Merrill 8th Edition Complete Test Bank

Chapter 1 Questions

1. The definition of epidemiology includes all of the following, EXCEPT:
   1. study of determinants.
   2. study of disease frequency.
   3. study of disease patterns.
   4. health-related states or events.
   5. All of these are included in the definition of epidemiology.
2. True or False? Descriptive epidemiology involves identifying and quantifying associations, testing hypotheses, and identifying causes of health-related states or events.
   1. True
   2. False
3. True or False? Application of the study of the distribution and determinants of health-related states or events in order to prevent and control health problems is not included in the role of epidemiology.
   1. True
   2. False
4. List four types of epidemiologic information that can influence public health policy, planning, and individual health decisions.

i.

ii.

iii.

iv.

1. Completing the clinical picture involves all of the following, EXCEPT:
   1. identification of who is susceptible for disease.
   2. identification of types of exposures capable of causing disease.
   3. identification of the efficacy of the public health problem.
   4. identifying the probability of recovery.
   5. All of these are part of completing the clinical picture.
2. __________ refers to the benefits of a treatment, procedure, or service among those who use it in contrast to those who do not.
   1. Efficacy
   2. Effectiveness
   3. Validity
   4. Healthy participant effect
3. True or False? Epidemiology involves studying only infectious communicable disease, not events like injury, obesity, mental health disorders, seat belt use, etc.
   1. True
   2. False
4. We sometimes classify epidemics by how they spread through a population. Which of the following is NOT an example of a point source epidemic?
5. Hepatitis B contracted through contaminated water consumed after a football practice
6. Salmonella poisoning contracted by a group of family and friends from grandma’s potato salad
7. Influenza
8. All of these are examples of point source epidemics.
9. Public health surveillance includes all of the following, EXCEPT:
   1. public health action.
   2. systematic collection of data.
   3. analysis of data.
   4. interpretation and dissemination of data.
   5. All of these are included in public health surveillance.
10. True or False? A primary case is the same as an index case.
    1. True
    2. False
11. In the epidemiology triangle, the term agent is equivalent to which of the following?
    1. Host
    2. Pathogen
    3. Environment
    4. Field investigator
12. Which of the following best defines a fomite?
    1. Clothing
    2. Fly
    3. Habitat
    4. Time
13. Humans can serve as all of the following, EXCEPT:
    1. fomites.
    2. reservoirs.
    3. hosts.
    4. Humans cannot serve as any of these.
14. A subclinical case is the same as which of the following?
    1. Incubatory carrier
    2. Intermittent carrier
    3. Convalescent carrier
    4. Healthy carrier
15. Which of the following is an example of active primary prevention?
    1. Screening
    2. Vitamin-fortified bread
    3. Immunization
    4. All of these are correct.

For questions 16–18, refer to the following diagrams:

1. Which of the following is a sufficient cause?
   1. A
   2. A, B, C
   3. A, A, D
   4. B
2. Which of the following is a necessary cause?
   1. A
   2. A, B, C
   3. A, A, D
   4. B
3. Which of the following is not a component cause?
   1. A
   2. A, B, C
   3. A, A, D
   4. B
4. Those diseases and infections that are transmitted between vertebrate animals and humans are referred to as _____________________.
5. The second leading cause of death in the United States is _________________.

Chapter 2 Questions

• 1. Who introduced the words epidemic and endemic?

1. Hippocrates
2. John Graunt
3. James Lind
4. Thomas Sydenham
   1. Who advanced useful treatment and remedies (which other physicians rejected at the time) such as exercise, fresh air, and a healthy diet?
5. Hippocrates
6. John Graunt
7. James Lind
8. Thomas Sydenham
   1. Who used an experimental study design to determine that dietary factors were influential in treating and preventing scurvy?
   2. Hippocrates
   3. John Graunt
   4. James Lind
   5. Thomas Sydenham
   6. In the 1700s, it was observed that armies lost more men by disease than by the sword. James Lind focused on illnesses in populations. He observed the effect of _______________, ______________, _______________, and _______________ on the spread of disease.
   7. The Chinese observed that getting a weaker strain of smallpox was protective against encountering a stronger form of the diseases. What is this called?
9. Immunity
10. Herd immunity
11. Variolation
12. Virulence
    1. Who invented a vaccine against smallpox based on careful observation?
13. Benjamin Jesty
14. Edward Jenner
15. Louis Pasteur
16. Robert Koch

7. Who received a Nobel Prize in 1905 for his paper on waterborne epidemics?

• 1. Benjamin Jesty
  2. Edward Jenner
  3. Louis Pasteur
  4. Robert Koch
     1. John Graunt first developed and calculated life tables and life expectancy in the:

1. 1600s.
2. 1700s.
3. 1800s.
4. 1900s.

