- produced by chemical reactions in water with chlorine; liver and kidney damage, cancer - Most common (primary) disinfection by product (DBP)- resulting unintended chemical reaction when chlorine added to water with humic substances; in high doses, known to cause liver and kidney disorders, CNS problems, birth defects, and cancer 3. Lead (Pb)- old pipes and solder in water systems; nerve problems, learning disabilities, birth defects, cancer - Drinking water is major route of lead exposure; EPA estimates that more than 40 million Americans are drinking water over the legally permissible level of lead - 50 ppb - Introduced in home plumbing through Pb pipes or when Pb solder was used (putting pipes together); before 1930- Pb pipes; after 1930- copper pipes with Pb solder - problem when water is corrosive i.e. low pH/ when water pipes are used for electrical ground (accelerates the corrosion of Pb in pipes) 4. Polychlorinated biphenyls (PCBs) - wastes from manufacturing operations (industrial areas); liver damage, cancer 5. Bacteria and viruses- leaking septic tanks, overflowing sewer lines; GI illness, serious diseases (meningitis)

Public Health Model for Prevention

1. Economic Impact/Cost of Illness (problem identification)= Estimates total costs incurred because of a disease or condition (Costs of medical resources to treat disease/ non-medical resources to treat disease; Loss in productivity) 2. Cost-analysis (program and policy development)= cost-minimization (selecting a policy, program or initiative that has the least direct cost without doing any estimation of possible benefit); cost-benefit (considers whether fiscal value of benefits could outweigh costs); cost-effectiveness (identifies which of several options produces the most benefit for the least expenditure); cost-utility analysis (weighing of financial benefit in terms of perceived desirability of such benefits to recipients) 2. Economic evaluation (program/policy evaluation; implementation/ dissemination)= systematic identification, measurement and valuation of the inputs and outcomes of two alternative activities, and the subsequent comparative analysis of these; identify the best course of action, based on the evidence available.

measures of association for case-control studies

1. Exposure Odds Ratio (EOR or OR) 2. Risk Ratios (RR)

risk assessment process

1. Hazard identification- understand what the risk is 2. Toxicity assessment- Dose/response 3. Exposure assessment 4. Risk characterization Additional (generally used clinically) 5. Risk management 6. Risk communication

Community Health Practice

1. Identify stakeholders- program sponsor, decision makers, organization, individuals affected by program --> advisory board for research project have person from each group apart of decision making 2. Community mobilization-a collective efforts by groups and community members to increase awareness about problem and advocate for change 3. Community assessment- mapping community assets, identifies community capacity for addressing community needs - needs assessment (strengths/ resources) - Surveillance (morbidity/mortality/national Vital Statistics System) - Behavioral factors (BRFSS) - social economic, environmental (Directory of social determinants of health) 4. Community-based participatory research (CBPR)- partnerships with community members + research/dissemination; shared decision making

Policy Process

1. Problem definition 2. Agenda setting 3. Policy making 4. Budgeting 5. Implementation 6. Evaluation

Social Marketing (P's)

1. Product- behavior, program, technology (service) 2. Price- cost of adoption ($/social cost) 3. Place- where the product available/promoted (operating hours) 4. Promotion- how to promote first 3 (convince service to pursue) 5. People- how services provided; mini clinics; staff required; attitudes

Logic Model

1. Resources (inputs)- what resources are available to conduct program activities? 2. Activities- what are program staff doing to accomplish program objectives? 3. Outputs- what are the direct/immediate results of program activities (materials produced, services delivered, etc.)? 4. Outcomes- what are the intended effects of the program activities?

measures of association for cohort studies

1. Risk/Rate/Hazard Ratios (RR) 2. Disease Odds Ratios (DOR or OR)

SMART objectives

1. Specific- well defined/detailed 2. Measurable- (analyze) quantifies impact 3. Achievable/attainable - feasible within given time frame/available resources 4. Relevant/Realistic- correspond with overall goals and consider constraints 5. Time-Bound- (focused, discrete, directive) has time-frame for when it will be met and/or measured

hierarchy of evidence

1. Systematic Reviews and Meta-analysis 2. Randomized controlled trials 3. Cohort studies 4. Case control studies. 5. Case series, case report 6. Editorials, expert opinions

human resources goals

1. attract 2. reward (salary) 3. educate 4. empower (authority) 5. motivate 6. train

governance staff

1. board of directors (BOD)- group of people elected/ appointed to oversee organization role in defining overall policies retiring mission 2. executive director- day to day implementation 3. line- individuals who direct actions that advance organization core function/work 4. staff- assist to line personnel in activities

odds ratio used to estimate the Relative Risk in case control study when

1. cases are representative of people with the disease in the population with respect to history of exposure AND 2. the controls are representative of the entire study population ("source population") with respect to history of exposure AND 3. the disease is rare (< 10% have it) When the disease is rare, the number of people with the disease (a+c) is small so that a+b≈b and c+d≈d *for most case-control studies, we do not know the incidence of disease because we determine the number of cases and controls when the study is designed, we don't really know the underlying cohort

common elements among planning models

1. community involvement and mobilization 2. needs assessment (community/organization levels) 3. select of specific target audiences 4. SMART objectives 5. action plan development/implementation 6. evaluation of program processes and outcomes 7. institutionalization

main diseases influenced by poor enviornment

1. diarrhea 2. lower respiratory infections 3. unintentional injuries 4. malaria

typical environmental exposures

1. fire byproducts (particulates, PAHs, CO) 2. heavy metals (lead, mercury, palladium, cadium) 3. industrial chemicals (PCBs, Dioxin, Toxaphene, VOCs, Phthalates, Adipates, PBDEs, and many others) 4. chlorination byproducts (chloroform, bromoform, etc.) 5. vehicular emissions (CO, ozone, particulates, benzne, etc.) 6. pesticides (DDT, mirez, 2,4-D, Atrazine, Malathion, etc.)

different structure organization models

1. function- director of organization based on 2. geography- organization based on location 3. client- organization based on who is served 4. purpose- organization against specific services 5. matrix organization- divided using more than one models, multiple responsibilities across different domains, more complex 2 bosses- planning, resources, communication, finance; support 2 different ways; used to improve performance

important variables influencing employee motivation

1. individual characteristics - interest - attitudes (toward self, job, aspects of work situation) - needs (security, social, achievement) 2. job characteristics - types of intrinsic rewards - degree of autonomy - amount of direct performance feedback - degree of variety in tasks 3. work environment characteristics - immediate work environment (peer/supervisors) - organization action (reward practice, systemwide rewards, individual rewards, organizational climate)

government sectors

1. local- variation, community based health departments ex) National Association of City & County Health Officers (prevention, promotion, protection) 2. state- more focused, based on population/resources 3. federal- record keeping (birth, death certificates) ex) Centers for Disease Control & Prevention (CDC) 4. private sector (non-government) ex) coke, industrial safety, research (pharmaceutical companies)

Planned Approach to Community Health (PATCH)

1. mobilizing the community 2. collecting and organizing data 3. choosing health priorities 4. developing a comprehensive intervention plan 5. evaluation

essential public health services

1. monitor health status 2. diagnose + investigate 3. inform, educate, empower 4. mobilize community partnerships 5. develop policies and plan 6. enforce laws and regulations 7. link people to needed services 8. assure competent work force 9. evaluate effectiveness, accessibility, and quality 10. research for new insights

national health expendtiures

1. private health insurance 2. medicare 3. medicaid/CHIPs 4. other public spending 5. out of pocket payments 6. other private spending services: 1. hopsital care, 2. physician/clinical services 3. other professional services (PT) 4. Retail- Rx drugs 5. investment; net cost of health insurance 6. other health, residential and personal care; nursing home care 7. Home health care; retail other products 8. Gov admin

how a bill becomes a law

1. propose 1 or 2 houses- assigned to committee 2. goes to house 3. president (sign, 10 days without signature in session, veto - 2/3 house/senate can override)

CDC top 10 achievements in PH

1. vaccination 2. motor vehicle safety 3. safer work place 4. control of infectious diseases 5. decline in deaths from coronary heart disease and stroke 6. safer and healthier foods 7. healthier mothers and babies 8. family planning 9. fluoridation of drinking water 10. recognition of tobacco use as a health hazards

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

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

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

2) Consulting stakeholders to decide what best serves public interest The three 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.

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) Creating maximum benefit for all while minimizing individual harm 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.

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

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) Decrease in number of children age 0-2 with vaccine preventable disease 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 1 and 4 are examples of program activities or OUTPUTS.

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

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

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) Embracing the community as a full and equal research partner 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 term is used to characterize the movement addressing the social condition of unequal distribution of environmental hazards experienced by minority populations or groups with low income? 1) Environmental equity 2) Environmental justice 3) Environmental pollution 4) Environmental democracy

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

Activists criticized America's public health policy response during initial years of its AIDS epidemic on the grounds that: 1) Absence of universal health care insurance prevented victims from accessing expensive treatment 2) Government indifference and political infighting resulted in apathy toward a suffering gay community. 3) Too much money was being spent on treatment, not enough on prevention to stop the epidemic. 4) Too much resource was being spent on urging people to change risk behaviors, not enough on medication.

2) Government indifference and political infighting resulted in apathy toward a suffering gay community. The 1987 book "And the Band Played On: Politics, People and the AIDS Epidemic" by Randy Shilts describes feelings among those in the most affected community. overt denial toward the prevalence of high-risk behaviors in the country and, more importantly, a conscious disregard for and apathy toward those whom most believed were at risk for infection. In summary, the government and public abhorred the disease, but more so the behaviors associated with it; little was done to stop virus transmission or to broadly educate the public for the first five years of the epidemic. Denial in accepting that the entire public was in the midst of a rapidly growing epidemic led to the delays in implementing public health measures, the marginalization of patients with AIDS and those at high risk, and the development of compulsory laws that only further fueled the spread of the virus. Accordingly, attempts to control an epidemic must first begin with government recognizing and acknowledging high-risk behaviors without judgment. Denying the presence of these behaviors promotes transmission of the pathogen and perpetuates harmful rumors.

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

3) Be at a reading level suitable to the target population 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.

Hazard Analysis and Critical Control Points (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

2) Identify and control problems that may cause foodborne illness before they happen HACCP is a systematic, science-based approach to identify and control problems that may cause foodborne illness before they happen: 1. conduct a hazard analysis to identify all biological, physical, and chemical hazards associated with a food product. 2. 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). 3. there must be robust monitoring to assess whether the measures taken at each critical control point are effective and if corrective actions are necessary.

The most important reason for reduced mortality during the initial stage of a demographic/epidemiologic transition in a population is: 1) Increased use of antibiotics 2) Improved sanitation 3) Increased immunization 4) Screening for common infectious diseases

2) Improved sanitation Reduced mortality due to improved sanitation outweighs the impact of immunization and antibiotic use.

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

2) Improvements in sanitation and hygiene 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.

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

2) It covers preventive services for children who otherwise might not have access to them The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

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.

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 corrective statements surrounding a reinforcing statement. 3) Give feedback to the staff member as the supervisor catches them on their way into the office. 4) Hold the entire team accountable in group meeting.

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

Chaos Theory

A field of study in mathematics with applications in a wide number of disciplines to explain a dynamic system and that is highly sensitive to the initial conditions, so that small changes in initial conditions produce wildly different results. The changes occur through fixed rules about changing relationships, and without randomness.

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

2) Societal values The Constitution does not provide explicit direction when it comes to balancing individual rights and promoting the common good. Public health policy and regulation, although based on scientific evidence and general moral considerations is not likely to be adopted where there is not general consensus and support by the public it serves to protect. The definition: "Public Health is what we, as a society, do collectively to assure the conditions in which people can be healthy" suggest the need for cooperative actions built on overlapping values and trust. Reference: Public Health Ethics Mapping the Terrain Childress, JF, Faden, RR, Gaare RD, Gostin ,LO et al, 2002, p 170. "Health regulation that overreaches, in that it achieves a minimal health benefit with disproportionate human burdens, is not tolerated in a society based on the rule of law." (Public Health Law, Gostin, LO, 2000, p.20)

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

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

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

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

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

2) interested in capturing the context of program participation and the participants' stories. Qualitative methods place emphasis on lived experiences and are especially useful for capturing context and complexity.

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

2) open attitudes and mutual respect CUSP tools support change at the unit level to create a culture of safety. This is more fundamental than checklists alone, although empowering all staff to participate in use of checklists also has been part of CUSP's success in reducing the incidence of preventable adverse patient outcomes. Studies have found that working in an environment where open and mutual communication is present enhances clinical proficiency and job satisfaction. 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.

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) perspective outside an organization. In "The Effective Executive" (Harper & Row Publishers, 1967), Drucker comments that "...the organization is an abstraction... Specifically, there are no results within the organization. All the results are on the outside. The only business results, for instance, are produced by a customer who converts the costs and efforts of the business into revenues and profits through his willingness to exchange his purchasing power for the products or services of the business... Similarly, a hospital has results only in respect to the patient. But the patient is not a member of the hospital organization. For the patient, the hospital is 'real' only while he stays there. His greatest desire is to go back to the 'nonhospital' world as fast as possible."

