Question 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?

Accepted Answer

This establishes a group association, which can be useful for generating hypotheses but does not prove individual association or causation.

Question 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?

Accepted Answer

The statement addresses the "strength of the association" as it provides a specific relative risk or odds ratio, indicating a strong association between prone sleeping and SIDS.

Question 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?

Accepted Answer

The statement describes a dose-response relationship, where the risk of SIDS increases with the frequency of being put to bed prone.

Question 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?

Accepted Answer

Biological plausibility refers to the existence of a biological mechanism that can explain the association between an exposure and an outcome. The statement discusses research into brain development as a potential mechanism for SIDS, which relates to biological plausibility.

Question 5

Which of the following roles does a case-control study primarily play in establishing contributory cause?

Accepted Answer

A case-control study primarily helps establish an individual association by comparing individuals with a condition (cases) to those without (controls) to identify factors that may contribute to the condition.

Question 6

Which of the following roles does a cohort study primarily play in establishing contributory cause?

Accepted Answer

A cohort study primarily helps establish that the cause precedes the effect by following a group over time to see if the exposure leads to the outcome.

Question 7

Which of the following roles does a population comparison or ecological study primarily play in establishing contributory cause?

Accepted Answer

Population comparison or ecological studies primarily help in identifying group associations, which can suggest potential relationships between exposures and outcomes at the population level.

Question 8

Which of the following roles does a natural experiment primarily play in establishing contributory cause?

Accepted Answer

A natural experiment primarily helps in establishing that altering the cause alters the effect by observing changes in outcomes when a naturally occurring event or intervention affects the exposure.

Question 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?

Accepted Answer

The statement describes the magnitude and distribution of a health issue, which aligns with the "Problem description" component of the evidence-based public health approach.

Question 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?

Accepted Answer

The statement refers to a recommendation based on evidence to reduce the incidence of SIDS, which aligns with the "Recommendations" component of the evidence-based public health approach.

Question 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?

Accepted Answer

Case-control studies are used to investigate the etiology or cause of a health outcome by comparing those with the condition (cases) to those without (controls) to identify potential risk factors or causes.

Question 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?

Accepted Answer

The statement describes the implementation of the Back-to-Sleep campaign and its evaluation through the observed reduction in SIDS mortality, fitting the implementation and evaluation component of the evidence-based public health approach.

Question 13

Which of the following is true of a primary intervention?

Accepted Answer

Primary intervention involves strategies to prevent the onset of a disease or condition by avoiding exposure, increasing resistance, or removing the cause.

Question 14

If vaccination for meningococcal meningitis is required of all entering college students, this would be an example of which type of intervention?

Accepted Answer

Requiring vaccination is a primary intervention because it aims to prevent the disease before it occurs, and it is an obligation because it mandates action (vaccination) for all entering college students.

Question 15

If insulin is recommended for a diabetic patient with symptoms to prevent complications, this would be an example of which type of intervention?

Accepted Answer

The answer of If insulin is recommended for a diabetic...

Question 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?

Accepted Answer

This is a secondary intervention because it involves screening for early detection of a disease (colon cancer) in an asymptomatic individual. The motivation aspect is the reduction in health insurance costs.

Question 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?

Accepted Answer

Quarantining Ebola patients is a tertiary intervention aimed at preventing the spread of the disease by isolating those already affected, which is an obligation to protect public health.

Question 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.
$\text { Classification of Recommendations }$
$\begin{array}{|l|l|l|l|l|}
\hline \begin{array}{l}
\text { Quality of the } \
\text { Evidence }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Substantial }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Moderate }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Small }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Zero/negative }
\end{array} \
\hline \text { Good } & \text { A } & \text { B } & \text { C } & \text { D } \
\hline \text { Fair } & \text { B } & \text { B } & \text { C } & \text { D } \
\hline \text { Poor } & \text { I } & \text { I } & \text { I } & \text { I }\
\hline
\end{array}$
$\text { Adapted from United States Preventive Services Task Force. }$

Accepted Answer

Expert opinion is typically considered poor quality evidence, which corresponds to Grade I in the classification table.

Question 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.
$\text { Classification of Recommendations }$
$\begin{array}{|l|l|l|l|l|}
\hline \begin{array}{l}
\text { Quality of the } \
\text { Evidence }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Substantial }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Moderate }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Small }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Zero/negative }
\end{array} \
\hline \text { Good } & \text { A } & \text { B } & \text { C } & \text { D } \
\hline \text { Fair } & \text { B } & \text { B } & \text { C } & \text { D } \
\hline \text { Poor } & \text { I } & \text { I } & \text { I } & \text { I }\
\hline
\end{array}$
$\text { Adapted from United States Preventive Services Task Force. }$

Accepted Answer

The evidence is based on well-conducted randomized controlled trials and extensive clinical use, indicating a substantial net benefit, which aligns with a Grade A recommendation.

Question 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.
$\text { Classification of Recommendations }$
$\begin{array}{|l|l|l|l|l|}
\hline \begin{array}{l}
\text { Quality of the } \
\text { Evidence }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Substantial }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Moderate }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Small }
\end{array} & \begin{array}{l}
\text { Net Benefit } \
\text { Zero/negative }
\end{array} \
\hline \text { Good } & \text { A } & \text { B } & \text { C } & \text { D } \
\hline \text { Fair } & \text { B } & \text { B } & \text { C } & \text { D } \
\hline \text { Poor } & \text { I } & \text { I } & \text { I } & \text { I }\
\hline
\end{array}$
$\text { Adapted from United States Preventive Services Task Force. }$

Accepted Answer

The evidence shows that the new treatment has the same effectiveness as the standard treatment but with increased side effects, resulting in a zero or negative net benefit.

Quiz 2: Evidence-Based Public Health