9. John Graunt divided deaths into two types of causes. What were these types of causes?

• 1. Which woman was a pioneer in the field of toxicology?

1. Florence Nightingale
2. Janet-Lane Claypon
3. Alice Hamilton
4. Beverly Ririe

11. Who revealed the dangers of poisoning from lead used by potters in their glaze?

1. John Graunt
2. William Farr
3. Bernardino Ramazzini
4. Lemuel Shattuck

12. Whose report set forth the importance of establishing state and local boards of health in the United States?

1. John Graunt
2. William Farr
3. Bernardino Ramazzini
4. Lemuel Shattuck

13. Who developed and applied the case-control study design?

1. Florence Nightingale
2. Olli S. Miettinen
3. Janet Lane-Claypon
4. Jerome Cornfield

14. Who investigated the relationship between smoking and lung cancer using a cohort study design?

a. Wynder & Graham

b. Doll & Hill

c. All of these are correct.

15. Who is considered the father of modern epidemiology?

1. John Snow
2. Wade Hampton Frost
3. Sir Richard Doll
4. Olli S. Mietinen

16. List three contributions to health made by Florence Nightingale.

i.

ii.

iii.

Chapter 3 Questions

1. Which of the following contains, spreads, or harbors an infectious organism?

1. Fomites
2. Vectors
3. Reservoirs
4. Carriers

2. Epidemiology originally involved the study of what type of disease?

a. Infectious

b. Noninfectious

c. Both of these are correct.

3. Epidemiology includes the study of which of the following?

a. Human behavior

b. Accidents

c. Disease

d. All of these are correct.

e. None of these is correct.

4. Infectious disease is best defined as:

a. harmful development in a microscopic organism.

b. alteration of the organism’s normal functioning.

c. disease caused by an invading pathogen.

d. body not capable of carrying on its normal functions.

5. Which of the following best defines pathogen?

a. Extent of pathogenicity

b. A microscopic organism (plant or animal)

c. An organism capable of causing disease

d. All of these are correct.

• 1. The capacity and strength of the disease to produce severe and fatal cases of illness is its:

1. Variolation.
2. virulence.
3. pathogenicity.
4. pathogenesis.
   1. True or False? An organism is only pathogenic if it is able to enter a host.
   2. True
   3. False
   4. The capacity of a microorganism to enter and grow in or upon tissues of the host is called its:
5. etiology.
6. pathogenesis.
7. invasiveness.
8. virulence.
   1. True or False? Antibiotics are toxic.
9. True
10. False
    1. List five major classifications of disease.

i.

ii.

iii.

iv.

v.

• 1. Which of the following stages is associated with the incubation period?
     1. Stage of susceptibility
     2. Stage of presymptomatic disease
     3. Stage of clinical disease
     4. Stage of recover, disability, or death
  2. Which of the following is NOT a type of immunity?

1. Acquired
2. Active
3. Passive
4. Transfer
   1. A description of communicable disease prevention and control may include all of the following, EXCEPT:
5. remove, eliminate, or contain the cause or source of infection.
6. disrupt and block the chain of disease transmission.
7. protect the susceptible population against infection and disease.
8. All of these could be part of a description of communicable disease prevention and control.
   1. True or False? Chronic diseases and conditions are not typically caused by pathogens.
9. True
10. False
    1. Which of the following best defines limitation of activity?
11. Difficulties an individual may have in executing activities
12. Problems an individual may experience in involvement in life situations
13. Problems in body function or structure as a significant deviation or loss
14. All of these are correct.

