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Community Health & Policy

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School of Community Health & Policy

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PUBH 500

EPIDEMIOLOGY SPRING 2021

MIDTERM EXAMINATION (87 POINTS)

MULTIPLE CHOICE [2 points per question for a total of 24 points]

  1. Which of the following activities characterize an epidemiologic approach as opposed to a clinical approach?
  1. Description of a single individual’s symptoms
  2. Surveillance of a population
  3. Treatment of a patient with diagnosed illness
  4. A and C
  1. Which of the following is not usually an aim of epidemiology?
  1. To describe the health status of a population
  2. To fund new public health programs
  3. To explain the etiology of disease
  4. To predict the occurrence of disease
  5. To control the distribution of disease
  1. There are usually 100-200 cases of disease X monthly. Last month there were 180 cases. Which term best describes the pattern of disease occurrence?
  1. Endemic
  2. Pandemic
  3. Outbreak
  4. Sporadic
  1. Prevalence of a chlamydia in Chester is 3.5 per 1,000 persons. If 2 million people live in Manor, how many have the disease?
  1. 3,400
  2. 7,000
  3. 1,000
  4. 1,728
  5. 108,000
  1. The risk of acquiring a given disease during a specified time period is best determined by which of the following?
  1. The mortality rate from that disease in the 0 – 4 age group
  2. A spot map that records all cases of the disease in the past year
  3. The period prevalence of that disease in the past year
  4. The cumulative incidence for that disease in a specifiedperiod of time
  1. We followed 500 people, each for 4 years. How many person-years of follow-up did we have?
  1. 1,000
  2. 2,000
  3. 3,000
  4. 550
  5. 2,555
  1. The habitat in which the agent normally lives, grows, and multiplies is the:
  1. Reservoir
  2. Portal of entry
  3. Vehicle
  4. Portal of exit
  1. The table below shows the mumps experience of children in 390 families exposed to mumps by a primary case within the family:
Age in years Total Number of susceptible before primary cases occurred Primary cases
2 – 4 300 250 100
5 – 9 450 420 204
10 – 19 152 84 25

The attack rate among children aged 2 – 4 years is:

  1. 18%
  2. 33%
  3. 40%
  4. 50%
  5. 60%
  1. You are conducting an outbreak investigation and you have finished administering a food/drink questionnaire to ill and non-ill participants in a church potluck dinner. The ill individuals developed moderate to severe diarrhea 12 – 72 hours after the dinner. Sixteen people experienced vomiting. The following data were collected.
Number of people who ATE Number of people who DID NOT EAT
Food item Ill Not Ill Total Ill Not Ill Total
Stuffed pasta shells 30 40 70 25 5 30
Hamburger Stew 25 45 70 20 40 60
Fried chicken 35 35 70 15 25 40
Layered lettuce salad 60 25 85 5 35 40
Apple Pie 40 40 80 20 20 40

Which food item appears to be the most probable vehicle for the salmonella infection associated with the illness?

  1. Stuffed pasta shells
  2. Hamburger stew
  3. Fried Chicken
  4. Layered lettuce salad
  5. Apple Pie
  1. Researchers conducted a cohort study to investigate the relationship between infant feeding practices and Disease X. Review some of the results in the table below. What is the rate ratio of Disease X for infants fed soy formula compared to those who were not fed soy formula?
Fed soy formula Disease X Person-years
Yes 780 8,000
No 2,000 125,000
  1. 1.07
  2. 2.71
  3. 0.37
  4. 0.35
  5. 6.09
  1. The population of Dearborn is 200,000. There are 78,000 men and 122,000 women in Dearborn. On December 31, 2017, there were 150 people in Dearborn with diagnosed HIV. During the period Jan 1 2018 to December 31 2018, there were 1500 new cases of HIV. What is the cumulative risk of HIV in Dearborn in 2018 per 1,000?
  1. 19.2 per 1,000
  2. 12.2 per 1,000
  3. 0.75 per 1,000
  4. 8.9 per 1,000
  5. 7.5 per 1,000
  1. Estimating the frequency of exposure.
  1. This is a use primarily for incidence data.
  2. This is a use primarily for prevalence data.
  3. This application could apply equally for both incidence and prevalence data.
  4. This is a use for neither incidence data nor prevalence data.

TRANSMISSION OF DISEASE [6 points]

For Questions 13 through 15, indicate which of the following matches (A) Direct transmission or (B) Indirect transmission.

  1. Congenital syphilis occurs when syphilis is transmitted from a pregnant woman to her developing fetus.
  1. Direct transmission
  2. Indirect transmission
  1. Transmission of E. coli through the consumption on contaminated food
  1. Direct transmission
  2. Indirect transmission
  1. Lyme disease via tick bites
    1. Direct transmission
    2. Indirect transmission

For questions 16 & 17, read the text and answer the questions that follow:

Jennings is community of 100,000 persons. During 2019, there were 1,000 deaths from all causes. There were 300 cases of pneumonia during 2019, and there were 60 deaths from pneumonia during this time.