Groundwater pollution

225 chemical, biological, and radiological pollutants have been identified in groundwater; degradation by humans generated pollutants occur largely from faulty waste practices or poor land management

local health departments (LHDs) spending

25% local sources (city/township and county revenue) 20% direct state funds 17% federal funds that pass through states en route to localities 11% fees 10% medicaid 5% medicare 7% other 2% not specified/ federal direct

Which of the following estimates of an odds ratio most strongly suggests a computational error? 1) 7.8 2) 1.2 3) -0.9 4) 20.9

3) -0.9 An odds ratio of -0.9 most strongly indicates a computational error because an odds ratio is calculated using probabilities, which cannot be negative. An odds ratio is the probability that an event will occur divided by the probability that it will not occur. Since probabilities cannot be negative, a negative odds ratio would indicate computational error.

A public health professional is asked to conduct a needs assessment for a community. A needs assessment: 1) Introduces resources to fill community gaps 2) Ensures a competent public and personal health care workforce 3) Assists to identify and prioritize health problems 4) Provides health resources for medically underserved populations

3) Assists to identify and prioritize health problems uses "systematic, comprehensive data collection and analysis" to identify and priortize the key health needs of a community

By what programmatic mechanism does the U.S. Environmental Protection Agency (EPA) work with states to implement national environmental standards such as NAAQS? 1) By creating a memorandum of understanding focusing on cost-sharing of environmental burdens 2) By establishing air quality monitoring stations 3) By using a State Implementation Plan (SIP) approved by the EPA 4) By funding risk assessment

3) By using a State Implementation Plan (SIP) approved by the EPA The Constitutional division of powers between the Federal and State governments means that both levels of government must operate with mutual respect, recognizing that cooperation rather than conflict better serves the public interest. The natural continuum of the environment cuts across geopolitical boundaries and rightly elicits the concerns of both Federal and State governments. To avoid or minimize contradictory measures and standards among States, the Federal government provides the umbrella (uniform) guidance and standards for ambient air quality and requires States to participate in the implementation by developing a plan that meets Federal requirements. That plan is known as the SIP and contains a number of air quality control measures.

Which of the following disinfection methods is most commonly used in US drinking water supply systems? 1) Ozonation 2) Bromination 3) Chlorination 4) Ultraviolet irradiation

3) Chlorination Although disinfection can be accomplished with ozone, bromine, and ultraviolet radiation, most municipalities use chlorine. Chlorine is easy and relatively cheap to use, does not cause the taste problems associated with bromine, and a residual chlorine concentration in the water provides protection against re-contamination in the water distribution system.

For the governance of an organization, which of the following should be measurable? 1) Vision and values 2) Mission and vision 3) Goals and objectives 4) Mission and goals

3) Goals and objectives Numbers and quantities provide means of measurement and comparison for goals and objectives.

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) Individual autonomy versus community welfare 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.

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, is based on: 1) internal assessment and strategic goals 2) External assessment and department policy review 3) Internal assessment and external assessment 4) Strategic planning and maximizing program efficiency.

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

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

3) No one set of traits has been established as necessary 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.

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

3) Police powers permit each state the right to define and delegate authority and responsibility for public health services Police power in this context does not refer to criminal law enforcement. Rather, police powers may be used by states to promote laws in the interests of the general welfare and health of society. Public health examples include laws authorizing: (1) isolation and quarantine; (2) community vaccination; (3) licensure of medical professionals; and (4) response to public health emergencies, such as bioterrorism or infectious disease outbreaks. 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.

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) Provide information to justify the increased number of positions. 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.

Which of the following components of a strategic planning process in a public health agency has logical priority over the others? 1) Preparing an action plan for eradicating giardiasis in the municipal water system 2) Developing the operating budget and staffing plan for the agency 3) Reviewing (and revising) the vision and mission statements for the agency 4) Setting strategic goals for a three-year cycle

3) Reviewing (and revising) the vision and mission statements for the agency 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.

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) 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. 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 cohort studies, which of the following is correct about the role of a suspected factor in the etiology of a disease? 1) There are equal numbers of people in both study groups. 2) At the beginning of the study, those with the disease and those without the disease have equal risks of having the factor. 3) The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders. 4) The incidence of the disease is low.

3) The exposed and non-exposed groups under study should be as similar as possible with regard to possible confounders. Ensuring that exposed and unexposed groups enrolled in a study are as similar as possible in regard to potential confounders helps ensure that the two groups will be comparable. This increases the internal validity of the findings.

Which of the following can be considered a concern with live, attenuated vaccines? 1) They are very expensive to produce 2) They produce a weak response and require booster shots 3) They can cause disease in an immunocompromised individual 4) People can develop allergic reactions to them

3) They can cause disease in an immunocompromised individual Live attenuated vaccines are prepared by growing live pathogens under conditions that induce mutations in the pathogen that reduce its virulence, but not its immunogenicity. There is a small, but definite, risk that the pathogen can undergo reversion mutations.

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 benificence, a core public health ethical principle 3) They provide strategic leadership in leading local and international solutions 4) They demonstrate their compentence in Zika research

3) They provide strategic leadership in leading local and international solutions In an ever interconnected world where diseases have no boarders, cutting edge public health research has to be disseminated with local stakeholders as well as international communities. * Please note leadership is a communication act.

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

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

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) need explanation in a budget narrative. 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.

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

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

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) should plan to confirm the team norms and dynamics are productive. 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.

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

In low resource countries during an outbreak, what simple, low-tech sanitation measure can dramatically reduce the spread of enteric bacteria and viruses? 1) Disposing of stagnant water 2) Sleeping under an insecticide-soaked bednet 3) Vaccination of those individuals who work on the water supply 4) Add chlorine to water storage containers

4) Add chlorine to water storage containers In addressing an outbreak of bacteria and viruses in a low resource country, disinfection is considered a primary mechanism for inactivating/destroying pathogenic organisms and preventing the spread of waterborne diseases to downstream users and the environment. Some of the most commonly used disinfectants for decentralized applications include chlorine, iodine, and ultraviolet (UV) radiation. Chlorine is one of the most practical and widely used disinfectants.

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) Perception of economic insecurity Of all the options, perception of economic insecurity (e.g., concern about food insecurity) best assesses an individual's current economic status while reducing non-response due to concern about stigma. Respondents are least likely to respond to income and public assistance questions, while educational attainment does not accurately reflect one's economic situation.

A researcher is working with local barber shops to plan a health promotion intervention. The intervention activities will include health education training workshops and educational print materials for the customers. The intervention activities are hypothesized to lead to changes in customers' fruit/vegetable intake, physical activity, and screening adherence. Which of the following statements describes how the researcher might start a formative evaluation plan? 1) Document which participating barbers attended each of the training workshops 2) Document the barbers' change in fruit/vegetable intake 3) Document the customers' change in physical activity 4) Convene focus groups in two barber shops to discuss print materials

4) Convene focus groups in two barber shops to discuss print materials Formative evaluation assesses the feasibility and appropriateness of a program before full-scale implementation.

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

4) Developing and testing emergency preparedness plans on a monthly basis While all of the answers would be correct in one or more venues, the time period between developing and testing emergency preparedness plans varies based on state, local, and national laws and organizational practice.

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) Including diverse constituencies in the decision-making groups Allocating resources based simply on population size may not target resources to the most needy populations or issues in a community, nor will it guarantee an improvement in equity. Collecting data is important and can be useful in the policy process. However, collecting data alone without interpreting the data and having a diversity of stakeholders weigh in on how the results will be used to make health policy decisions that impact the community will not enhance equity. Finally, it is important to frame questions that need evidence and then select the most appropriate type of evidence rather than accept only randomized controlled trials aving 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. CBPR is appropriate for engaging in policy advocacy efforts given community partners' knowledge of local contexts and their relationships with policymakers, and the fact that partnerships are uniquely positioned to identify problems, engage community members in research and interventions, disseminate research findings, and mobilize community members and organizations to advocate for policy change

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.

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. 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.

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

4) It may not reflect the current programmatic priorities of the organization Incremental budgeting does allow for easy year-to-year comparisons (1), does not require last-dollar justification (2), and requires a considerably lower investment than fully implemented ZBB (3). 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.

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) Meals or social events provided to all registrants at a regional conference attended as a registrant at an agency approved event Modest items of food and non-alcoholic refreshments such as soft drinks, coffee, and donuts, not offered as part of a meal are excluded from the definition of a gift and may be accepted purusant to certain specific regulatory exclusions.

Which measure of mortality would you calculate to determine the proportion of all deaths that is caused by heart disease?

4) Proportionate mortality ratio 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.

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

4) Reciprocal transfer of knowledge and skills among all collaborators and community partners It is very common to talk about empowerment and community involvement. However, a paternal approach to community work has been the main means of this involvement. An appropriate approach focuses on the true meaning of engagement; that is, members of the community taking the lead to address what the community needs to become empowered, and public health workers assisting them in a bi-competent manner.

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) Refrain from adding the item - it is not germane to program decision needs. 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".

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) Results in plans that may be immediately necessary but may overlap or leave gaps Issel writes that though the incremental approach to program planning may address an immediate need (i.e.: closing bathhouses in the early days of HIV/AIDS epidemic) it may also leave gaps (i.e.: did not identify the virus). The incremental approach to program planning will address only part of the problem, may be the result of disjointed efforts and leave many factors unaccounted for. developing solutions to problems as they arise rather than planning for them in a comprehensive, overarching way as rational planning does

The principal difference between other industrialized countries and the United States in terms of providing universal health care coverage is that: 1) This is recognized as a basic human right in the other countries' founding document but not in the United States Constitution 2) All hospitals are owned by and all physicians are employees of the other governments while the United States takes a free market approach 3) The other countries spend more per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population. 4) The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population

4) The other countries spend less per capita on healthcare while achieving similar or better health outcomes for a larger proportion of their population Legislation long after other industrialized countries were founded added universal health care as a right, with variations from country to country in the way this is funded and organized. The United States has been unique among these nations in not providing coverage for all its citizens, in paying much more per capita for healthcare, and in ranking at the lowest levels on the metrics that usually are monitored to reflect a nation's health. Comparative data from the Organization for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) are published in annual reports on the performance of healthcare systems.

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) Their numbers give general indication of a water supply's sanitary condition. Coliform bacteria are a group of bacteria present in the environment, and in the feces of humans as well as all warm-blooded animals. Few cause disease in humans. Some strains of E. coli are common only in wild 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

Which of the following statements is TRUE about public health surveillance data? 1) They cannot be used to detect geographical clusters 2) They include information on health outcomes, but not exposures or risk factors 3) They only include data pertaining to vaccine-related diseases 4) They can be used to monitor temporal trends in disease

4) They can be used to monitor temporal trends in disease Monitoring temporal trends in disease is a primary function of surveillance systems. While surveillance historically, and perhaps more frequently, is conducted for infectious diseases, in recent years it has become increasingly important in monitoring changes in other types of conditions, such as cancer, congenital malformations, asthma, occupational exposures and diseases, and injuries and illness after natural disasters.

The recent HIV/AIDS campaign to encourage testing and 'knowing your status' has resulted in an increase in testing in group A but has not had the intended impact in group B. In thinking about the campaign and to increase its impact on group B, the most important consideration in redesigning the print and social media content should be: 1) To present additional statistics to highlight the magnitude of the problem 2) To request a larger budget -- print and post more posters; more radio, and TV ads 3) To hire a consultant to determine if the literacy level is appropriate 4) To conduct focus groups to learn more about the groups' beliefs and values

4) To conduct focus groups to learn more about the groups' beliefs and values The current campaign seems not to address the actions, behaviors, values, gender, and culture of the target population. When presenting health communication messages to a particular community, it is necessary to understand the actions, behaviors, values, and beliefs of the group. In some instances this means understanding gender, race, history, and the culture of the group and between the group and external systems which include public health systems. In taking this time to "connect" with the target group, the campaign will be more targeted and "speak" to the target group. For example, if the HIV campaign is aimed at MSM, it is important to have images and messaging that the community can relate to. For example, a campaign with an image of two men will more so grab the attention of MSM, but less so the attention of a married women of color who may knowingly or unknowingly engage in sex with a MSM. Similarly, early HIV/AIDS campaigns focused on homosexual men. Some men of color who have sex with men often do not identify as gay or homosexual but rather as a man who has sex with men.

Ethical standards apply to government officers and employees. For such individuals, these standards apply: 1) only during their normal working hours. 2) just when performing official duties regardless of time. 3) when they identify themselves with their official title. 4) at all times, whether they are on or off duty.

4) at all times, whether they are on or off duty. Ethical standards require employees to place loyalty to the Constitution, the laws, and ethical principles above private gain at all times.

The primary purpose of strategic planning is to: 1) assign tasks and responsibilities to individuals based on expertise 2) determine the organization's annual budget allocation 3) maximize return on investment for programming 4) determine the direction an organization will pursue

4) determine the direction an organization will pursue Strategic planning 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.

