Multiple Choice

1. An association between populations that eat more fish and a lower mortality rate from coronary heart disease in the same population would establish which of the following?
A. A group association that may be helpful in generating a hypothesis about the relationship between fish consumption and coronary heart disease.
B. An individual association establishing that eating fish is associated with coronary artery disease.
C. A cause and effect relationship between fish consumption and coronary heart disease.
D. None of these is correct.

Answer: A
Complexity: Difficult
Ahead: What Is the Implication of a Group Association?
Subject: Chapter 2
Title: Evidence-Based Public Health

2. Which of the following ancillary or supportive criteria is addressed in this statement: The relative risk or odds ratio for sudden infant death syndrome (SIDS) and infants who sleep prone is approximately 6?
A. Strength of the association
B. Dose–response relationship
C. Consistency
D. Biological plausibility

Answer: A
Complexity: Moderate
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

3. Which of the following ancillary or supportive criteria is addressed in this statement: Infants who are put to bed prone less than half the time have an increased incidence of SIDS compared to those who are never put to bed prone. Those who are always put to bed prone have an increased incidence of SIDS compared to those who are put to bed prone less than half the time?
A. Strength of the association
B. Dose–response relationship
C. Consistency
D. Biological plausibility

Answer: B
Complexity: Moderate
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

4. Which of the following ancillary or supportive criteria is addressed in this statement: The mechanism that predisposes some infants to SIDS is unknown, but active research is beginning to identify predisposing factors related to brain development?
A. Strength of the association
B. Dose–response relationship
C. Consistency
D. Biological plausibility

Answer: D
Complexity: Moderate
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

5. Which of the following roles does a case-control study primarily play in establishing contributory cause?
A. Group association
B. Individual association
C. Cause precedes the effect
D. Altering the cause alters the effect

Answer: B
Complexity: Easy
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

6. Which of the following roles does a cohort study primarily play in establishing contributory cause?
A. Group association
B. Individual association
C. Cause precedes the effect
D. Altering the cause alters the effect

Answer: C
Complexity: Easy
Ahead: Etiology: How Do We Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

7. Which of the following roles does a population comparison or ecological study primarily play in establishing contributory cause?
A. Group association
B. Individual association
C. Cause precedes the effect
D. Altering the cause alters the effect

Answer: A
Complexity: Difficult
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

8. Which of the following roles does a natural experiment primarily play in establishing contributory cause?
A. Group association
B. Individual association
C. Cause precedes the effect
D. Altering the cause alters the effect

Answer: D
Complexity: Difficult
Ahead: What Can We Do If We Cannot Demonstrate All Three Requirements to Definitively Establish Contributory Cause?
Subject: Chapter 2
Title: Evidence-Based Public Health

9. The statement “Sudden infant death syndrome (SIDS) is the most common cause of death between age 1 month and 1 year. Twenty years ago, it resulted in over 5,000 deaths per year” is best described as which component of the evidence-based public health approach?
A. Problem description
B. Etiology
C. Recommendations
D. Implementation and evaluation

Answer: A
Complexity: Difficult
Ahead: Introduction
Subject: Chapter 2
Title: Evidence-Based Public Health

10. The statement “The guidance for having infants sleep on their backs to reduce the incidence of SIDS has a grade of A” is best described as which component of the evidence-based public health approach? 
A. Problem description
B. Etiology
C. Recommendations
D. Implementation and evaluation

Answer: C
Complexity: Difficult
Ahead: Introduction
Subject: Chapter 2
Title: Evidence-Based Public Health

11. The statement “Case-control studies were important in establishing a cause and effect relationship between having infants sleep prone and sudden infant death syndrome” is best described as which component of the evidence-based public health approach?
A. Problem description
B. Etiology
C. Recommendations
D. Implementation and evaluation

Answer: B
Complexity: Difficult
Ahead: Introduction
Subject: Chapter 2
Title: Evidence-Based Public Health

12. The statement “The Back-to-Sleep campaign directed information at parents and caregivers with the involvement of clinicians, crib manufacturers, and the media. The mortality from SIDS fell by approximately 50% within several years of the beginning of the Back-to-Sleep campaign” is best described as which component of the evidence-based public health approach?
A. Problem description
B. Etiology
C. Recommendations
D. Implementation and evaluation

Answer: D
Complexity: Difficult
Ahead: Introduction
Subject: Chapter 2
Title: Evidence-Based Public Health

13. Which of the following is true of a primary intervention?
A. It may be accomplished by preventing exposure through creation of barriers.
B. It may be accomplished by increasing resistance to the condition.
C. It may be accomplished by removing the presence of the cause.
D. All of these are correct.

