The Basic Science of Public Health Quiz Answer

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Epidemiology: The Basic Science of Public Health

Offered By ”The University of North Carolina at Chapel Hill”

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Instructor: Dr. Karin Yeatts +1 more instructor

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Week- 1

Module 1 Quiz

1. Which one of the following is the definition of epidemiology focused on in this course?

The study of the distribution of health outcomes, risk factors and exposures in people

The study of the distribution of health outcomes, risk factors and exposures in populations
The study of the distribution of health outcomes, risk factors and exposures in individuals
The study of the distribution of health outcomes, risk factors and exposures in communities

2. Which of the following are part of epidemiology? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

Provision of health care to people with diseases

The study of the factors that determine whether someone gets a particular health outcome
The study of the distribution of health outcomes, risk factors and exposures in populations
The study of the natural history of health outcomes

3. Which of the following were driving factors in the past history of epidemiology? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

The desire to find other explanations for witchcraft

The desire to increase the standard of living
The desire to understand frightening natural phenomena
The desire to provide better occupational conditions

4. The epidemiologic transition of Hunter-gatherer to cities is related to which event?

Resurgence of infectious diseases

From few epidemics to major epidemics
From major epidemics to endemic disease
From a focus on occupational health to environmental health

From infectious to non-infectious diseases
From a focus on individual health to population health

5. Which of the following is the best definition of an epidemiologic transition to fill in the blank?

An epidemiologic transition_____.

Describes changing patterns of population age distributions, mortality, fertility, life expectancy, and causes of death

Describes a transition from high mortality to lower mortality
Refers to a change in how epidemiologists are trained
Describes changing patterns of individual age distributions, mortality, fertility, life expectancy, and causes of death

6. Which of the following is the best description of the second epidemiologic transition from major epidemics to endemic disease?

A transition from high mortality to lower mortality

A period when newly emerging diseases appeared frequently
A period when human immune systems adapted and changed
An increase in zoonotic disease and increased encounters with disease vectors

A transition from chronic disease to more infectious disease

7. What was John Snow’s major contribution to the field of Epidemiology?

Did an experiment with fresh fruit
Contributed work during the cholera epidemic of 1854
Wrote about “disease seeds”

Showed the first occupational link to cancer
Developed the “poor laws”
Characterized births by parish and sex

Greek physician who was interested in rational rather than supernatural explanations for diseases
Father of modern vital statistics
One of the first demographers

Studied the effects of snowy environments on health

8. Which of the following are true about the cholera epidemic of 1854? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

This cholera epidemic affected people throughout Europe
A water pump in London was implicated as being the source of the epidemic
Sir Edwin Chadwick contributed to discovering the cause of this epidemic

John Snow contributed to discovering the cause of this epidemic
Approximately 600 people died by the end of this epidemic

9. Fill in the blank. Epidemiology ____________?

Is all of the above
Is the basic science of public health

Asks who, what, when, where, why and how regarding health and disease
Studies health and disease on a population level

10. True or False: The season can be a good epidemiologic measure of time.

False
True

11. Which of the following is NOT an epidemiologic measure of person?

education level

living conditions
genetic factors
physical location

diet

12. True or False: Qualitative data deals with narrative descriptions and quantitative data deals with measurements.

True
False

Week- 2

Module 2 Quiz

1. What is the primary difference between risk and prevalence?

Risk describes the number of diseased persons present in the population divided by the number of persons in the population during a specified time period, whereas prevalence describes the number of newly diseased person present in the population in a specified time period divided by the number of at- risk persons in the population.

Prevalence describes the number of diseased person present in the population in a specified time period whereas risk describes the number of people who die from the disease in the population in a specified time period.
Prevalence describes the number of diseased persons present in the population divided by the number of persons in the population in a specified time period, whereas risk describes the number of newly diseased person present in the population divided by the number of at-risk persons in the population in a specified time period.