Chapter 4 Questions

1. Which of the following is not a descriptive study design?
   1. Ecologic study
   2. Case report/case series
   3. Cohort
   4. Cross-sectional
   5. All of these are examples of descriptive study designs.
2. Which of the following study designs involves the population as the unit of analysis?
   1. Ecologic study
   2. Case report/case series
   3. Cohort
   4. Cross-sectional
3. Which of the following study designs provides a useful way to obtain prevalence data?
   1. Ecologic study
   2. Case report/case series
   3. Cohort
   4. Cross-sectional
4. “Sex” reflects what type of data?
   1. Nominal
   2. Ordinal
   3. Discrete
   4. Continuous
5. How does a proportion differ from a rate?
   1. The numerator is not contained in the denominator for a rate.
   2. The numerator is not contained in the denominator for a proportion.
   3. A rate is a proportion with the added dimension of time.
   4. Proportions and rates are the same.
6. The attack rate is associated with which of the following?
   1. Cumulative incidence
   2. Incidence density
   3. Cases of disease occurring of an extended period of time
   4. Person-years
7. Suppose a highly effective new drug is discovered for treating a form of rapidly fatal cancer. Which of the following rates would be least affected by the widespread use of this drug?
   1. Five-year survival rate for this type of cancer
   2. Prevalence proportion for this type of cancer
   3. Incidence rate for this type of cancer
   4. Mortality rate for this type of cancer
8. An age-adjusted rate is a weighted average of which of the following?
   1. Age-specific rates
   2. Point prevalence proportions
   3. Attack rates
   4. None of these is correct.

Questions 9–11: Consider the following two populations.

Population A

Age (years) Population Number of deaths

15–29 1,000 34

30–49 4,000 26

50+ 6,000 121

Population B

Age (years) Population Number of deaths

15–29 5,000 120

30–49 2,000 10

50+ 1,000 10

1. For the two populations below, calculate and compare the crude death rates. Next, age-adjust population B using population A as the standard. Compare the death rates again. Finally, indicate which comparison is more meaningful. Use a rate base of 1000.
2. What is the standardized morbidity ratio (SMR) for Population B, using Population A as the standard?
   1. 68.9%
   2. 63.8%
   3. 1.45%
   4. 74.3%
   5. None of these is correct.
3. What is the 95% confidence interval for the crude cumulative incidence rate for Population A?
   1. 7.3, 11.6
   2. 14.6, 20.4
   3. 14.1, 18.8
   4. None of these is correct.
4. If the mean age of a group of people is 45 and the median age is 50, what do you know about the distribution of ages?
   1. The age distribution is skewed left.
   2. The age distribution is skewed right.
   3. The age distribution is symmetric.
   4. There is insufficient information to know how ages are distributed.
5. Suppose a simple regression model is calculated assessing the association between exercise (hours per week) and pulse per minute. Pulse is the dependent variable. The estimated slope is –0.5, r = –0.5 and r² = 0.25. Which of the following is true?
   1. There is a perfect negative association.
   2. 25% of the variation in pulse is explained by exercise.
   3. As exercise increases by 1 hour, pulse increases by 0.5, on average.
   4. There is a positive association between exercise and pulse.

14. What is an appropriate technique for adjusting for confounding when the dependent variable is dichotomous?

1. Simple regression
2. Multiple regression
3. Logistic regression
4. Multiple logistic regression
5. Restriction

15. True or False? The correlation coefficient is useful for measuring associations among variables in ecologic studies.

• 1. True
  2. False
  3. How does prevalence proportion differ from incidence?

Chapter 5 Questions

• • 1. Describing health-related states or events by person, place, and time allows us to do all of the following, EXCEPT:

1. identify the extent of the public health problem.
2. describe the public health problem in a way that can be communicated easily.
3. identify who is at greatest risk.
4. provide clues as to the causes of disease.
5. All of these are can be done when describing health-related states or events by person, place, and time.
   • 1. True or False? A beehive-shaped pyramid indicates that the population is having low birth rates as well as low death rates.