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) tailor expression of need or gap, logic model of intervention, and expression of magnitude of anticipated benefit or harm to each audience. While writing in plain language always is encouraged, there are important differences between lay, professional and policy audiences in terms of information needs, perspective, literacy and numeracy. At times, confidentiality requirements also limit what can be revealed to groups outside an agency or the legislature to which it reports. However, a so-called "theatre of risk" format is an important universal framework to summarize anticipated benefit and harm numbers because studies show that all people have more difficulty making accurate decisions when presented with ratios rather than risk differences recommend using frequency statements instead of single-event probabilities, absolute risks instead of relative risks, mortality rates instead of survival rates, and natural frequencies instead of conditional probabilities. health policy makers, like clinicians, are more impressed by measurements that report relative benefits compared with those entailing an index of absolute benefit. The mean estimate obtained with the relative risk reduction for both scenarios was distinctly higher than the mean obtained with all other methods. quantitative data presented in trials and systematic reviews reflect absolute as well as relative benefits. Associated efforts, costs, and side effects of different forms of interventions can then be measured in a common currency. in the absence of information about the costs of alternative programs the number needed to treat is more realistic as a proxy for cost effectiveness than is relative risk reduction.

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

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

catastrophe theory

A theory in mathematics and geometry to study how small changes in parameters of a nonlinear system can lead to sudden and large changes in behavior of a system.

Negative feedback loop

According to the systems theory, patterns of interaction where results to a change in an original element dampens (negative) or buffers its effect (balancing). a positive change in one leads to a push back in the opposite direction, ex) when increasing body temperature produces sweating, which in turn cools down the body

dose response curve for chronic toxicity

After threshold- As increase dose, see increase effect; continue to increase until reach maximum effect

John Snow and the pump handle

By using a geographical grid to chart deaths from the outbreak and investigating each case to determine access to the pump water, Snow developed what he considered positive proof the pump was the source of the epidemic.

outcome/impact evaluation

Assess the main program objective (or objectives) to determine how the program actually performs. Was the program effective, did it meet the objective(s)? The goal is to determine whether outcomes observed are due to the program Ex) Randomized control trial: For a new peer mentor program at a local health center to increase percentage of Tb patients who are compliant with their medication regimens, randomly half were selected to receive a new program with one-on-one peer mentoring while the other half received the standard discussion with their provider and an informational brochure. Quasi experimental: A time series design, to explore the impact of a new sexual education course within a school district on teen pregnancy. Data on teen pregnancy rates were collected for five years prior and five years after program implementation to see if rates changed post-program initiation.

McGregor's Theory Y of Human Motivation

Behavioral approach- assumption that employees are highly motivated to do the work when staff are able to grow and develop staff performance results are better employees highly motivated in jobs; salary is important, what accomplish is equally/more important

Mutations in the _______________ gene lead to an increased risk for developing breast or ovarian cancer.

BRCA2 Tumor-Suppressor gene. Mutations in this gene, and the related gene BRCA1, account for 5-10% of breast and ovarian cancer cases.

determinants of health

Biological, environmental, behavioral, organizational, political, and social factors that contribute to the health status of individuals, groups, and communities

Public Health Emergency Preparedness (PHEP)

CDC's cooperative agreement is a critical source of funding for state, local, and territorial public health departments. - provided assistance to public health departments across the nation. - helps health departments build and strengthen their abilities to effectively respond to a range of public health threats, including infectious diseases, natural disasters, and biological, chemical, nuclear, and radiological events. - specifically targeted the development of emergency-ready public health departments that are flexible and adaptable. 1. Community Resilience- Preparing for and recovering from emergencies 2. Incident management- Coordinating an effective response 3.Information Management- Making sure people have information to take action 4. Countermeasures and Mitigation- Getting medicines and supplies where they are needed 5. Surge Management- Expanding medical services to handle large events 6. Biosurveillance- Investigating and identifying health threats

The test would be used to compare the frequency of diabetes between groups

Chi-square test of independence 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 collaborative approach to research that equitably involves all partners in the research process and recognizes the strengths that each brings. For example, these partners could include community members, organizational representatives, and researchers.

Community Based Participatory Research (CBPR)

Efficiency Evaluation

Compares incremental cost of the program to its effects (cost-effectiveness analysis) or to monetized effects (cost-benefit analysis). May also investigate several competing programs to determine whether alternative, less costly programs achieve the same results as more expensive programs.

Interpretation of Linear Regression Model (slope, β1)

Conduct hypothesis test with β1 to tell whether the difference away from 0 is significant (is there an effect), then sign of β1 , will tell if positive/ negative association (how great is the effect?) β1= relationship between X and Y; When X increases by 1 unit, Y changes by β1 β1 > 0 = X and Y are directly proportional= positive association β1 < 0 = X and Y are inversely proportional= negative association (β1 = 0) = Y does not dependent on X at all= no association Usually β0 (intercept) not of interest (does not tell about relationship between 2 variables)

Nuremberg Code

Created after Nuremberg Trials (series of court proceedings in Germany after WWII in which Nazi leaders tried for aggression, violations of rules of war and crimes against humanity) includes human research provisions: - voluntary consent - results for good of society, out-weight risk - designed/based on results of animal experiments - avoid unnecessary physical/mental suffering/injury - proper preparations/facilities provided - conducted by scientifically qualified persons - right to leave experiment/ terminate at any time

prevalence

EXISTING cases (how many people have the disease); measure proportion of existing disease in population at given time; "snapshot"; not rate- no time component in calculation; dimensionless, positive number (0 to 1) ; time because in order to determine prevalence you need to sweep over population = (# of existing cases)/ (total population= #of existing cases+ # of non-cases ) = incidence x duration (how long you have the disease) - Input: prevalence increases the new cases (bringing disease into population) added to the existing cases (incidence) - Output: prevalence decreases as people are cured or died sometimes an increase in prevalence does not mean more people are getting the disease, but means that more people are living with the disease; found a way to stop people from dying (allowing people to live with condition) Ex) The Dept. of Education wants to organize an after-school program for children with learning disabilities and needs to know if there are sufficient children in need within the country to warrant such a service

Donabedian model for quality measurement

External environment (less control= patients, societal values, politics, resources, expectations, healthcare professionals, scientific discovery, knowledge about patient care)---> 1. structure (of system) 2. process (within system; providing care) 3. outcomes (results) 4. feedback (fine tune activities based on success/failures)

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 will leave public health departments unable to respond to crisis.

Cybernetics Systems Theory

Historically used as a synonym for systems theory, it is a field of study of the communication and control of regulatory feedback in both living and non-living systems (e.g., organizations, machines).

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?

Impact evaluation 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.

general systems theory

Less of a theory than a way of finding a general theory to explain systems in all fields of science. It was not intended to be a single theory of systems, but more of a systematic inquiry into different domains of philosophy, science, and technology.

Minimata, Japan

Minamata disease first discovered in Minamata City in Kumamoto, Japan in 1956. It was caused by the release of methylmercury in the industrial wastewater (point source pollution) from the Chisso Corporation's chemical factory, which continued from 1932 to 1968. This highly toxic chemical bioaccumulated in shellfish and fish in Minamata Bay and the Shiranui Sea, which when eaten by the local populace resulted in mercury poisoning. By 2004, Chisso Corporation had paid $86 million in compensation, and in the same year was ordered to clean up its contamination. Lawsuits and claims for compensation continue to this day. A second outbreak of Minamata disease occurred in Niigata Prefecture in 1965. Both the original Minamata disease and Niigata Minamata disease are considered two of the Four Big Pollution Diseases of Japan.

incidence rate (incidence density, incidence)

NEW occurrences (how many get the disease) = (# of new onset cases of disease) / (# of person-time units of observation) Time, place, and population should be specified Ex) The number of new cases of Parkinson's disease that develops per 1,000 Knox residents over 30 years of age per year= # of new cases of Parkinson's disease/ total # years disease-free subjects observed x 1000 - The University hospital epidemiologist wants to know the rate of TB skin conversion (going from negative to positive indicates an infection with the causative agent of TB) occurring in 3rd year MD students during 2001 - A medical school research team has developed a new drug which is purported to cure chronic schizophrenia and the team wants to study a large number of patients to determine the efficacy of the drug

In the PRECEDE-PROCEED model, the step in program planning where planners use data to identify and rank health problems is called:

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.

Network Analysis (or Social Network Analysis)

Network analysis uses graphical methods to demonstrate relations between objects. Grounded in computer science, it has applications in social, biological, and physical sciences. Social network analysis involves application of network theory to social entities (e.g., people, groups, organizations), demonstrating nodes (individual actors within a network), and ties (the type of relationships) between the actors, and uses a range of tools for displaying the networks and analyzing the nature of the relationships.

Systems dynamics modeling

Not a single method, but an approach that uses a set of tools to understand the behavior of complex systems over time. The methods focus on the concepts of stocks and flows and feedback loops. They are designed to solve the problem of simultaneity (mutual causation) by being able to change variables over small periods of time while allowing for feedback and various interactions and delays. The common tools include causal loop diagrams and stock and flow diagrams.

path dependency theories

Occurs in economics, social sciences, and physics, and refers to the explanations for why processes can have similar starting points yet lead to different outcomes, even if they follow the same rules, and outcomes are sensitive not only to initial conditions, but also to bifurcations and choices made along the way.

hospital ownership types

PRIVATE (non government) OWNERSHIP: 1. voluntary (not for profit) a. Sectarian (religious) b. Non-sectarian (community, industrial, Shriners, Kaiser) 2. Investor owned (for profit)- individual owner/partnership/corporation (single hospital) GOVERNMENT OWNERSHIP: 1. Federal a. Department of defense/ Veterans Affairs- Army, Navy, Air Force b. Department of Health & Human Services- Indian Health Services c. Department of Justice- prisons 2. State- long-term psychiatric, chronic, and other university academic medial (health concerns) 3. Local- hospital district/authority, county, city-county, city

Title XVII & Title XIX (1965)

President Lyndon B. Johnson signs into law the landmark federal health insurance programs known as Medicare(Title XVIII) and Medicaid(Title XIX).

A 911 emergency operation center is flooded with call at certain times of the day. What is the distribution that is most often used to assess this data?

Poisson used to model data that represent the number of occurrences of a specified event in a fixed period of time.

In the planning process, the group being served is referred to as the:

Priority (or target) population; people for whom the program is intended

PRECEDE-PROCEED Model

Predisposing Reinforcing Enabling Constructs in Educational Diagnosis Evaluation: 1. Social Diagnosis- going to community to figure out wants/needs to improve community health/quality of life; identification of community health outcome 2. Epidemiological Diagnosis- identify health behaviors from socio-ecological model that influence community; determine risk factors most significant (behavioral and environmental); developing program objectives 3. Educational & Organizational Diagnosis- identify predisposing (knowledge, attitudes, beliefs, values, confidence), enabling (ability of resources, accessibility of services, community and/or government laws, policies, priority and commitment to issue, issue related skills), and reinforcing factors (attitudes of influential people ie family, peers, community, decision makers) that may facilitate/impede changing factors identified (phase 2) 4. Administrative & Policy Diagnosis- identify and modify internal administrative issues/policies to external policies as needed to generate funding/other resources for intervention Policy Regulatory Organizational Constructs in Educational Environment Development: 5. Implementation- starting up /conducting intervention 6. Process Evaluation- determination whether intervention is proceedings as planned (with adjustments as needed) 7. Impact Evaluation- determination whether intervention changing planned risk factors; effectiveness of program with regard to intermediate objects + changes in predisposing, enabling, reinforcing factors; evaluate performance of educators 8. Outcome evaluation- determination whether intervention producing outcome identified in phase 1; measuring change in objectives, overall health, quality of life of entire community

Medicare Part D (2003)

President George W. Bush signs a law adding prescription drugs to Medicare Part D.

Waiting until a program or intervention is complete to begin evaluation activities misses important and valuable opportunities for what type of evaluation?

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

Which of the following 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

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.

Hill criteria

Sir Austin (Bradford) Hill came up with best known criteria/ guidelines (1965); smoking/lung-cancer/disease research 1. strength of association (harder to determine if a weak association is real) 2. consistency (same results in multiple studies; not grantee) 3. specificity of the association (proportion of people without disease who test negative) 4. temporal relationship** (not negotiable- did the exposure come before the outcome) 5. biological gradient (the higher the dose, the higher the risk) 6. biological plausibility (is the plausible) 7. coherence (logical and consistent) 8. experiment (the more experiments you have, the better) 9. analogy (comparison between two things; more likely to believe if we see something happen with one drug than see something similar with another)

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

multiple factors influence health behavior influences across levels multi-level interventions most effective most powerful when behavior specific 1. Individual- biology, knowledge, attitudes, beliefs, self-efficacy and skills 2. interpersonal- role modeling, social support, social norms through relationships with families, friends, and peers 3. organizational- rules, regulations/policies, norms of institutions (schools/workplaces) 4. community- relationships among organizations, informal community networks/norms 5. policy level- religious/cultural belief systems, societal norms, economic/social policies, national/state/local laws

Social Ecological model

program evaluation

Systematic process using qualitative and quantitative methods to answer questions about: - Nature and Magnitude of the Problem - Processes - Outcomes - Efficiency Helps to orient PH efforts towards outcomes; Encourages the use of scientific evidence to guide decisions about PH programs and policies

Systems archetypes

Systems archetypes are a number of generic structures that describe common behaviors between the parts of a system. They provide templates to demonstrate different types of balancing and reinforcing feedback loops, which can be used by teams to come to a diagnosis about how a system is working, and particularly about how performance changes over time.