2. Which of the following types of events can be measured by a risk and/or a rate?

Recurrence of a disease
Development of a drug or treatment side effect

All of the above
Newly developed cases of disease

3. True or false: The term “incidence” is used to refer to prevalence, risks and rates.

True
False

4. True or False: The formula for a rate is the number of existing cases of the disease outcome divided by the number of people studied, with a mention of the time period under observation.

False

True

5. True or False: The denominator of a risk is not fixed by the “at-risk” population size at the beginning of a study observation period.

True
False

6. In order to calculate a risk, which of the following steps must be taken? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

define a case definition for the health outcome under study
determine the number of new cases of the outcome under study

define the at-risk study population
determine how many people in the study were exposed or unexposed to the exposure under study
determine the number of males and females in the study

7. The denominator of a rate is affected by which of the following? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

loss to follow-up

births
deaths
migration

study drop-outs

8. Which of the following are advantages of using a rate measure? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

good for health outcomes or diseases that are of long duration
suitable for a dynamic population
good for health outcomes or diseases with long latent periods

flexibility
can accommodate repeated events that affect the same study participant

9. Which of the following measure(s) is/are able to capture the reality of a dynamic population? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

prevalence
odds

risk
rate

10. If you are studying the rate of leukemia, which of the following events would affect a participant’s person-time? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

death
participant goes out of town for a weekend

participant decides to no longer participate in the study
loss to follow-up
being sick with influenza

11. If you are studying the rate of breast cancer, which of the following events would affect a participant’s person-time? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

loss to follow-up

participant decides to no longer participate in the study
death
patient undergoes a double mastectomy

diagnosis with uterine cancer

12. If you are studying the rate of relapse for lung cancer after treatment, which of the following events would affect a participant’s person-time? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

time of initial diagnosis with lung cancer
time period(s) the patient is in remission from lung cancer
participant decides to no longer participate in the study
time period(s) when the patient is considered to have active lung cancer

13. Once the study population has been defined, the denominator of a risk is affected by which of the following? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

who is at risk of developing the health outcome
loss to follow-up
births
migration
deaths

14. Which of the following are acceptable ways to express “person-time”? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

person-months
person-days
person-years
person-minutes

15. Which of the following measures is sometimes used because of its convenient mathematical properties?

rate
odds
risk
prevalence

Week- 3

Module 3 Quiz

1. True or False: It is always ethical to randomly have the investigator assign exposures to study participants in experimental studies.

False
True

2. Which of the following studies is best described in this statement: “A study where the effectiveness of 2 different diabetes drugs are compared.”

cohort study
randomized controlled trial
cross-over clinical trial
intervention study
case-control study

3. Which of the following studies is best described in this statement: “A study where the participants receive one drug for heart disease and then later receive a different drug for heart disease.”

cross-over clinical trial
cohort study
randomized controlled trial
case-control study
intervention study

4. Which of the following best relates to equipoise?

use of a sham treatment that appears identical to the real treatment but lacks the treatment’s active agent
an uncertainty about the benefits/harms of the possible treatments or exposures
analysis of subjects according to their randomized treatment, regardless of whether they actually got or took the treatment
whether or not participants follow the treatment recommendations of the study

5. A cohort may be defined based on which of the following? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

gender
race
geography
age
behavioral characteristics

6. Which of the following are disadvantages of cohort studies? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

loss to follow-up
expensive
time-consuming to conduct
inefficient for rare outcomes
good for studying single outcomes only

7. True or False: The denominator for a measure of occurrence in a cohort study is always person-time since the study participants are followed through time.

True
False

8. The study population in a cohort study can be which of the following? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

closed
open
dynamic (changing over time)
very large

9. Subjects are selected into case-control studies based on their:

health outcome and exposure status
health outcome or disease status
exposure status

10. True or False: In a case-control study it is possible to sample on exposure status.

True
False

11. Prostate cancer occurs mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 67. (Source)

A case control study is conducted to determine the effect of fish oil consumption on prostate cancer in the state of Colorado. Which of the following would be an appropriate source population for this study?