a. True

b. False

• • 1. Suppose that, in a given region, 20% of its population is younger than 15 and 10% is older than 65 years of age. What would the dependency ratio be?
  1. 43
  2. 50
  3. 46
  4. None of these is correct.
     1. In the United States, for which of the following is the age-adjusted cause-specific death rate for males least-similar to females?
  5. Occupational injury
  6. Firearm-related injuries
  7. Suicide
  8. Homicide
  9. Cerebrovascular diseases
     1. In the United States, for which disease is the age-adjusted death rate higher among Hispanics than Whites?
        1. Diseases of the heart
        2. Malignant neoplasms
        3. Chronic lower respiratory diseases
        4. Homicide
        5. Suicide
     2. True or False? Married individuals have been shown to experience lower mortality than nonmarried individuals, regardless of the whether the nonmarried persons were never married, divorced, separated, or widowed.
        1. True
        2. False
     3. Classifications of occupation include all of the following, EXCEPT:

1. professional.
2. intermediate.
3. skilled.
4. unskilled.
5. All of these are classifications of occupation.
   • 1. In the United States, education has the largest impact on which of the following?
6. Chronic and noncommunicable diseases
7. Injuries
8. Communicable diseases
   • 1. True or False? Secular trends represent periodic increases and decreases in the occurrence of health-related states or events.
9. True
10. False
    • 1. True or False? Evaluation cannot be effectively performed in descriptive studies because of confounding.
11. True
12. False

Chapter 6 Questions

• • 1. In 2020, the crude death rate was 800 per 100,000 in the United States and 500 per 100,000 in Malaysia. The life expectancy was 77.1 in the United States and 72.2 in Malaysia. How would the death rates compare if we age-adjusted the Malaysia death rate using the United States 2005 population as the standard?
       1. They would be less similar.
       2. They would be more similar.
       3. It cannot be determined with the data provided.

Questions 2–11: Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

• • 1. Crude death rate
    2. Maternal mortality rate
    3. Infant mortality rate
    4. Neonatal mortality rate
    5. Fetal mortality rate
    6. Fertility rate
    7. Age-specific mortality rate for persons ages 55 years or older
    8. Cause-specific mortality rates for those who died from heart disease
    9. Cause-specific mortality rates for those who died from stroke
    10. Proportionate mortality ratio for cancer among persons ages 55 years or older

Questions 12–18: The following table refers to deaths attributed to all causes, all malignant cancers, accidents and adverse effects, suicide and self-inflicted injury, and homicide and legal intervention among Black males in the United States, 2002.

• • 1. What is the crude mortality rate (per 100,000) for all causes?
  1. 802
  2. 746
  3. 818
  4. None of these is correct.
     1. What is the rate ratio of all malignant cancers to accidents?
     2. 3.8
     3. 5.3
     4. 4.3
     5. 4.5
     6. None of these is correct.
     7. Assuming a life expectancy of 65 years, what is the YPLL in the age group 0–4 for accidents?

1. 9,250
2. 1,595
3. 25,000
4. 25,938
5. None of these is correct.
   • 1. In what age group is the YPLL for suicide the greatest?
6. 5–14
7. 15–24
8. 25–34
9. 35–44
10. 45–54

Chapter 7 Questions

Questions 1–6: Two cohort studies were conducted. The first involved an assessment of the relationship between cigarette smoking and incidence of lung cancer. For cigarette smokers, the lung cancer incidence rate was I_e = 200 per 100,000. For nonsmokers, the lung cancer incidence rate was I_o = 25 per 100,000. The lung cancer incidence rate in the entire population was I_t = 100 per 100,000. The second study involved an assessment of the relationship between cigarette smoking and incidence of coronary heart disease. For cigarette smokers, the coronary heart disease incidence rate was I_e = 500 per 100,000. For nonsmokers, it was I_o = 250 per 100,000. In the overall population, the coronary heart disease rate was I_t = 300.

• 1. What is the relative risk (or sometimes called risk ratio) of developing lung cancer in the first study and of developing coronary heart disease in the second study? Interpret.
  2. From the data involving cigarette smoking and lung cancer incidence, what are the attributable risk and the attributable-risk percent? Interpret the result.
  3. From the data involving cigarette smoking and coronary heart disease incidence, what are the attributable risk and the attributable-risk percent? Interpret the result.
  4. Is cigarette smoking a stronger risk factor for lung cancer or coronary heart disease? Explain.
  5. Hypothetically speaking, if cigarette smoking could be eliminated from this population, what percentage of lung cancer and of coronary heart disease could be avoided?
  6. Did cigarette smoking result in a larger public health burden for lung cancer or coronary heart disease? Explain.