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:

Tertiary Prevention and Harm Reduction Strategy

Scenario planning

This is a strategic planning method that uses a series of tools to identify and analyze possible future events and alternative possible outcomes. These can involve quantitative projections and/or qualitative judgments about alternatives. The value lies more in learning from the planning process than the actual plans or scenarios.

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:

Transactional leadership

A public health department government employee manages that department's non-infectious conditions epidemiology program. The program's recent report on traffic accident deaths has attracted attention. Mothers Against Drunk Drivers, a non-profit incorporation, has asked that person to simultaneously take a leadership role in MADD's program to oversee fund-raising activities and promote compliance with laws about drinking and driving. Would it be ethical for this person to accept MADD's offer of simultaneous employment?

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

Nested case-control study

a case control study nested in a cohort study; controls selected either at baseline (case-cohort) or at time the case occurs (nested) advantages: - data on exposure are obtained before disease develops - possibility of recall bias is thus eliminated - less expensive than expanding the analysis to include the entire cohort - OR is statistically unbiased estimate of relative risk

community based participatory research (CBPR)

a collaborative approach to research that equitably involves all stakeholders in the process of defining the problem, identifying and implementing solutions, and evaluating outcomes - appropriate way to disseminate findings to community directly - build upon existing strengths/ resources - facilitate collaborative partnership (active participants co-learn experience, empowering) - different from other research methods because the community (participants; target population) is part of the research process from planning to implementation and is seen as a researcher instead of a subjects.

survival analysis

a collection of statistical procedures used for outcome that is time until an event (from the time we start observing them, when does the even occur) - DV= time to event (dies, cancer free), i.e. whether an event occurred (yes/no) at time it took for it to occur (how long did it take for cancer to get cured) - time= years, months, weeks, days, etc. from the beginning of follow-up until the event for an individual (may refer to age of individual when event occurs) - event= death (mortality), disease incidence (how long does it take for someone to develop the disease), relapse from remission, recovery, or any other occurrence of interest (how long it takes to go back to work after work related injury) - goal= to analyze experience survival experience of the population of interest Ex) study that follows leukemia patients in remission over several weeks to see how long they stay in remission; study that follows a disease-free cohort of individuals over several years to see who develops heart disease; parolee's time until re-arrest; heart transplant patient's time until death

community capacity

a community's ability to survive, adapt and thrive The more skills, assets, and strengths that a community has, the better prepared it is to achieve its goals.

Transactional Leadership (TRL)

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. contingent reward, Passive management by exception, and Active management by exception focuses on the role of supervision, organization, and group performance. Leaders who implement this style focus on specific tasks and use rewards and punishments to motivate followers.

acute toxicity

ability of substance to do systematic damage as a result of one time exposure of relatively short duration

Health Impact Assessment (HIA)

a method for describing and estimating the effects that a proposed project or policy may have on the health of a population - used to evaluate the public health consequences of proposed decisions in non-health sectors. - systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and whether the health effects are distributed evenly within the population. -provide practical recommendations for how to minimize negative health effects and maximize beneficial health effect - doesn't examine the costs associated with its recommended strategies to promote health and mitigate adverse health impacts

Alma Ata Declaration

adopted at the International Conference on Primary Health Care (PHC), it expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people; called for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries

Contingency theory (Theory Z)

adoption of management style to meet the needs of all personnel; 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. situational management; not all employees are the same - some motivated by salary vs. accomplishments - different nature of jobs (routine vs. programming) - evaluate supervising needs

The Patient Protection and Affordable Care Act (2010)

aka Obama Care, the aim of the law was to provide an expansion of health insurance coverage to more Americans through both individual health insurance exchanges.

Sulfur dioxide (SO2)

ambient result largely from stationary sources (coal and fuel combustion, steel mills, refineries, pulp, and paper mills and from nonferrous smelters) - Health effects- irritation to the eyes, nose, throat, and respiratory tract; affect breathing and may aggravate existing respiratory and cardiovascular disease; may cause permanent damage to lungs - environmental effects- ingredient in acid rain (acid aerosols), which can damage trees and lakes and reduce visibility - property damage- acid aerosols can eat away stone used in buildings, statues, monuments, etc.

Relative risk

an estimate of the magnitude of an association between exposure and disease; indicates the likelihood of developing the disease for the exposed group relative to those who are not exposed Requires an estimate of the incidence of the disease - When between 1 and 2 = RR - 1 = % increased risk Ex) RR = 1.50 1.50- 1= 0.50 = 50% increased risk of outcome given exposure - When > 2 = RR number = number of times increased risk Ex) RR= 3 = 3 times increased risk of outcome given exposure - When < 1 = 1.0- RR = % decreased risk Ex) 1.0 - 0.75 = 0.25 = 25% less risk of outcome given exposure - Evaluating the precision of the RR = 95% CI is the measure of precision = (lower limit - upper limit); 95% confident that true relative risk lies between these values

Risk Factors

any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Ex) underweight, unsafe sex, high blood pressure (HTN),(high levels of) tobacco and alcohol consumption, and unsafe water, sanitation/hygiene, parent who smokes, and sedentary lifestyle,

multiple regression model

any regression model one dependent and more than one independent variable; used when other variables (confounders) may affect relationship between dependent and independent variables include confounding variable(s) as additional independent variable in regression, e.g. (dependent variable)= β0 + β1 (main independent variable) + β2 (confounder) adding including confounders in the model as additional independent variables will improve the model can control for more than one confounder (can be continuous or categorical)

bias

any systematic error (not random or due to chance) in a study which leads to an incorrect (invalid) estimate of the (measure of) association between exposure and disease can create spurious association when there is none (bias away from the null- observed value is farther from 1.0 than is the true value) can mask an association when there is one (bias towards the null- observed value is closer to 1.0 than is the true value)

Validity

assessment of degree to which a measure represents what it is supposed to be measuring; accuracy of measure (does the result actually reflect the true measure) - Measure could be reliable but not valid - Ex) suppose a person weighing 200 lbs get on a scale 20 times, each time scale reads 250 lbs, this scale is highly reiable as it gives the same measure under the same conditions, it is not valid because the true weight is 200 lbs - In general, unreliable measure cannot be valid (because if it is all over the place you won't have an accurate measure) - Harder to attain than reliability 1. accurate- free of systematic error/bias 2. precise- minimal variations; repeatability

Multi-Level Approach to Community Health (MATCH)

assist communities in planning and evaluation of community programs; intervention model aimed at influencing health at individual, organizational, and governmental levels; "organizing framework" designed to be applied after risk factors and priorities for action have been identified 1. goals section 2. intervention planning 3. program development 4. implementation preparations 5. evaluation each phase has multiple components that give model flexibility to be adapted to context of target population, community, or intervention

Causation

associations between 'exposures' and outcomes identified in observational studies may or may not be 'causal'; there is a need to pay attention to valid assessment of exposure and outcome in order to think about causality

Social epidemiology

assumes that the distribution of advantages and disadvantages in a society reflects the distribution of health and disease. branch of epidemiology that focuses particularly on the effects of social-structural factors on states of health. Social epidemiology

Institute of Medicine (IOM) Public Health System model

assure conditions for population health - government public health infrastructure, community healthcare delivery system, employers/businesses, media, academic

Systematic Reviews and Meta-analysis

at the top of the hierarchy of evidence pyramid that examines a number of relevant and valid studies on a topic, and combines results from those studies using accepted statistical methodology

fee for service

attaches price based on services provided patient care / supplemental insurance

Nitrogen dioxide (NO2)

brownish, highly reactive gas that's present in all urban atmospheres; generated by burning of fossil-derived fuel, during which O2 and nitrogen react to form nitrate particles, acid aerosols, and nitrogen oxides (NO) which further react to form NO2 and other NOx Indoor NO2 - common contaminant of indoor air, and indoor levels often exceed those found outdoors - sources: kerosene heaters, un-vented gas stoves and heaters; environmental tobacco smoke; burning of gasoline; natural gas, coal, oil, etc.; cars are an important source of NO2 - levels in homes: average level without combustion appliances is ~1/2 that of outdoors; in homes with gas stoves, kerosene heaters, or un-vented gas space heaters, indoor levels often exceed outdoor levels outdoor: - concentration highest during AM/PM rush hours - concentrations higher in winter than summer due in part to poorer local dispersion conditions caused by light winds and other weather inherent of the winter

Zero-based budgeting (ZBB)

budgeting process starts from a base of zero, with no reference being made to the prior period's budget or actual performance. All of the budget headings, therefore, literally start with a balance of zero. Every department function is then reviewed comprehensively, with all expenditure requiring approval, rather than just the incremental expenditure requiring approval. 1. Activities are identified by managers. Managers are then forced to consider different ways of performing the activities. These activities are then described in a 'decision package' - Analyses of cost of activity - States its purpose - Identifies alternative methods of achieving same purpose - Establishes performance measures for activity - Assesses consequences of not performing activity at all or of performing it at different levels 2. Management will then rank all the packages in the order of decreasing benefits to the organization. This will help management decide what to spend and where to spend it. This ranking of the decision packages happens at numerous levels of the organization 3. The resources are then allocated based on order of priority up to the spending level. Benefits: - does not assume that last year's allocation of resources is necessarily appropriate for the current year, all of the activities of the organization are re-evaluated annually from a zero base. Most importantly therefore, inefficient and obsolete activities are removed, and wasteful spending is curbed. - encourages a bottom-up approach, should encourage motivation of employees. - Challenges the status quo and encourages a questioning attitude among managers. - Responds to changes in the business environment from one year to the next. - should result in a more efficient allocation of resources. Draw backs: - Departmental managers may not have the necessary skills to construct decision packages. They will need training for this, and training takes time and money. - In a large organization, the number of activities will be so large that the amount of paperwork generated will be unmanageable. - Ranking the packages can be difficult, since many activities cannot be compared on the basis of purely quantitative measures. Qualitative factors need to be incorporated but this is difficult. Top level management may not have the time or knowledge to rank what could be thousands of packages. - The process of identifying decision packages and determining their purpose, costs and benefits is massively time consuming and costly. - Since decisions are made at budget time, managers may feel unable to react to changes that occur during the year. This could have a detrimental effect on the business if it fails to react to emerging opportunities and threats. - management information systems might be unable to provide the necessary information. far more suitable for public sector than for private sector organizations: far easier to put activities into decision packages in organizations which undertake set definable activities/ far more suited to costs that are discretionary in nature or for support activities.

temperature inversion

cold air trapped pollution from iron and steel mills, zinc smelters/acid plant (cap) - Donora, PA (Oct. 1948)- small industrial town south of Philadelphia; 20 people died, over 7,000 hospitalized due to air pollution; led to air pollution research and Clean Air Act - The Great London Smog (1952)- meteorological event, measured air pollution using smoke intext (mg/cu m), on average 250 people day a die in London, this increased by a factor of 4 (more than 1,000 people per day); HIGH came in and sat under London, and nothing moved; pollution didn't blow off and stayed there; lid on jar, temperature inversion; low to the ground smoke/soot from indoor fires

2 sets of 2+, 0 IV, interval & normal

canonical correlation

survival experience

captured by survival function or equivalently a survival curve (in theory curve is continuous and smooth)

Matched case control study

cases are matched with a control based on age, sex, etc.; describe the results for each pair (McNair's)

Dichotomous variable

categorical variable with two possible outcomes (special case)

ordinal variables

categorical variables different categories of values ranked to give an order; fixed number of outcomes on ordinal scale with inherent order (e.g. socioeconomic status- low, medium, high) level of difference between ranks is not constant (e.g. Likert Scale, where answers choices are 'bad', 'fair', 'good', inherent order- good is better/higher ranked than fair, but does not indicate how much better; relative goods; ambiguity)

Tertiary prevention

clinical services delivered when person already has a disease to limit disability and complications, and reduce severity or progression of disease. Ex) retinal exams for diabetic retinopathy, stroke and post-heart attack rehabilitation programs, cancer survival programs, hospice programs that ensure dignity and reduce suffering in terminal conditions.