The entire population of Colorado.
The entire population of men in Colorado.
The entire population of men in Colorado over the age of 50.

12. True or False: Hospital controls would be a good choice of control group to accurately represent the source population of prostate cancer cases for a study of the effect of fish oil consumption and prostate cancer.

True
False

13. Which of the following study designs is sometimes referred to as a “snapshot in time”?

Cross-sectional study
Intervention study
Time to treat study
Cohort study
Case-control study

14. Which of the following measures of occurrence are used for cross-sectional studies? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

Risk
Time
Rate
Odds
Prevalence

15. Which of the following are ways in which cross-sectional studies can be used / conducted? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

Characterize data on prevalence of an exposure as well as a health outcome
Study a population at a point in time
Study a population over a defined period of time
Only characterize the prevalence of a health outcome

16. Which of the following are possible uses of cross-sectional study results? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

Evaluate the proportion of a population with the health outcome or risk factor of interest
Help with planning or administering preventative or health care services
Evaluate the risk of a population with the health outcome or risk factor of interest
Help with developing surveillance programs
Study a chronic health outcome lacking information on time of onset.

17. Aggregate level data provide information on which of the following? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

The average exposure of the group, but not of individuals
The ability to link exposures and other risk factors to those who became diseased and those who did not
The health outcome rate of the group, but we don’t know exposures of individuals who became diseased and those who did not
Exposures of each person

18. True or False: The ecological fallacy is when you conclude that an association between exposure and the health outcome at individual level is true at group level when this may not be true.

False
True

19. Which of the following conclusions to explain the hypothetical statement that “Air pollution is higher in New York City than in Washington D.C., but mortality from lung disease is lower in New York City than in Washington D.C.” would be an example of ecologic fallacy?

Air pollution protects against lung disease deaths
New York City may provide better treatment for lung disease than Washington D.C.
Persons dying of lung disease in Washington D.C. may have moved from high air pollution cities
People in New York City may have better health insurance than people in Washington D.C.

20. Which of the following are advantages of ecologic studies? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

Help conservationists understand ecological principles
Convenience
Low cost
Useful for evaluating impact of community-level interventions
Individual-level data on exposure and health outcomes are often publicly available in state and national data bases

Week- 4

Module 4 Quiz

1. Interpret the meaning of one study’s reported odds ratio of 1.6 (95% CI 1.1, 3.4) for the association between high level of fish oil consumption and prostate cancer.

Cases are more likely than controls to have a high level of consumption of fish oil, but it is not statistically significant.
There is no association between fish oil intake and prostate cancer.
Cases are statistically significantly more likely than controls to have a high level of consumption of fish oil.
Fish oil is protective against prostate cancer.

2. Interpret the meaning of an odds ratio of 1.00 for the association between consumption of fish oil and prostate cancer.

Cases are more likely than controls to have a high level of consumption of fish oil.
Fish oil is protective against prostate cancer.
There is no association between fish oil intake and prostate cancer.

3. True or false: both a prevalence ratio and a prevalence difference are considered measures of occurrence.

True
False

4. True or false: both a risk ratio and a risk difference are considered measures of disease occurrence.

False
True

5. True or false: The term “relative risk” is the most precise term to use when discussing measures of association.

False
True

6. True or false: The term “relative risk” is sometimes used to refer to any of the ratio measures of association.

True
False

7. Which of the following are ratio measures used in epidemiology? (You must choose all that apply to receive credit for this question; no partial credit will be awarded.)

rate ratio
odds ratio
risk ratio
prevalence ratio
occurrence ratio

8. True or false: It is best to use a difference measure when trying to understand the cause or etiology of a health outcome or disease.