Questions 7–11: Refer to the following table showing postmenopausal hormone use and coronary heart disease with selected exposure categories.

Coronary heart disease Person-years

Postmenopausal hormone use

Ever use 30 54,308.7

Past use 19 24,386.7

Current use 11 29,922.0

Never use 60 51,477.5

• 1. What is the risk of coronary heart disease among ever users of postmenopausal hormones?
  2. Use the appropriate statistic to measure the strength of the association between ever versus never use. Interpret.
  3. Use the appropriate statistic to measure the strength of the association between past versus never use. Interpret.
  4. Use the appropriate statistic to measure the strength of the association between current versus never use. Interpret.
  5. Postmenopausal hormone use results in a percentage decrease in risk of coronary heart disease of:

1. 33%.
2. 69%.
3. 53%.
4. None of these is correct.
   1. In a study assessing the association between cholesterol (high vs. otherwise) and heart disease, the PAR% was 25%. Interpret.
   2. Which of the following is NOT a type of selection bias in cohort studies?

a. Healthy worker effect

b. Loss to follow-up

c. Neyman bias

d. All of these are types of selection bias in cohort studies.

• 1. Which of the following is the most time consuming and costly study design?

1. Case-control
2. Retrospective cohort
3. Prospective cohort
4. Cross-sectional
   1. Which of the following is a nuisance variable to be controlled?
5. Effect modifier
6. Confounder
7. Dichotomous variable
8. Binary variable
   1. Match the following:

___ Attack rate      a. Incidence density rate

___ Person-time rate    b. Results in biased RR

___ Berkson’s bias    c. Results in underestimation of OR

___ Healthy worker effect   d. Cumulative incidence rate 

Chapter 8 Questions

• • • 1. True or False? Experimental studies involving randomization are always preferred over nonrandomized studies.
  1. True
  2. False

2. A factorial design may be useful for all of the following reasons, EXCEPT:

1. allows testing of a less-mature hypothesis along with a more mature hypothesis.
2. allows one to answer two or more questions in a single study.
3. reduce cost.
4. reduce feasibility.

3. Which of the following designs is potentially most useful for making a judgment about causality?

a. Cross-sectional

b. Case-control

c. Case series

d. Experimental

• 1. True or False? Selection of a high-risk population of developing the outcomes of interest is a primary strategy to ensure the accumulation of an adequate number of cases that will develop the end point(s).

1. True
2. False
   1. What effect does randomization in a large intervention study have?

a. Minimizes bias in the observation of outcomes of interest

1. Minimizes potential bias in the allocation of participants to treatment group
2. Both A and B are correct.
3. Neither A nor B is correct.
   1. What is a limitation of using a run-in period in an intervention study?
   2. The study subjects may differ from the general population.
   3. Compliance
   4. Loss to follow-up
   5. All of these are limitations.

Questions 7–8: For each of the following descriptions, choose whether it best describes a (a) therapeutic trial or (b) prophylactic trial:

• 1. Investigation of the effectiveness of the poliomyelitis vaccine
  2. Assessment of the effectiveness of radiation versus surgery in prostate cancer patients
  3. Was the Tuskegee syphilis study an experimental study?

a. Yes

b. No

• 1. True or False? The experimental study is effective when the outcome of interest is rare.

a. True

b. False

• 1. The __________ is defined as the effect on patient outcomes that may occur due to the expectation by a patient that a particular intervention will have an effect.

a. interviewer effect

b. recall effect

c. selection effect

d. placebo effect

• 1. True or False? The within-group design provides less control over confounders than the between-group design.

a. True

b. False

• 1. An unplanned type of experimental study where the levels of exposure to a presumed cause differ among a population in a way that is relatively unaffected by extraneous factors, such that the situation resembles a planned experiment, is called:

a. a nonrandomized experiment.

b. a natural experiment.

c. a placebo-controlled experiment.

d. All of these are correct.

14. Underlying the estimation of sample size are all of the following, EXCEPT:

a. formulation of the null and one- or two-tailed research hypothesis.

b. the appropriate statistical test.

c. α and β.

d. All of these are involved in sample size estimation.