Carbon monoxide (CO)

colorless, odorless, nonirritating gar; generated by incomplete combustion of carbon-containing fuels (oils, gasoline, coal and wood); exposure to high levels of CO is leading cause of poisoning deaths in US Outdoor CO - by-product of MV exhaust, which contributes to 50% if all CO emissions nationwide - in cities, MV pollution can cause as much as 9% of all CO emissions - high levels coincide with AM/PM rush hours Indoor CO - unvented kerosene and gas space hearts; leaking chimneys and furnaces; back-drafting from furnaces, gas water heaters, wood stoves, and fireplaces; gas stoves; automobile exhaust from attached garages; environmental tobacco smoke, burning of gasoline, natural gas, coal, oil etc. - average levels in home without gas stoves vary from 0.5 to 5 parts per million (ppm); levels near properly adjusted gas stoves are often 5 to 15 ppm and those near poorly adjusted stoves may be 30 ppm or higher - CO concentration rises with the early morning and late afternoon traffic peak - low wind and low temperature conditions may contribute to accumulating CO levels - highest levels of CO in the outside air typically occur during the colder months of the year when inversion conditions are more frequent; the air pollution becomes trapped near the ground beneath a layer of warm air

Cronbach's apla

common value to qualify reliability; indicator of internal consistency - varies from 0 to 1 - Higher values (closer to 1) indicate higher internal consistency

Vision

communicates what your organization believes are the ideal conditions for your community

Mobilizing for Action through Planning and Partnerships (MAPP)

community-driven strategic planning process for improving community health. Facilitated by public health leaders, this framework helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. not an agency-focused assessment process; rather, it is an interactive process that can improve the efficiency, effectiveness, and ultimately the performance of local public health systems. 1. Community Themes and Strengths Assessment- provides a deep understanding of the issues that residents feel are important: "What is important to our community?" "How is quality of life perceived in our community?" and "What assets do we have that can be used to improve community health? 2. Local Public Health System Assessment (LPHSA)- focuses on all of the organizations and entities that contribute to the public''s health: "What are the components, activities, competencies, and capacities of our local public health system?" and "How are the Essential Services being provided to our community?" 3. Community Health Status Assessment- identifies priority community health and quality of life issues: "How healthy are our residents?" and "What does the health status of our community look like?" 4. Forces of Change Assessment- identifies forces such as legislation, technology, and other impending changes that affect the context in which the community and its public health system operate: "What is occurring or might occur that affects the health of our community or the local public health system?" and "What specific threats or opportunities are generated by these occurrences?"

case-control study

compare various characteristics (past exposure) for cases (subjects with disease) to those of controls (subjects without disease), compare the proportion with the exposure in the cases to the proportion with the exposure in the control group - backwards directionality: started collecting cases (with disease) and controls (without disease) and facing backward in time, starting from the point of disease and comparing to non-disease, inquiring about information from the past - if the exposure is associated with the disease, we expect that the proportion of persons with the exposure in the cases will be greater than the proportion with the exposure in the control group also known as case-referent studies, estimate the magnitude of an association between and exposure and an outcome; subjects are selected because they have the outcome of interest. exposure histories is collected from a group of persons with a specific disease and from a comparison group to determine the relative frequency of an exposure Ex) start with those who have lung cancer and those who do not have lung cancer and have them look back in time and say how much smoking they engaged in; expect higher proportion of lung cancer patients to report greater history of smoking cigarettes - Danish women with a first time MS discharge diagnosis from a neurological department at most 40 years old during period 1998-2005, and an age and geographically matched healthy group. Information on number of full-term pregnancies was elicited - hypothesis- number of pregnancies you have is related to risk of MS - Starting with people with outcome, asking about past history of exposure (looking backwards)

To work effectively, a public health specialist should be able to meet the social, cultural and linguistic needs of individuals within the community. This is termed cultural:

competence

risk reduction

conceptual framework of elements considered with the possibilities to minimize vulnerabilities and disaster risks throughout a society, to avoid (prevention) or to limit (mitigation and preparedness) the adverse impacts of hazards, within the broad context of sustainable development 1. assessment- vulnerabilities to hazards 2. implications- of disasters , if occurred what could happen 3. preparedness- (limit) for disasters what to do to prepare if occurs could do 4. prevent- (avoid) some way to prevent occurrence 5. mitigation- (limit) what can we do reduce severity/seriousness

Triangulation

confirming conclusions from qualitative data through multiple data sources, multiple methods, multiple theories, or multiple data collectors 1. Data- gathering data through differing sampling strategies such as collecting data at different times, in different contexts, and from different people. 2. Investigator- involves multiple researchers in an investigation 3. Theory- uses more than one theoretical scheme in interpretation 4. Methodological- uses more than one option to gather data, such as interviews, observations, questionnaires, and documents - adds credibility to findings - facilitates validation of data through cross verification from more than 2 sources - tests the consistency of findings obtained through different instruments - increases the chance to control, at least assess, some of the treats or multiple causes influencing our results - enriching (add value to each other by explaining different aspects of an issues) - refuting (disproves hypothesis) - confirming (confirms hypothesis) - explaining (sheds light on unexpected findings)

quality management

continuous improvement 1. plan 2. do (implement) 3. check (eval) 4. act

Interval variables

continuous variables distances between values are equally spaced to indicate level of difference in ranks (e.g. lower temperature one-degree increase has the same meaning for given temperature; choice of 0 is arbitrary, 0 degrees Celsius and Fahrenheit are not the same)

Stress and Coping Theory

coping strategies as determinants of health demands from internal/external environment upset balance of physical/psychological well-being --> action to restore balance (how coping adapt to stressor) impact of external stressor mediated by individual's appraisal of stressor and psychological, social, and cultural resources

frequencies

counts of categories

Methods of Least Squares

creates line that best fits data for linear regression model; Coefficient of determination (R2; correlation coefficient squared) quantifies how much variability is explained by the line that best fits data for linear regression model - R2 is between 0 and 1 (percentage/proportion of variation that's explained) - Higher R2 (closer to 1)= explain a lot of variation; for linear regression to work want R2 to be higher - Lower R2 (closer to 0)= don't explain much variation

Social Influence Theory

creation of new behaviors, reinforcement of existing behaviors, behavior change directed through formal (doctor-patient) and informal (parent-child) interpersonal relationships communicator- source of social influence by being shared message/communication- being exchanged channel- how it is being delivered target audience- recipient of message situation- of message being presented interactions with others- similar, esteemed/valued *respected/value/expert more likely to engage in behavior change

prospective (cohort) study

define sample free of the disease/outcome of interest, measure the exposure and classify to exposed vs. unexposed at "baseline", then follow-up to ascertain outcome -measure the proportion of outcome between exposed and unexposed (Risk Ratio/ Relative Risk) or rate (Rate Ratio)

Succession planning

deliberate and systematic effort by an organization to ensure leadership continuity in key positions, retain and develop intellectual and knowledge capital for the future, and encourage individual advancement involves a defined plan to cultivate a new group of leaders

secondary sewage treatment

depends on biological process state has decided to use; further reduce solids - trickling filters (takes a long time) - activated sludge process (carbon compound) - after tx, 90-95% of solids and BOD are reduced

lethal dose

describes acute toxicity (inversely related); mg of chemical/ kg of body weight LD50= dose lethal for 50% of population administered dose LD0= no resultant deaths LD100= entire population died smaller LD50= fewer mg of chemical/ kg of body weight will be required to kill larger LD50= lower the acute toxicity

Mission statement

describes what the group is going to do, and why it's going to do that.

administrative regulations

developed under the authority of law legislative bodies enact laws / authorize personnel within government to develop admin regulations for implementation of laws doesn't require action of congress/executive branch (federal/state/county level)

Particulate matter (PM)

directly emitted into air by sources such as factories, powerplants, cars, construction activity, fires and natural windblown dust (dust, dirt, soot, smoke, liquid droplets) - Source- burning of wood, diesel and other fuels; industrial plants; agriculture (plowing, burning off fields); unpaved roads - health effects- nose and throat irritation, lung damage, bronchitis, early death - environment effects- particulates are the main source of haze that reduces visibility - property damage- ashes, soots, smokes and dusts can dirty and discolor structures and other property, including clothes and furniture - Depicted by sizes = PM2.5 (SMALLEST; serious damage into lungs), PM10 - highest exposure in home (kitchen)

Pure Food and Drug Act (1906)

ensured the safety of food and cosmetics and the safety and efficacy of prescription drugs and medical devices.

Clean Air Act (1963)

established federal enforcement in interstate air pollution and assistance to state and local government in controlling air pollution.

State Children's Health Insurance Program (CHIP, 1997)

established to help provide medical care to children in low-income families that are not poor enough to qualify for Medicaid.

process evaluation

explore and describe actual program implementation. It can indicate whether the program was implemented with fidelity, as intended. It may help explain why a program did or did not meet its main objectives. examine how the program was implemented Investigates fidelity of program implementation and investigates outputs - what program activities are delivered - who delivers program activities -when/where activities are delivered -# people served Ex) Assess what percentage of parents in an online course surrounding talking to your teen about drugs, fully completed the online education module. Interview program coordinators surrounding internal procedures for training healthcare providers on new guidelines for a hospital-based screening program targeted at identifying the early warning signs of psychosis in their patient population.

Theory of Reasoned Action (TRA)/ Theory of Planned Behavior (TPB) Model

explores the relationship between behavior and beliefs, attitudes, and intentions behavioral intentions are the best predictors of behavior and behavioral intentions are directly influenced by the attitude about performing the behavior and the belief whether important others approve or disapprove 1. attitude- evaluation of behavior a. behavioral belief b. evaluations of behavioral outcomes- value 2. subjective norm- perceived expectation to perform behavior from others (most people approve/disapprove of behavior) a. normative beliefs- what most people believe b. motivation to comply- agree to most people 3. perceived behavioral control- perceived control over behavior itself a. control beliefs- each facilitating/constraining condition actually occurring b. perceived power- how likely will each condition make behavior change easy/difficult to perform 4. behavioral intention- intent to enact on behavior; perceived likelihood to perform

Two-factor theory (Herzberg)

factors that influence motivation in the workplace by either enhancing employee satisfaction or hindering it. 1. Hygiene factor- cause dissatisfaction in the workplace, are extrinsic (or independent of the work itself), and are linked to things such as compensation, job security, organizational politics, working conditions, quality of leadership, and relationships between supervisors, subordinates, and peers; making an employee feel comfortable, secure, and happy; don't motivate employees, but when they are missing or inadequate can cause serious dissatisfaction. 2. Motivators (or satisfiers)- linked to employee motivation and arise from intrinsic, or dependent, conditions of the job itself (responsibility, job satisfaction, recognition, achievement, opportunities for growth, and advancement)

Paracelsus

father of toxicology "dose makes the poisson"- everything in moderation; substances considered toxic are harmless in small doses; ordinary harmless substances can be deadly if over-consumed

Municipal sewage treatment

fecal wastes were dumped into an open cesspool near the well; brick lining of cesspool deteriorated, and wastes seeped through group and pathogens contaminated well water - Open cesspools still common practice through early 20th century - Waste collected in pits, stabilized by bacterial action, no disinfection used - (19th century) flushing toilets became popular, increasing volume of waste water, causing overflow and increasing water borne disease (cholera, typhoid) - (today) 70% of pop in US have water that goes to sewage treatment prior to discharge

1918 federal grants to states to

federal grants to states to provide public health services

John Graunt's Bills of Mortality

first time someone attempted to describe in methodical way what was causing people to die (causes of death), precedence setting for collecting/monitoring data, assessing what learned, acting upon it

General Welfare Clause

from U.S. Constitution, general basis for environment of health "promote the general welfare"

Commerce Clause

from Us. Constitution, under section 261 of the Public Health Service Act gives authority to federal government for isolation and quarantine Empowers US Secretary of Health & Human Services is authorized to take measures to prevent entry and spread of communicable diseases from foreign countries into US/ between states

reciprocal determinism

from social cognitive theory (SCT), refers to the interrelationship between a person, their environment, and their behavior; behavior both influences, and is influenced by, the social and physical environment.

Causative factors

generically categorized as risk factors that cause or contribute to a negative health outcome. Risk factors may be indirect (community-specific) or direct (scientifically based). Causative factors may be individual or population level.

diagnostic test

gold standard is needed to asses those clarified as test positive/negative

focus groups

group interviews where a facilitator guides the questions and discussion. qualitative method that collects data through a simultaneous conversation with a group of people.

hyperplasia tumor

growth of cells in excess of what is normally observed, but it does not necessarily become malignant.

chronic toxicitiy

harmful systemic effects produced by long-term, low-level exposure to chemicals; far more complex - noted certain trades had poorer health (e.g. mining, metallurgy, pottery - described severe colic in men who extracted metals- lead (Pb) poisoning - mercury (Hg) poisoning (neurological impairments) in miners from the quicksilver mines of Spain

Absolute excess measures

have to subtract the background (incidence rate in unexposed, risk they would have anyway) to get the excess rate; not relative

ratio variables

highest level of information; continuous variables values are equally spaced with an absolute zero point (e.g. height, an inch is always an inch and 0 inches is the same as 0 centimeters Variable with ratio scale is NOT the same as ratio (a/b); the latter is simply the relationship between 2 numbers, (e.g. odds ratio is the ratio of two odds); the former only indicates the level of information in a variable

system thinking

how to integrate health in system components: (measures to different groups) 1. access to care 2. cost of service 3. quality of care provided Much of the work has involved bringing together scientists from many disciplinary traditions, in many cases allowing them to transfer methods from one discipline to another (inter disciplinarity), or to work across and between disciplinary boundaries, creating learning through a wide variety of stakeholders, including researchers and those affected by the research (trans-disciplinarity)

control for confounding among design phase

i. randomization- with sufficient sample size, randomization is likely to control for both known and unknown confounders- but not guaranteed ii. restriction- restrict admissibility criteria for study subjects and limit entrance to individuals who fall within a specific category of the confounder iii. matching- not so much to control for confounding, but one more way to maximize efficiency

control for confounding among analysis phase

i. standardization- by age, race, gender, or calendar time in order to make fair comparisons between populations ii. restriction- restrict during data analysis iii. stratified analysis- way of eliminating variation in the confounding factor; feasible with small number of variables iv. multivariate analysis- to enable controlling for several potential confounders simultaneously

indicated interventions

identify and target individuals experiencing early signs of risky behavior/related problems