  1. Calculate the crude mortality rate per 1,000 in Jennings in 2019. [3 points]
  1. Calculate the case fatality rate for pneumonia in Jennings in 2019. (Express as a percentage) [3 points]

TRUE / FALSE [10 points]

For Questions 18 – 22, indicate which of the following are (A) True or (B) False

  1. When an infectious disease can be transmitted from one person to another, it is a communicable disease.
  1. True
  2. False
  1. When the duration of disease becomes short and the incidence is high, the prevalence of the disease increases relative to the incidence.
  1. True
  2. False
  1. Diseases that have only human reservoirs and are transmitted from person to person are the zoonoses.
  1. True
  2. False
  1. Herd immunity refers to the protection of a population against an infectious disease when a large proportion of individuals are immune through either vaccination or past infections.
  1. True
  2. False
  1. Incubation period refers to the time between the start of an infection and the beginning of the period of communicability.
  1. True
  2. False

SHORT ANSWER QUESTIONS

  1. What is epidemiology? Write a clear and accurate definition in the space provided below. [3 points]
  1. Indicate which of the following is best applicable to incidence or prevalence, by circling I or P [5 points]
    1. To demonstrate the risk of depression following HIV diagnosis.

[I or P]

  1. To estimate the burden of type 2 diabetes in the population.

[I or P]

  1. To estimate the proportion of high school students currently vaping or using e-cigarettes.

[I or P]

  1. Proportion of college freshmen diagnosed with a new sexually transmitted infection within the first 6 weeks of the semester.

[I or P]

  1. Proportion of recent college graduates who report having been bullied in the workplace by a work colleague in 2019.

[I or P]

For questions 25 & 26, read the text and answer the questions that follow:

The table below shows the number of cancers occurred in people exposed and those unexposed to a certain exposure. Follow up was 10 years. Find the cumulative risk in the exposed and unexposed. Express your answers as a percentage. [4 points]

Disease No Disease
Exposed 300 1900
Unexposed 200 7800
  1. What is the cumulative incidence in the exposed group? (Express your answer as a percentage and round to 1 decimal place) [2 points]
  1. What is the cumulative incidence in the unexposed group? [2 points]

For questions 27 & 28, read the text and answer the questions that follow

Person-years of observation for 186 study subjects in a 10- year colon cancer research project is presented in the table below. There were 100 new cases of colon cancer observed during the 10-year period.

Number of subjects Length of observation (years) Person-Years
70 10 700
90 9 810
15 8 120
6 7 42
5 1 5
  1. What is the total number of person-years of follow up in this study? [2 points]____ ___________
  1. What is the incidence rate of colon cancer in this 10-year study per 1,000 person-years? [2 points]

For questions 29 – 34, read the text and answer the questions that follow:

The table below shows data on driving under the influence of marijuana and other illicit drugs in the population of Driscoll. Driscoll is a city with 47,450 residents aged ≥years. Review the table below and answer the questions that follow:

Characteristic Total population (N=47,450) Marijuana Illicit Drugs Other than Marijuana
Number who reported driving under the influence Number who reported driving under the influence
Sex
Male Female 18,980 28,470 7,711 4,249 1,578 722
  1. What is the prevalence of driving under the influence of marijuana for all residents of Driscoll age ≥ 16 years? (Express as a percentage and round to 1 decimal place) [2 points]
  1. What is the prevalence of driving under the influence of marijuana among males ≥ 16 years of age in Driscoll? (Express you answer as a percentage and round to 1 decimal place) [2 points]
  1. What is the prevalence of driving under the influence of marijuana among females ≥ 16 years of age in Driscoll? (Express you answer as a percentage and round to 1 decimal place) [2 points]
  1. What is the prevalence of driving under the influence of illicit drugs other than marijuana among males ≥ 16 years of age in Driscoll? (Express your answer as a percentage and round to 1 decimal place) [2 points]
  1. What is the prevalence of driving under the influence of illicit drugs other than marijuana among females ≥ 16 years of age in Driscoll? (Express you answer as a percentage) [2 points]
  1. You are a public health analyst in the Driscoll City Health Department and the Director would like your recommendation identifying the target audience and focus for public health messaging to reduce the prevalence of driving while under the influence. State your recommendation and the reasoning behind it. (In your answer state whether males and females should be targeted, whether messaging should be focused on marijuana or all illicit drugs and why. Limit your answer to no more than 4-5 sentences) [5 points]

For questions 35 – 38, read the text and answer the questions that follow.

In a study examining the relationship between air pollution exposure and the development of asthma, 450 women were enrolled in a cohort study. One hundred and fifty women reported being exposed to air pollution. Review the table below answer the questions that follow.

Exposure to Air Pollution Asthma Person-years of follow up
Yes 150 8,000
No 300 20,000
  1. Calculate the incidence rate of asthma among those who have been exposed to air pollution. (Express your answer per 1,000 person-years and round to 1 decimal place) [2 points]
  1. Calculate the incidence rate of asthma among those who have not been exposed to air pollution. (Express your answer per 1,000 person-years and round to 1 decimal place) [2 points]
  1. What is the association between air pollution and asthma? (Select the appropriate relative measure of association? Calculate it and interpret your results) [4 points]

Calculation:

Interpretation:

  1. What is the rate difference in asthma for those exposed to air pollution compared to those who have not been exposed to air pollution? [2 points]

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