15. True or False? Surrogate endpoints become particularly useful in randomized controlled trials when the outcome phenomenon of interest is common.

a. True

b. False

• • 1. Which of the following is NOT associated with a Phase II trial?

Fewer than 50 patients

Randomization

Tests side effects

Tests tolerability

All of these are associated with Phase II trials

Chapter 9 Questions

1. Why is a strong statistical association in a single study insufficient to show causal relations?

• • • 1. A valid statistical association in any analytic study design requires consideration of confounding. Which of the following best describes confounding?

a. When an extrinsic factor influences the disease outcome and may or may not influence the exposure

1. When the exposure variable influences the extrinsic factor, which then influences the disease outcome
2. When an extrinsic factor influences the disease outcome and, independent of that relationship, also influences the exposure
3. When an exposure and disease outcome are related
   • • 1. True or False? Establishing a valid statistical association is a necessary part of establishing a cause-effect relationship.

True

False

Questions 4–7: For each of the following statements, indicate whether the statistical association is likely due to (a) chance, (b) bias, or (c) confounding.

4. A case-control study showed that a strong negative association existed between exercise and heart disease.

5. A case-control study found a positive association between self-reported alcohol use during pregnancy and fetal alcohol syndrome.

6. A cohort study found no statistical association between smoking and coronary heart

disease (RR = 1, p-value = 0.75).

• 1. The interviewer in a case-control study assumed that an association existed between alcohol consumption and myocardial infarction. She was aware of whether individuals in the study had myocardial infarction or not.
  2. Match the following:

___ A way to control for confounding    a. Blind

___ A way to control for bias     b. Increase sample size

___ A way to control for a chance finding   c. Randomize

• 1. Precipitating factors are best defined as:

1. factors essential to the development of disease, conditions, injuries, disability, and death.
2. factors or conditions allowing or assisting the disease, condition, injury, disability, or death to begin and to be able to run its course of events.
3. factors or conditions already present that produce a susceptibility or disposition in a host to a disease or condition without actually causing it.
4. None of these is correct.
   1. Match the following:

___ Method of difference a. Increased numbers of children not immunized against measles cause the incidence rate for measles to go up.

___ Method of agreement b. Valley Fever (coccidioidomycosis) occurs only in the deserts of the southwestern United States.

___Method of concomitant variation c. Increasing trends in cigarette smoking are directly associated with increasing trends in lung cancer in many different places throughout the world.

• 1. Among the causal criteria presented in the text, temporality was mentioned. Of the following study designs, which is best for establishing temporality?
     1. Cross-sectional
     2. Ecologic
     3. Case-control
     4. Experimental
     5. None of these is correct.

Chapter 10 Questions

1. What is the most appropriate type of rate for investigating an outbreak?

a. Incidence density

b. Cumulative incidence

c. Mortality

d. Prevalence proportion

2. When is it appropriate to refer to an epidemic as an outbreak?

a. When the epidemic is more localized

b. When the epidemic is more widespread

c. When the epidemic is more prolonged

d. When you are trying to promote fear

3. How would you classify an epidemic if the epidemic curve shows a rapid rise, peak, and gradual decrease?

a. Propagated

b. Continuous source

c. Intermittent source

d. Point source

• • • 1. Field investigations involving acute problems may differ from conventional epidemiologic studies in three important ways. Describe these.

i.

ii.

iii.

• • 1. Which of the following is NOT part of the definition of field investigation?

The problem is unexpected.

Time response may be demanded.

Work in the field is often avoided to prevent contracting the illness.

Investigation time is likely to be limited because of the need for a timely intervention.

All of these are part of field investigation.

• • 1. True or False? Assessment of the clinical findings should be done to assure correctness and reliability of the findings.

True

False

7. True or False? Field investigations often do not start with a clear hypothesis.

a. True

b. False

8. True or False? The field epidemiologist does not have time to search for missing cases.

a. True

b. False

9. Which of the following is NOT an example of a common source epidemic?

a. Salmonella traced to undercooked turkey at a potluck dinner

b. Thyroid cancer associated with radiation exposure

c. Typhoid fever traced to contaminated food

d. HIV/AIDS

10. If established facts or information are lacking to substantiate a hypothesis, then what should be done?

a. More information should be gathered.

b. The research hypothesis should be rejected.

c. Either of these may be appropriate.