Non-differential misclassification

inaccuracies with respect to disease classification are independent of exposure; with respect to exposure are independent of disease status; probability of exposure (or outcome) is same of cases and controls (or in study/comparison groups) bias results toward the null (if exposure has 2 categories, will make groups more similar) --> use multiple measurements/choose the most accurate sources of info

age-specific mortality rate

includes all deaths in specific-age group, population in the specific age group, in a time period Remove confounding by age: 1. Separate (stratify) the population into age groups and calculate rates for each age group --> compare age-specific mortality rates (different rates) 2. if 2 different populations, adjust (standardize) the mortality rates of the 2 populations, taking into account the age structures --> results in comparable rates between populations or in the same population over time

scaling up (4 categories)

increasing a program's impact while maintaining quality 1. Quantitative- Increasing # of clients reached by a program - Addition of new target audience - Expansion into new geographic area - Adoption and use of programs novel materials and approaches by others - Diffusion of innovations theory may be of use 2. Functional- Expanding program breadth - Increasing # and type of technical areas addressed by a program 3. Political- Ability to address national-level barriers to effective program services - Advocating for and/or developing efficient processes/ clear policies and guidelines - Standardizing materials and techniques for education + training 4. Organizational: improving ones own or another org's ability to continue to support an initiative in effective and sustainable manner - Diversifying and/or stabilizing funding base - Increasing use of effective financial schemes - Developing strategic alliances to increase resources - Building technical and management capacity of collaborating agency in order to sustain efforts

Health Belief Model (HBM)

individual beliefs as determinants of behavior Determined by perception of threat of health problem, appraisal of recommended behavior to prevent problem, and cues to action 1. perceived susceptibility- belief about the chances of experiencing a risk of getting a condition/ disease 2. perceived severity- belief about how serious a condition and its related consequences are 3. perceived benefits- belief in the efficacy of the advised action to reduce the risk of seriousness of impact 4. perceived barriers- belief about the tangible and psychological costs of the advised actions 5. self-efficacy- confidence in one's ability to perform the advised action 6. cues to action-strategies to activate an individual's readiness to perform the advised action

Trans-Theoretical Model

individual readiness to change as determinant of behavior behavior change is a process, individuals differ in their readiness to change, and intervention strategies must be tailored for each stage of readiness to change 1. Pre-contemplative- no intention of change within the next 6 months; sees not problem but others disapprove a. strong principle- progression to action is a function of increase in the pros of a behavior change b. weak principle- progression to action is a function of decrease in the cons of a behavior change 2. Contemplative- thinking about change in next 6 months; weighing pros and cons of changing 3. Determination- going to do in next 30 days; to carry on as before or to change 4. Active change- change in the last 6 months (early stages); putting the decision into practice 5. Maintenance- sustain last 6 months/longer; actively maintaining change 6. Relapse- return to previous behavior moving through stages requires decisional balance (weighing the benefits of changing vs. costs of changing) and self-efficacy (perceived ability to engage in healthy behavior)

lethal concentration

inhalation work determined by exposing several groups of animals (rats/mice) each to different air concentration of chemical for one hour period, then observed for 14 day period (short-term effect)

Universal Declaration of Human Rights

international document that states basic rights and fundamental freedoms to which all human beings are entitled. includes civil and political rights, like the right to life, liberty, free speech and privacy , economic, social and cultural rights, like the right to social security, health and education.

Kyoto Protocol

international treaty which extends 1992 UN Framework Convention on Climate Change (UNFCCC) that commits state parties to reduce greenhouse gas emissions, based on scientific consensus that (part one) global warming is occurring and (part two) it is extremely likely that human-made CO2 emissions have predominately caused it

chi-square test for homogeneity

interpret is the distribution of dependent variables different among the various independent variables used to determine whether observed sample frequencies differ significantly from expected frequencies specified in null hypothesis

clinical trial

involves active follow-up of group of people and determines their outcomes (disease, cure, side-effects, etc.) - viewed experimental prospective cohort study (forward directionality; record exposure before record the outcome; starting with exposure and looking forward in time to see what happens) - Cohort typically referred to is observational (no assigned treatment), however in clinical trial, exposure is manipulative (assigned treatment) - calculate incidence (forward directionality; new cases developed over study time period)/ Risk Ratio (risk in exposed/risk in unexposed)

Public Health Accreditation Board (PHAB)

joint commission; international (globally) meet standards accredits local health departments demonstrating they met local standards eligibility/requirements increase standards for personnel/facilities

Transformational leadership (TFL)

leadership approach that causes change in individuals and social systems. In its ideal form, it creates valuable and positive change in the followers with the end goal of developing followers into leaders. Enacted in its authentic form, transformational leadership enhances the motivation, morale and performance of followers through a variety of mechanisms. These include connecting the follower's sense of identity and self to the mission and the collective identity of the organization; being a role model for followers that inspires them; challenging followers to take greater ownership for their work, and understanding the strengths and weaknesses of followers, so the leader can align followers with tasks that optimize their performance Charisma/Inspirational, Inspirational motivation, Intellectual motivation, Individualized consideration, and Behavioral and/or Attributed influence

Path-goal theory

maintains that the leader can affect the performance, motivation, and satisfaction of followers process in which leaders select specific behaviors that are best suited to the employees' needs and the working environment so that they may best guide the employees through their path in the obtainment of their daily work activities (goals) Based on Vroom's (1964) expectancy theory in which an individual will act in a certain way based on the expectation that the act will be followed by a given outcome and on the attractiveness of that outcome to the individual

correlation

measure of association (is there an effect and how much) for continuous independent and dependent variables; equivalent to simple linear regression

risk ratio

measure the proportion of outcome between exposed/unexposed in cohort study the risk of disease among the exposed is X times higher/lower than the risk of disease among unexposed Ex) in exposed group- started with 4 people, 2 people got outcome= 0.5 (50%) in unexposed group- started with 4 people, 1 person got outcome= 0.25 (25%) RR= 0.5/0.25= 2 (Your risk of outcome is 2x as likely if you are exposed versus unexposed)

Cost-benefits analysis

measures both costs and benefits (i.e., negative and positive consequences) associated with an intervention in dollar terms. - conducted to help decide which HIA recommendations are the most feasible.

Lead (Pb)

metal that occurs naturally and produced by human activity; exposure can be by air and ingestion (contaminated food, water soil or dust) - widespread outdoor airborne exposure has ceased to be a major health problem in the US - source- leaded gasoline (being phased out), paint (houses, cars), smelters (metal refineries); manufacture of lead storage batteries - health effects- brain and other nervous system damage; children are at special risk; some lead-containing chemicals cause cancer in animals; lead causes digestive and other health problems

False negative

miss people who have disease; poor sensitivity

linear regression

model linear (actual) relationship between continuous independent (X) and dependent (Y) variables; model 2 variables as a line dependent variable (Y) and independent variable (X) are continuous model is line with intercept β0 and β1 (Y= β0 + β1X) Data are points on scatter plot, use methods of least squares to find a line that fits well Can measure how well the line does in fitting the data ¯(Y )= sample mean of y (outcome; dependent variable) Linear regression, incorporates different x variables Minimize differences between linear regression

Cause-Specific Mortality Rate

mortality rate from a specified cause for a population. = number of deaths attributed to a specific cause/ size of the population at the midpoint of the time period. - proportion is dependent on all other causes of death (if higher proportion of people that die from something else, lowers the proportion of dying from disease of interest)

Baldrige Health Care Criteria Framework

national hospital award; state awards local health department (step higher than accreditation) 1. leadership 2. strategic planning 3. focus on patients/other customers/markets 4. measurement, analysis, knowledge, management 5. staff focus 6. process management 7. organization performance results

1. primary prevention- before biological onset 2. secondary prevention- screening (before symptoms) 3. tertiary prevention- after diagnosis, before disabled

natural history of chronic disease and prevention

Hierarchy of Needs (Maslow)

needs must be met in the following order: 1. physiological needs- air, food, drink, shelter, warmth, sex, sleep, etc. 2. safety-security- protection from elements, security, order, law, stability, etc. 3. belongingness- friendship, intimacy, trust, and acceptance, receiving and giving affection and love. Affiliating, being part of a group (family, friends, work). 4. esteem- (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the desire for reputation or respect from others (e.g., status, prestige). 5. self-actualization- realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

cross-sectional study

observational studies (estimate prevalence); all measurements of exposure and outcome are made simultaneously (snapshot) - disease proportions are determined and compared among those with or without the exposure or at varying level of the exposure - examine association- determination of associations with outcomes; generates hypotheses that are the basis for further studies - most appropriate for studying the associations between chronic diseases and chronic exposure -sometimes useful for common acute diseases of short duration - define population, gather data on exposure (cause) and existing disease (effect/outcome) at the same time and correlate them; no directionality (slice of time) Ex) If in bad mood raise hand, so record number of people. If wearing bright colored clothing raise your hand, and see if wearing dark clothing is correlated with being in a bad mood 200 children aged 9 to 12 were recruited to evaluate the effect of BMI on foot structure. In addition to BMI, 3 reliable anthropometric measures were recorded: foot length, forefoot width, and navicular height A survey was performed in 9 European countries (Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden) from October-December 2003, as part of Pro Children study. Data on usual intake of fruit and vegetables, and related correlates were collected by means of self-administered questionnaire among 11-year-old school children.

misclassification

observational/information bias) of exposure and outcome-error arising from inaccurate measurement/classification of study subjects/variables; subject's exposure/disease status is erroneously classified; happens at assessment of exposure/outcome (cohort/case-control)

cohort study

observational; groups, defined on the basis of some characteristics (often exposure and non-exposure) are prospectively followed to see whether an outcome of interest occurs - compare the proportion of persons with disease in the exposed group to the proportion with disease in the unexposed group (or compare rates) - if the exposure is associated with the disease, we expect that the proportion is associated with the disease, we expect that the proportion of persons with the disease in the exposed group (or rate of disease) will be greater than the proportion with disease in the unexposed group Ex) Cigarette smoking data were collected on all household members during two private censuses in Washington County, Maryland. These two groups were followed up one from 1963-1978 and other from 1975-1994 for first-time diagnoses of rectal cancer

epidemic

occurrence of a disease clearly in excess of normal expectancy in a defined community of region; increasing prevalence of non-infectious chronic diseases

censored data

occurs in survival analysis when exact survival time is unknown; event didn't occur - study ends before individual experiences the event (e.g. leukemia patient may stay in remission even after end of study) - individual is lost to follow-up during study (e.g. parolee may flee and will not be able to be located) - individual is withdrawn from the study (e.g. person in disease free cohort may die of a car accident before developing disease)

Effect modification

occurs when the effect of an independent variable on the dependent variable differs depending on the level of the third variable (effect modifier) - Graph on left shows same effect for men and women, so no effect modification (X and Y both increase in the same matter for men and women) - Graph on right shows different effects, sex is an effect modifier (rate of growth/slope is higher for men vs. women)

Radon

odorless, colorless, and tasteless; naturally occurring (can't take action) radioactive gas resulting from the decay of radium (out of the ground); decay product of uranium - breaks down into radon decay products (radionuclides) which may be inhaled and continues its decay in the lungs - remediated with a fan to blow it out - EPA estimates as many as 6 million homes throughout the country have elevated levels - 2nd leading cause of lung cancer, following smoking - Tobacco smoke/radon exposure have synergistic effect

Poisson distribution

often used to describe count data and can be used to describe rate data by including an offset term for the denominator of the rate. models number of events out of infinite observations (no fixed population) - independent events - use when the event is rare over time - One parameter mean λ (lamda) and mean (usually indicates how frequent event occurs)=variance

malignant tumor

one that has begun to invade surrounding tissues, but has not yet necessarily metastasized.

metastatic tumor

one that has begun to shed cells into the bloodstream that can then spread to other locations throughout the body

Community Organizational Theory

organization + build community capacity as key determinant of health work with community members 1. themselves to help identify/describe problems that exist 2. collaborating with organization to utilize resources (monetary/staff) 3. activate partners in design + implementation to reach overall goals of community

strategic planning

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. means: 1. mission (more specific than vision) 2. strategies 3. tactics ends: 1. vision 2. goals (long-range/board) 3. objectives (shorter/specific) Process: 1. analyze situation (environment/ operations) - SWOT assessment - identify priority issues/challenges - explore alternative ways of dealing with issues = goal formulation 2. define directions (vision, mission, goals, objectives) 3. strategies (to achieve results)/ strategy and formulation - resource requirements for each strategy - budgets (capital/operating) 4. adjust (performance/objective)/ evaluation and control - ongoing evaluation performance - management information system (MIS, day to day operation) to gather and display data

Healthy People (systematic approach to health improvement)

over 10 years; play into systems of determinants of health; goal (further into future) based on topics and objectives (measurable, more specific, time-specific)

routes of exposure

pathway by which chemical gets in body 1. dermal- penetration through skin (most common); skin effective barrier to chemicals 2. inhalation- absorption through lungs (2nd most common); lungs= poor barrier to chemical; surface very delicate (thin membrane) allows easy passage of O2/other chemicals from alveolar space to blood; small particles deep into the lungs/ visceral barriers scar lung tissue; systematic nature; issues of interference with function ex) pneumoconiosis (Byssinoisis- cotton, brown lung- dust, silicosis- sugar cane pulp/glass, black lung-coal miners, asbestosis- asbestos) 3. oral- passage across walls of GI tract; ingestion of food (enter body and absorbed through GI tract; majority small intestine) ex) nitrogly cerine absorbed through membranes of mouth vs. ethyl alcohol rapidly in stomach/intestines