Answer: D
Complexity: Easy
Ahead: Implementation: How Do We Get the Job Done?
Subject: Chapter 2
Title: Evidence-Based Public Health

14. If vaccination for meningococcal meningitis is required of all entering college students, this would be an example of which type of intervention?
A. Primary intervention—education
B. Primary intervention—obligation
C. Secondary intervention—education
D. Secondary intervention—motivation
E. Tertiary intervention—education
F. Tertiary intervention—obligation

Answer: B
Complexity: Moderate
Ahead: Implementation: How Do We Get the Job Done?
Subject: Chapter 2
Title: Evidence-Based Public Health

15. If insulin is recommended for a diabetic patient with symptoms to prevent complications, this would be an example of which type of intervention?
A. Primary intervention—education
B. Primary intervention—obligation
C. Secondary intervention—education
D. Secondary intervention—motivation
E. Tertiary intervention—education
F. Tertiary intervention—obligation

Answer: E
Complexity: Moderate
Ahead: Implementation: How Do We Get the Job Done?
Subject: Chapter 2
Title: Evidence-Based Public Health

16. If an asymptomatic patient older than 50 years is offered a test to detect colon cancer, which, if completed, will reduce the cost of his or her health insurance, this would be an example of which type of intervention?
A. Primary intervention—education
B. Primary intervention—obligation
C. Secondary intervention—education
D. Secondary intervention—motivation
E. Tertiary intervention—education
F. Tertiary intervention—obligation

Answer: D
Complexity: Moderate
Ahead: Implementation: How Do We Get the Job Done?
Subject: Chapter 2
Title: Evidence-Based Public Health

17. When Ebola patients are quarantined for 3 weeks to ensure that they do not expose others, this would be an example of which type of intervention?
A. Primary intervention—education
B. Primary intervention—obligation
C. Secondary intervention—education
D. Secondary intervention—motivation
E. Tertiary intervention—education
F. Tertiary intervention—obligation

Answer: F
Complexity: Moderate
Ahead: Implementation: How Do We Get the Job Done?
Subject: Chapter 2
Title: Evidence-Based Public Health

18. Using the table of classification of recommendations, indicate how the following evidence should be graded: Expert opinion suggests a large impact of a new intervention to cure breast cancer.

A. Grade A
B. Grade B
C. Grade C
D. Grade D
E. Grade I

Answer: E
Complexity: Easy
Ahead: Recommendations: What Works to Reduce the Health Impact?
Subject: Chapter 2
Title: Evidence-Based Public Health

19. Using the table of classification of recommendations, indicate how the following evidence should be graded: Well-conducted, randomized controlled trials and over a decade of use in clinical practice indicate that a large proportion of breast cancer can be cured among women with early breast cancer if the treatment is used on women with early breast cancer.

A. Grade A
B. Grade B
C. Grade C
D. Grade D
E. Grade I

Answer: A
Complexity: Easy
Ahead: Recommendations: What Works to Reduce the Health Impact?
Subject: Chapter 2
Title: Evidence-Based Public Health

20. Using the table of classification of recommendations, indicate how the following evidence should be graded: On the basis of good evidence, it is concluded that a new treatment cures approximately the same percentage of patients as the standard treatment but has a substantial increase in side effects.

A. Grade A
B. Grade B
C. Grade C
D. Grade D
E. Grade I

Answer: D
Complexity: Easy
Ahead: Recommendations: What Works to Reduce the Health Impact?
Subject: Chapter 2
Title: Evidence-Based Public Health