Chapter 11 Questions

1. Cancer may be classified as which of the following?

• 1. Infectious/communicable
  2. Noninfectious/noncommunicable
  3. Neither a nor b
  4. Both a and b

1. Which of the following is a contribution of William Farr?
2. He promoted the idea that many diseases, especially chronic diseases, have a multifactorial etiology.
3. He developed the eight guidelines listed in your text on chronic disease etiology.
4. He proposed five elements associated with chronic disease.
5. All of these are correct.
6. Which of the following types of risk factors is associated with all of the following: heart disease, cancer, stroke, accidents, diabetes, cirrhosis, suicide, and homicide?

a. Behavior

b. Environment

c. Biological/Genetic

d. Social environment

1. Cancer has been associated with all of the following, EXCEPT:
   • 1. poverty.
     2. high blood pressure.
     3. stress.
     4. It has been associated with all of these conditions.
2. True or False? Polyunsaturated fats, compared with monounsaturated fatty acids, are associated with greater risk of breast cancer.
3. True
4. False

Questions 6–8: Match the following chronic conditions to their risk factors.

1. Osteoporosis
   1. Asbestos
   2. Arsenic
   3. Lifetime exposure to estrogen
   4. Radiation
   5. Nickel
2. Respiratory/asthma
   1. Asbestos
   2. Arsenic
   3. Lifetime exposure to estrogen
   4. Radiation
   5. Nickel
3. Dermatologic
   1. Asbestos
   2. Arsenic
   3. Lifetime exposure to estrogen
   4. Radiation
   5. Nickel

Questions 9–12: Match the following cancers with their known carcinogens.

1. Leukemia
   1. Vinyl chloride
   2. Benzene
   3. Radon
   4. Aaromatic amines, solvents
2. Lung
   1. Vinyl chloride
   2. Benzene
   3. Radon
   4. Aaromatic amines, solvents
3. Liver
   1. Vinyl chloride
   2. Benzene
   3. Radon
   4. Aaromatic amines, solvents
4. Bladder
   1. Vinyl chloride
   2. Benzene
   3. Radon
   4. Aaromatic amines, solvents
5. An increased risk of Burkitt’s lymphoma has been associated with which of the following viruses?
   1. Hepatitis B and C viruses
   2. Human papillomavirus
   3. Epstein-Barr virus
   4. Human T-cell lymphotorophic virus
6. Epidemiologic research has associated several conditions with obesity. List at least five of these.

Chapter 12 Questions

Questions 1–8: A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known.

1. What was the sensitivity of the test?

1. 0.75
2. 0.71
3. 0.88
4. 0.93
5. 0.91

2. What was the specificity of the test?

1. 0.75
2. 0.71
3. 0.88
4. 0.93
5. 0.91

3. What was the predictive value of a positive test?

1. 0.75
2. 0.71
3. 0.88
4. 0.93
5. 0.91

4. What was the predictive value of a negative test?

1. 0.75
2. 0.71
3. 0.88
4. 0.93
5. 0.91
   • • 1. What is the overall accuracy of the test?
6. 0.75
7. 0.71
8. 0.88
9. 0.93
10. 0.91
    • • 1. What is the LR+ of the test?
11. 9.9
12. 0.2
13. 0.3
14. 0.4
15. 9.1
    • • 1. What is the LR– of the test?
16. 9.9
17. 0.2
18. 0.3
19. 0.4
20. 9.1
    • • 1. Which of the following is an appropriate interpretation for LR–?
           1. A negative test score is very unlikely to have come from a person with the health problem.
           2. A negative test score is suggestive, but insufficient to rule out the health problem.
           3. A negative test score is uninformative for ruling out disorder.

Questions 9–11: Match the following definitions to their correct term.

(a) validity

(b) reliability

(c) yield

• • • 1. Measures what it is supposed to measure
      2. Repeatability
      3. Amount in a given time period
      4. Which of the following describes lead-time bias?
         1. Slow-progressing cases of disease with a better prognosis are more likely to be identified than faster-progressing cases of disease with a poorer prognosis.
         2. Screening advances the time of diagnosis, making it difficult to evaluate the benefit of early treatment.
         3. Occurs when screening identifies an illness that would not have shown clinical signs before a person’s death from other causes