Positive feedback loops

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. where A produces more B which in turn produces more A, such as the vicious cycle of under-nutrition and infection. Ex) with an apple tree, once the first apple ripens, it gives off a gas known as ethylene (C2H4) through its skin. When exposed to this gas, the apples near to it also ripen. Once ripe, they too produce ethylene, which continues to ripen the rest of the tree in an effect much like a wav (feedback loop often used in fruit production, with apples being exposed to manufactured ethylene gas to make them ripen faster)

recall bias

people with disease remember/report exposures differently (more/less accurately) than those without disease; can result in over-or under-estimation of measure of association use controls who are themselves sick, use standardized questionnaires that obtain complete information, mask subjects to study hypothesis

Organizational Change Theory

polices/practices as determinants of health directly/indirectly effect health (protection plans for occupational health) STAGE APPROACH- strategies based on stage 1. defining problem + evaluating solution= awareness of problem 2. adoption (initiating action to solve problem)= policy formulated + resources allocated to start change 3. implementation= changes made (short-term reaction) 4. institutionalization= new goals internalized, common knowledge/acceptable fact DEVELOPMENT APPROACH- factors of organizational functioning identified/changed; improve quality of work like; process continuous diagnosis + action planning/ implementation + evaluation 1. organizational climate= personality/mood of organization as whole 2. organizational culture= assumption/beliefs shared by members 3. organizational capacity= optimum functioning of all sub systems within organization 4. overall goal= transfer knowledge/ skill to organization to improve capacity of problem solving to address challenges

policy analysis

policy making development 1. problem statement- concise, focus, options related to solution 2. background- relevant, natural tone 3. landscape- stakeholder's view describe accurately/appropriately 4. options- alternatives considered, which ideal directly addresses issue identified in problem statement within power of client 5. recommendations- one of options assessed strategies to address problem

relative frequencies

portions/percentages of categories

ozone

present in 2 layers of atmosphere; has same chemical structure whether it occurs high above earth (stratosphere) or at ground level (troposphere) - Sources- chemical reaction of pollutants; VOCs and NOx - Health effects- breathing problems, reduced lung function, asthma, irritates eyes, stuffy nose, reduced resistance to colds and other infections, may speed up aging of lung tissue - Levels in homes- average levels in homes without gas stoves vary from 0.5 to 5 parts per million (ppm); levels near properly adjusted gas stoves are often 5 to 15 ppm and those near poorly adjusted stoves may be 30 ppm or higher - up and down pattern over time, based on weather and vehicle usage

primary prevention strategies

prevention services delivered prior to disease onset in order to prevent disease occurrence. Ex) air bags, immunizations, safe drinking water and food system, adequate diet and physical activity, sunscreen and protective clothing, workplace safety regulations

Belmont Report

primary purpose is to protect subjects and participants in clinical trials or research studies; Principles: 1. Respect for persons- protecting autonomy and treating them with curtesy, respect (informed consent) 2. Beneficence- do no harm, maximizing benefits for research/ minimizing risks (avoiding behavior that results in harm; promoting welfare of others) 3. Justice- ensuring reasonable, non-exploitative, well-considered procedures are administered fairly (distribution of costs/benefits to potential research participants) and equally Areas of application: 1. informed consent 2. assessment of risks and benefits 3. subject selection Created in 1979 by the former U.S. Department of Health, Education, and Welfare (now the Department of Health and Human Services), 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.

Binomial distribution

probability distribution for the number of successes, which are a series of trials where each trial can either succeed or fail, the trials are independent, and the probability of success is the same for each trial. smaller group, fixed number of independent binary events

differential misclassification

probability of misclassification of disease/exposure status differs for exposed and unexposed persons (cohort) or presence of absence of exposure (case-control); different for cases/controls or for levels of exposure within cases/controls known that observed RR and OR deviates from truth, but direction is unknown (i.e. over/underestimation of true risk)

Positive Predictive Value (PPV)

probability that subjects with a positive screening test truly have the disease

Negative Predictive Values (NPV)

probability that subjects with negative screening test truly don't have disease

Environmental Impact Assessment (EIA)

process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of proposed developments prior to major decisions being made. - U.S. National Environmental Policy Act (NEPA) requires federal agencies to integrate environmental values into their decision-making processes by considering the environmental impacts of their proposed actions and reasonable alternatives to those actions

Communication Theory

production and exchange of info as determinant of health how we produce information/ exchange info between groups uses media/communications to provide info, influence behavior change/what individuals are concerned about norms- recognize concerns + health priorities + strategies to address behavior change

risk

proportion = (# of new onset cases) /(population at beginning of follow-up) Ex) Follow 2,000 newborns to measure development of respiratory infection in the first year 50 infants develop respiratory infection in the first year of life 50/2,000 = 0.025 = 2.5% the risk (probability) of developing a respiratory infection in the first year of life is ~2.5% CANNOT ASSUME THIS RISK TO OTHER POPULATIONS; NOT INDEPENDENT OF TIME/PLACE/POPULATION; must specify: - time period of observation (because risk changes with time) - population (because risks varies across populations) - region/place (because risk varies across region/place) = hazard x exposure (ability to come to contact with compound)

case fatality rate (ratio)

proportion of deaths within a designated population of "cases" (people with a medical condition) over the course of the disease. = (# of deaths from an illness)/ (# of people with that illness) NOT RATE; PROPORTION of deaths from specific illness; what percentage of people diagnosed with having a disease die within a certain time after diagnosis - measure of severity of disease; damaging/no cure= increased case-fatality rate - can be used to measure benefits of new therapy; as therapy improves the case-fatality rate would be expected to decrease

Specificity

proportion of people without disease who test negative; probability of screening negative if the disease is truly absent if test result is positive you can be nearly certain they actually have the disease SPIN= rules in disease with high degree of confidence = true negatives/ (true negative + false positives)

sensitivity

proportion of truly diseased people in the screened population who are identified as having the disease by the screening test (true positives). if test result is negative, you can be nearly certain they don't have the disease SNOUT= helps rule out disease (when result is negative) = true positives /(true positives+ false negatives)

Assessment Protocol for Excellence in Public Health (APEXPH)

provides local communities with a means of increasing their organizational capacity and strengthening their leadership role in their communities. Through a three-part process, local health departments (LHD) assess internal capacity, identify priority community health issues, and develop action plans. -increased understanding of community's actual and perceived health problems - strengthened relationships with government and community partners -community recognition of the LHD as having a major role in ensuring the public's health.

Social Security Act (1935)

providing pensions and other benefits to the elderly, is signed into law by President Franklin Delano Roosevelt. National health insurance is left out of the final Social Security bill because of the opposition of organized medicine and its allies.

Human Resources Workforce

public health agencies

Human Health Risk Assessment

quantitative, analytic process to estimate the nature and risk of adverse human health effects associated with exposure to specific chemical contaminants or other hazards in the environment, now or in the future. - not comprehensive and tend to focus on biophysical risks from exposure to hazardous substances. - Results can be used within an HIA to predict human health effects of specific exposures.

Objectives

refer to specific measurable results for the initiative's broad goals.

"nosocomial" refers to infections acquired in what place?

refers to Hospital-associated infections (resistant to antibiotics)

Summative evaluation

refers to the assessment of participants where the focus is on the outcome of a program. This contrasts with formative assessment, which summarizes the participants' development at a particular time. 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.

epidemiologic triad

refers to the interactions between the host, agent, and the environment to produce disease, particularly communicable disease. Using this model, the host is typically a human, the agent is typically a bacteria, virus or other pathogenic organism, and the environment is the setting in which the interactions take place. In some cases, a fourth variable, known as a vector, may be involved in the interaction.

A nominal variable can to be coded using dummy variables in order to analyze its association with a continuous outcome variable via:

regression analysis Nominal variables need to be coded numerically in order to be included in an regression analysis. One easy way to code nominal variables is to use dummy variables coded as 0 and 1. Using this coding, the number of dummy variables needed would be one less than the number of levels of the categorical variable.

Social Support/Social Network Theory

relationships between individuals/how nature of these relationships influences beliefs ad behaviors types of support (aid/assistance/exchange): - emotional (empathy, caring, trust) - instrumental (action) - informational (advice/info) - appraisal (constructive feedback/affirmative)

systems resources

resources required to maintain a health care delivery system 1. financing 2. personnel (HR) 3. technology and supplies 4. facilities differences urban vs. rural (+ education) external environment (general/health care) + internal environment --> input (HR, materials, tech, info, capital resources, patients)--> structure, people, tasks (conversion- integration causes) --> output (outcomes- work results, objective accomplishments) --> feedback for refinement of process (continuous improvement to change)

chi-square distribution

right-skewed distribution where the area under the curve is equal to one, it starts at 0 on the x-axis and extends infinitely to the right but never touches the x-axis, and where the curve looks increasingly normal as the degrees of freedom increase.

sample theory/ central limit theorem (CLT)

sample mean (x) to estimate population mean (μ), even if distribution is not normal, and if large sample size (n ≥ 30) guarantees that the sample mean (x) is normal. - most conclusions we make is about an unknown feature of the population, to make conclusions we need to first estimate them (e.g. sample mean for population mean) to have better idea of population - sample statistics like sample mean only gives one value for the estimate - by standardizing the sample mean, the distribution becomes approximately normal (how test statistics are computed when doing hypothesis testing)

In a study to determine incidence of a chronic disease, 150 people were examined at the end of a 3 year period and 12 cases were found giving a cumulative risk of 8%. An additional 30 members of the initial cohort could not be found for re-examination. Which type of bias might this generate?

selection bias Non-response is a form of selection bias. Appropriate methods should be considered to adjust the confidence interval around a point estimate in this situation.

Expectancy theory (Vroom)

separates effort (which arises from motivation), performance, and outcomes. assumes that behavior results from conscious choices among alternatives whose purpose it is to maximize pleasure and to minimize pain. Variables to account for effort, performance and motivation: 1. Expectancy- increased effort will lead to increased performance i.e. if I work harder then this will be better (affected by having right resources, skills, support) 2. Instrumentality- if you perform well that a valued outcome will be received. The degree to which a first level outcome will lead to the second level outcome. i.e. if I do a good job, there is something in it for me (affected by clear understanding of performance/outcomes, trust in people who decide 3. Valence- the importance that the individual places upon the expected outcome; effort-performance expectancy (E>P expectancy) and performance-outcome expectancy (P>O expectancy).

randomized clinical trial

starting with exposure then manipulating exposure to determine outcome - obtaining groups that are comparable for everything expect the treatment, so that differences in outcome can fairly be ascribed only to the difference between the groups (i.e., to the treatment) Ex) 15 patients were randomized to receive a preoperative beverage with high (125mg/ml) or low (25mg/ml) carbohydrate content. Postoperative cognitive ability was subsequently measured ; 98 individuals 18-65 years of age were randomized to placebo or sertraline (Zoloft) 25mg/day for 2 days, followed by 50mg from 3 to 90, and buspirone 5mg 3 times a day for 7 days, and 10mg from day 8 to 90)

needs

state of felt deprivation including physical, social, and individual needs (ie hunger)

ANOVA (f-test)

statistical method testing the difference in population means between more than two groups H0: group means same HA: group means different

T-distribution/ t-test

symmetric like normal, use for t-tests for means when variance is unknown (shape is much like normal, but tails are "fatter"; has a "heavier" tail) - statistical method testing the difference in population means between two groups when population variance is UNKNOWN

hazard

synonym for toxicity and conditions of use 1. inherent ability of chemical to do harm by virtue of its explosiveness, flammability, corrosiveness, toxicity, etc. 2. ease with which contact can be established between chemical and object of concern

Causal loop diagrams (CLDs)

system dynamics tool that produces qualitative illustrations of mental models, focused on highlighting causality and feedback loops. Feedback loops can be either reinforcing or balancing, and can help to explain the role of such loops within a given system. often developed in a participatory approach. The drawings can be further developed by categorizing the types of variables and quantifying the relationships between variables to form a stock and flow diagram.

interviewer bias

systematic difference in soliciting, recording, interpreting information; can occur whenever exposure information is sought when outcome is known (case control) or when exposure is known (cohort study) mask interviewers to study hypothesis and disease or exposure status of subjects; use standardized questionnaires, or standardized methods of outcome/exposure ascertainment; use biomarkers to compare when possible

selection bias

systematic error that occurs in the process of identifying (or retaining) study populations - refusals, exclusions, non-participants - losses to follow-up are not independent of exposure and outcome (cohort study) - systematic difference between those selected for study versus those not selected for study (case-control) - when controls do not reflect the population (failure to enumerate entire population) - selection of cases and controls must be independent of the exposure status - do controls in the study have higher/lower prevalence of exposure than controls not selected for the study? - Occurs when controls/cases are more/less likely to be included in study if they have been exposed (inclusion isn't independent of exposure) - Results: relationship between exposure and disease observed among study participants is different from relationship between exposure and disease in eligible individuals who were not included - Odds ratio from the study that suffers from selection bias will incorrectly represent the relationship between exposure and disease in overall study population

Community Health (Needs) Assessment

systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. - develop strategies to address the community's health needs and identified issues. - prerequisite for tribal, state, local, or territorial public health departments seeking voluntary accreditation. -variety of tools and processes may be used to conduct; the essential ingredients are community engagement and collaborative participation. - Data obtained on health status and community health needs used in an HIA to describe the existing health status of the affected population.