True
False

9. True or false: When a ratio measure is less than 1 it means the prevalence, risk or rate in the exposed is greater than in the unexposed group.

True
False

10. True or false: When a ratio measure is greater than 1 it means the prevalence, risk or rate in the exposed is greater than in the unexposed group.

True
False

11. Which of the following is true about a ratio measure that equals 1.0?

there is an inverse association between the exposure and the health outcome
there is a direct association between the exposure and the health outcome
there is no association between the exposure and the health outcome
there is a small association between the exposure and the health outcome

12. Which of the following is true about a ratio measure is greater than 1.0?

there is a possible causal association between the exposure and the health outcome
there is no association between the exposure and the health outcome
there is a large association between the exposure and the health outcome
there is an inverse association between the exposure and the health outcome

13. Which of the following is true about a ratio measure that is less than 1.0?

there is a possible protective association between the exposure and the health outcome
there is no association between the exposure and the health outcome
there is a large association between the exposure and the health outcome
there is a positive association between the exposure and the health outcome

14. True or false: A ratio measure of association expresses the prevalence, risk or rate among exposed in excess of that among the unexposed or less-exposed.

True
False

15. True or false: A difference measure treats the prevalence, risk or rate of the health outcome among the unexposed group as a “background” prevalence, risk or rate.

False
True

16. Which of the following is true about a difference measure that is less than 0?

there is a large association between the exposure and the health outcome
there is no association between the exposure and the health outcome
there is a positive association between the exposure and the health outcome
there is a possible protective association between the exposure and the health outcome

17. True or false: The null value used when interpreting a difference measure is 0.

True
False

18. Interpret the meaning of one study’s reported rate ratio of 0.5 (95% CI 0.2, 0.9) for the association between high level of Vitamin D consumption and breast cancer incidence.

High Vitamin D consumption is associated with an increased breast cancer rate.
There is no association between high Vitamin D consumption and breast cancer rates.
Those who consume a high level of Vitamin D are less likely than those who consume little or Vitamin D, to have a high rate of breast cancer incidence, but it is not statistically significant.
Those who consume a high level of Vitamin D are statistically significantly less likely than those who consume low or no Vitamin D, to have a high rate of breast cancer incidence.

Week- 5

Module 5 Quiz

1.
Question 1
True or False: There are nearly always some genetic and some environmental causes in every causal mechanism.

1 point

True
False

2.
Question 2
True or False: If an exposure proceeds a health outcome and is strongly associated with that health outcome, we can then say that without a doubt that the observed association is causal.

1 point

True
False

3.
Question 3
True or False: Causal relationships provide interesting information to epidemiologists but are rarely used to make public health decisions and design interventions.

1 point

False
True

4.
Question 4
A spurious association may be due to which of the following?

1 point

insufficient control of confounders
bias
all of the above answers are correct
use of the wrong statistical methods

5.
Question 5
The 9 factors used as a guideline for determining causality are referred to as:

1 point

Bradford-Hill criteria
Rothman’s causal pies
Directed acyclic graphs
Koch’s postulates

6.
Question 6
True or False: The Bradford-Hill criteria were originally developed to answer the question of whether cigarettes cause disease, especially lung cancer.

1 point

False
True

7.
Question 7
True or False: The Bradford-Hill criteria were originally developed to answer the question of whether bacteria caused tuberculosis.

1 point

True
False

8.
Question 8
True or False: Failing to meet one or more of the 9 Bradford-Hill criteria means that the studied relationship should not be considered causal.

1 point

False
True

9.
Question 9
True or False: The 9 Bradford-Hill criteria should be used as a checklist to determine if a causal relationship exists.

1 point

False
True

10.
Question 10
The 9 Bradford-Hill criteria should be used as a guideline to consider if a causal relationship exists.

1 point

True
False

11.
Question 11
The statement “a number of studies by different investigators at various times using different methods in different populations show similar results” best refers to which of the following?

1 point