CDC Framework for Program Evaluation in Public Health

systematic method for evaluation, promotes participatory approach, focuses on using evaluation findings; steps taken when tailoring intervention 1. Engage stakeholders- development of the evaluation plan, conduct of the evaluation, and use of evaluation results (Funders, program management and leadership, grantees, program partners, evaluation team, those served or affected by the program, and users of the evaluation) 2. Describe program- Developing a logic model to guide the evaluation Includes inputs, activities within each program component, and a trajectory of client outcomes detectable immediately following intervention (short-term outcomes), at follow-up (intermediate outcomes), and after a sustained period of program implementation (long-term outcomes); Case studies may also be used to provide descriptive data about the program. 3. Focus eval design- Different evaluation Qs are relevant for different stages of a program (stakeholders involved) - implementation fidelity Qs: at program initiation - short-term outcome Qs: once fidelity is assured - long-term outcome Qs: appropriate once the program has documented short-and intermediate term effects. 4. Gather credible evidence- While existing data should be used whenever possible, evaluation tools should be developed as needed, and piloted prior to use in the evaluation. 5. Justify conclusions- Both quantitative and qualitative data analysis methods may be used to analyze implementation fidelity, program processes, and program outcomes 6. Ensure use + share lessons learned- A communication and dissemination plan for the evaluation should include - internal communication strategies - strategies for communicating with stakeholders - program and provider dissemination - scientific dissemination - policy-relevant dissemination - public access dissemination standards (quality of intervention activity) 1. utility- serves info needs of intended users 2. feasibility- ensuring realistic, diplomatic, frugal 3. propriety- eval conducted legally and ethically 4. accuracy- ensure eval relieve/convey accurate info

1915 Welch-Rose Report

template for public health professional education in the US and abroad; Rockefeller Foundation awarded grant to John Hopkins to establish first independent graduate school of public health; wove laboratory mindset together with methods of public health admin and epi fieldwork

cultural competence

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

person-time (PT)

the length of time for each person when accounting for all the time each person is in the population at risk; sum of person-times= total person-time at risk for the population assumes rate is constant over different periods of time - 100 persons followed 10 years= 1,000 person years - 1,000 persons followed 1 year= 1,000 person years

coliform bacteria

the presence of appreciable numbers in a water sample has been used as an indicator that the water is unsafe to drink - more historical activity than anything else - rarely cause disease - present in greater numbers than pathogenic bacteria of intestines of warm-blooded animals, coliforms serve as indicators that the water is polluted

random error (chance)

the probability that an observation occurred unpredictability without discernible human intention or observable cause; "that part of our experience we cannot predict" (not systematic) usually most easily conceptualized as sampling variability and can be influenced by sample size influence can be reduced by - increasing sample size - improve precision of instrument - probability of an observation occurring by chance can be quantified (e.g. p-value or CI width)

Capacity building

the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment and other resources needed to do their jobs competently or to a greater capacity (larger scale, larger audience, larger impact, etc). categorized by efforts of the organization to enhance its ability to competently achieve its (operational, programmatic, financial) goals now and into the future Ex) The leadership in a public health organization has decided to conduct a training needs assessment of its staff, identify training needs, and to invest in training and other resources to ensure that the organization is able to carry out its essential functions and its mission, now and into the future.

general inductive approach for analysis of qualitative evaluation data

the purposes for using an inductive approach are to: - condense raw textual data into a brief, summary format - establish clear links between the evaluation or research objectives and the summary findings derived from the raw data - develop a framework of the underlying structure of experiences or processes that are evident in the raw data. provides an easily used and systematic set of procedures for analyzing qualitative data that can produce reliable and valid findings; straightforward approach for deriving findings in the context of focused evaluation questions.

Crude Mortality Rate

the total number of deaths to residents in a specified geographic area (country, state, county, etc.) divided by the total population for the same geographic area (for a specified time period, usually a calendar year) and multiplied by 100,000 includes all deaths, total population, in a time period

ecological (correlational) study

the unite of observation is the population or community; disease rates and exposures are measured in each of a series of populations - disease and exposure information may be abstracted from published statistics and therefore does not require expensive or time-consuming data collection - measures that represent characteristics of entire population are used to describe disease in relation to some factor of interest - presence of suspected risk factor can be measured in different populations and compare with incidence of particular disease - no directionally, it is a slice of time - unit of analysis is population level with no connection to specific individuals Ex) During the period 1995 to 200, 81,132 lung cancer cases were reported in Texas. Researchers examined the association of metal air releases with the average annual age-adjusted primary and non-small cell lung cancer rates in the 254 Texas counties Limitations ¬ Hypothesis generating- cannot establish causal relationship - unable to control the effects of potential confounding factors - unable to link exposure with disease in particular individual; crude analysis (do not know personal level information and relationship to outcome)

Situational Leadership Theory

there is no single "best" style of leadership. Effective leadership is task-relevant, and the most successful leaders are those who adapt their leadership style to the performance readiness (ability and willingness) of the individual or group they are attempting to lead or influence. Effective leadership varies, not only with the person or group that is being influenced, but it also depends on the task, job or function that needs to be accomplished. The situational leadership model has two fundamental concepts: 1. leadership style - (S1) telling- the leader tells people what to do and how to do it. - (S2) Selling- more back-and-forth between leaders and followers; sell" their ideas and message to get group members to buy into the process. - (S3) Participating- offers less direction and allows members of the group to take a more active role in coming up with ideas and making decisions - (S4) Delegating- . less involved, hands-off approach to leadership; Group members tend to make most of the decisions and take most of the responsibility for what happens. 2. the individual or group's performance readiness level. (maturity levels) - (M1) lack the knowledge, skills, and willingness to complete the task. - (M2) willing and enthusiastic, but lack the ability. - (M3) have the skills and capability to complete the task, but are unwilling to take responsibility. - (M4) highly skilled and willing to complete the task.

police powers

through law empowers further activity 1. encourage/discourage behavior 2. coercive action - quarantine - seize property (imported products) - close business (restaurant inspectors for sanitation)

relative risk (RR)

to analyze prospective (cohort) study; measure of association (is there an effect and how much) for dichotomous/categorical independent (2) and dependent variables (2)/not continuous RR= (risk of getting outcome with the risk factor )/(risk of getting outcome without the risk) = (# with risk factor & outcome /(total # with risk factor))/(# with no risk factor & have outcome /(total # without risk factor)) = (a/(a+b))/(c/(c+d))

odds ratio (OR)

to analyze retrospective (case control) study; measure of association (is there an effect and how much) for dichotomous/categorical independent (2) and dependent variables (2)/not continuous; ratio between two odds (probability of success/ probability of failure; 1-p) = (a/b)/(c/d) = (Exposed cases / non-exposed cases)/ (exposed controls/ non-exposed controls) = (a*d)/(b*c) = (Exposed cases* non-exposed controls )/ (Non exposed cases*exposed controls) the odds of exposure among the diseased is X times higher/lower than the odds of exposure among the non-diseased

Stratification

to control for confounding variables, conduct separate analysis for each level of a confounding variable (e.g. one analysis for only males and another for females) - Need large enough sample size for each strata to have enough subjects - Need to categorize continuous confounder (to separate into groups) - Difficult to control when there are multiple confounders (e.g. testing for race and gender- need enough subjects in each strata - Better to include in multiple regression model (can control for more than one confounder, continuous/categorical)

Truism

toxicology that humans are not simply big rats, and attempts are made in risk assessment to take into consideration important differences between rats and humans (less obvious is that children aren't simply small adults) Differences between children and adults: 1. Differences in intake per unit body weight of air, food, and water (and associated contaminants) - increased respiratory minute ventilation in infants/children result in greater inspired air exposure per unit of time on weight basis as compared to adults 2. Differences in pharmacokinetic behaviors, such as absorption, distribution, metabolism and excretion of chemicals - rate of absorption is faster in a child and compound accumulates to greater extent in infant, resulting in enhanced toxicity - particulate size determines amount of inspired particles/chemicals absorbed via the lungs

Incremental budgeting

traditional budgeting method whereby the budget is prepared by taking the current period's budget or actual performance as a base, with incremental amounts then being added for the new budget period. These incremental amounts will include adjustments for things such as inflation, or planned increases in sales prices and costs. The current year's budget or actual performance is a starting point only; they all start with a balance at least equal to last year's budget or spend. Benefits: - easy to prepare and understand, quick, easily allocated to more junior members of staff. - Less preparation time/costs - Prevents conflict between departmental managers (consistent approach adopted throughout the organization) - impact of change can be seen quickly Drawbacks: - assumes that all current activities and costs are still needed, without examining them in detail. - looks backwards rather than forwards, causing problems in rapidly changing business environments. - no incentive for departmental managers to try and reduce costs and may end up spending money just for the sake of it, knowing that if they don't spend it this year; they won't be allocated the cash next year, since they will be deemed not to need it. - Performance targets are often unchallenging, since they are largely based on past performance with some kind of token increase. Therefore, managers are not encouraged to challenge themselves and inefficiencies from previous periods are carried forward into future periods

normal distribution

type of bell-shaped curve that is centered around a mean and approaches the x-axis when it is greater than 3 standard deviations away from the mean Area to the right of the mean (0) is 0.5, area to the left is 0.5 (curve area under it represents the probability) Calculate area under curve= probability of observation coming from population belonging to the interval - 68% of values within (mean ± 1 std dev)- 34% on each side - 95% of values within (mean ± 2 std dev)- 13.5% on each side - 99% of values within (mean ± 3 std dev)- 2% on each side - 1% of values within (mean ± 4 std dev) - 0.5% on each side

randomized control trial

type of experimental research designed for comparing different treatments, in which the assignment of treatments to patients is made by a random mechanism - customary to present table of patient characteristics to show that the randomization resulted in a balance in patient characteristics - check to make sure randomization worked (if you do randomize, it is not a guarantee; the purpose is to equalize groups) 1. start with study population 2. randomly assign to 2 or more outcomes (treatment) 3. then look to see if people improve more with one tx/exposure compared to other

log rank test

use for survival analysis compare Kaplan Meier curves -common application is to compare survival experiences of two groups (e.g. time in remission for leukemia patients, one receiving a new treatment other receiving standard treatment) - visually the curves above look to be different, but we would like to know are the two survival experiences significantly different? - Test hypothesis- H0: survival curves are the same (survival experiences are the same) vs. HA: survival curves are different (survival experiences are different) - if test rejects, the curves are significantly different (it can't tell you which one is better, to tell which one is better you have to visually observe the survival curves or calculate mean/median survival times) - method works for more than 2 groups as well (3 or more)

Retrospective (historical; historical prospective, non-concurrent prospective) cohort study

use records (information was gathered in the past); forward directionality= starting with records of those exposed first and then looking forward in time - do not design studies- prior question always in retrospect - exposures and outcomes have already occurred - data on relevant exposures and outcomes already have been collected

Logistic regression

use when dependent variable is dichotomous (1 or 0; someone has disease or not); independent might be continuous Model probability (p) of getting 1 (probability of success) Log (p/(1-p)) = β0 + β1X (regression format) Produces odds ratio to show effect; control for confounders e= exponential function β1 represents change in log odds when X changes by 1 unit eβ1 = odds ratio when X increases by 1 unit (odds ratio between x and x +1)

Endemic

usual presence of disease within a given population

point estimation

wanted to estimate mean of population, would use sample mean (x)

prospective study

watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period.

central tendency

what happens in the "center" of the population or what is typical value from the population mean median mode

Attributable risk percent

what is the proportion of occurrence of disease in exposed persons is due to the exposure

indirect standardization

when age specific rates are not available use age-specific mortality rates from the general population to calculate expected number of deaths -standardized mortality ratios (SMR)= observed deaths/expected deaths

Diffusion of Innovation Theory

widespread share successful innovation as determinant of health through certain channels overtime through social system (structure/function) Process of dissemination includes the development of the innovation, the process to communicate about the innovation, the "uptake" of the innovation by the target population, the regular use of the innovation, and a focus on sustainability and institutionalization of the behavior systematic effort to maximize reach/adoption make innovation more widely available effectiveness of innovation more able to diffuse if able to improve on previous work, new idea/practice/object (hard= technology, soft= cooperative learning techniques/conceptual ideas) Primary stages: 1. awareness- exposed to innovation (lack of complete info), heard of it, but don't know details 2. interest- in new idea/learning more about it to seek more info 3. evaluation- mentally apply to present situation (individual/organizational) to decide whether or not to adopt 4. trial (period)- making full use (short-term) 5. adoption- continue use of innovation Process: 1. development of innovation 2. communicate about innovation 3. uptake of innovation by target population 4. regular use of innovation 5. sustainability + institutionalization of behavior

Participatory Impact Pathways Analysis (PIPA)

workshop-based approach that combines impact pathway logic models and network mapping through a process involving stakeholder engagement. aim to help participants to make their assumptions and underlying mental models about how projects run explicit and to reach consensus on how to achieve impact.

pandemic

worldwide epidemic (occurrence of a disease clearly in excess of normal expectancy in a defined community of region; increasing prevalence of non-infectious chronic diseases)