2. Improvement of the environment requires primarily behavioral and social change: a. True b. False

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1 PH150 December 9, 2009 FINAL EXAMINATION Select the best answer for each multiple choice questions. There are 93 questions and 14 pages on the examination. Notify the instructor if your examination does not have 14 pages. Clearly indicate on the scan form the one best answer to each question among the answers provided. Be sure that you have selected your choice correctly on the scan form. Be sure that you have entered your name and identification number on the scan form and filled out the columns for the letters of your name and numbers of your identification number correctly (see front and back). Use a #2 pencil and fill all circles completely. 1. Which of the following is the usual progression from exposure to disease? a. Exposure - effective dose - disease b. Exposure - absorbed dose - early response - disease c. Exposure - absorbed dose - effective dose - disease d. Exposure - absorbed dose - effective dose early response - disease e. Exposure - absorbed dose - metabolic dose - effective dose - early response - disease 2. Improvement of the environment requires primarily behavioral and social change: 3. The four major elements of risk assessment are: a. Hazard identification, exposure assessment, hazard modification, risk characterization b. Hazard identification, exposure assessment, dose response assessment, risk characterization c. Hazard identification, exposure assessment, dose response assessment, legislation d. Hazard identification, dose response assessment, hazard modification, legislation 4. Development of environmental policy requires decisions in the face of uncertainty: 5. The International Agency on Research on Cancer identified how many proven carcinogens? a. 11 b. 74 c. 503 d e. >5,000

2 6. The highest concentration of diesel particles in Southern California is found along which freeway? a. 405 b. 110 c. 105 d. 710 e Precautionary measures are those taken to reduce exposures for which cause and effect has been fully established: 8. Lead is most difficult to remove from which of the following tissues in children? a. Blood b. Intestine c. Bone d. Hair e. Liver 9. Which of the following had the most profound effect in reducing lead in blood in humans from ? a. Removal of lead from batteries b. Removal of lead from gasoline c. Removal of lead from paint d. Removal of lead from metal used in automobile production e. Removal of lead from detergents 10. Which of the following compounds is most carcinogenic for humans? a. Cr VI b. Cr III c. Diesel exhaust d. Methylene chloride 11. Which of the following is a common contaminant of water causing dry gangrene and other skin problems in many areas of the world? a. Lead b. Arsenic c. Cr VI d. Cr III e. Mercury 12. The highest risk of air pollution-related cancer in the Los Angeles basin is from: a. Diesel particles b. 1,3 butadiene c. Carbonyls d. Benzene

3 13. Which of the following particles penetrate the blood-brain barrier? a. Large particles, fine particles and ultra-fine particles b. Fine particles and ultra-fine particles c. Ultra-fine particles only 14. The recent epidemic of syphilis in Los Angeles County is occurring primarily among: a. Commercial sex workers b. Men who have sex with men c. Heterosexual males d. Heterosexual females e. Drug users 15. Which of the following is NOT a reportable sexually transmitted disease in Los Angeles? a. Syphilis b. Human papilloma virus infection c. Chlamydia d. Gonorrhea e. HIV/AIDS 16. Which of the following is the most common sexually transmitted infection in Los Angeles County? a. Chlamydia b. Gonorrhea c. Syphilis d. HIV/AIDS e. Pelvic inflammatory disease 17. The majority of chlamydia and gonorrhea infections do not cause symptoms in women: 18. Focusing interventions on core transmitters is an effective strategy to reduce STDs: 19. InSpotLA is an effective tool to: a. Interrupt STD transmission b. Promote STD and HIV testing and treatment c. Promote notification of partners of infected individuals e. a. and b. above 3

4 20. Which of the following is the highest risk human papilloma virus type for cervical cancer? a. 16 b. 11 c. 43 d. 44 e The leading cause of death in Los Angeles County in 2005 was: a. Coronary heart disease b. Lung cancer c. Emphysema d. Alzheimer s disease e. Homicide 22. The decline in deaths from infectious diseases was more rapid before the development of vaccines than after: 23. The leading behavioral cause of death in the United States in 2000 was: a. Poor diet/activity patterns b. Tobacco smoking c. Alcohol ingestion d. Sexual behavior e. Use of illicit drugs 24. Life expectancy at birth in 2000 was highest for which of the following groups in the U.S.? a. European-Americans b. Hispanic-Americans c. African-Americans d. Asian-Americans e. Native Americans 25. The most rapidly increasing cause of disability-adjusted life years (DALYS) in Los Angeles County is: a. Coronary heart disease b. Cancer c. Alzheimer s disease d. Stroke e. Stomach cancer 26. The number of AIDS cases in Los Angeles County continues to rise: 4

5 27. The highest proportion of TB cases in Los Angeles County is occurring among: a. Native-Americans b. European migrants c. Hispanic- and Asian-American migrants d. African migrants e. African-Americans 28. Use of marijuana: a. Decreases motivation b. Diminishes cognitive functions (reasoning) c. Both of the above d. Neither of the above 29. Persons living in extended cities (e.g. Los Angeles) are more likely than persons living in concentrated cities (e.g. New York) to: a. Walk less in their leisure time b. Have high blood pressure c. Have higher body mass indices (weight for height) e. a. and c. above 30. The characteristics and qualities of the community in which we live are a major determinants of our health: 31. The percentage of the population living in poverty worldwide declined between 1970 and 2000: 32. Diesel particulate pollution of the air contributes to: a. Premature deaths b. Lost workdays c. Global warming e. a. and b. above 33. The factor that has caused the greatest improvement in health in the last 50 years in the United States has been: a. Implementation of new health-related policies b. Promotion of behavioral changes 5

6 c. Health education programs d. Environmental interventions e. STD programs 34. Childhood obesity is more prevalent in the more affluent (richer) communities in Los Angeles County: 35. Which of the following items from McDonald s contains the highest number of calories? a. Big Mac b. Four hamburgers c. One large McDonald s milkshake d. Two egg McMuffins 36. Regular physical activity is associated with: a. Increased life span and function b. Improved mental health c. Improved immune function e. a. and b. above 37. Which of the following represent the majority group in Los Angeles County? a. European-Americans b. African-Americans c. Hispanic-Americans d. Asian-American e. None of the above 38. Developing countries have which of the following dietary problems? a. Under-nutrition b. Over-nutrition c. Vitamin deficiencies e. a. and c. above 39. Children with Kwashiorkor: a. Are thin and emaciated b. Are swollen and edematous c. Have diets low in protein d. Recover within 2-3 weeks with proper diet e. b., c. and d. above 40. Over-use of sunscreen may result in: a. Vitamin C deficiency 6

7 b. Vitamin D deficiency c. Skin disorders d. Hyperthyroidism e. Iodine deficiency 41. Cardiovascular diseases are the number-one killer of women in all of the following groups EXCEPT: a. African-Americans b. Hispanic-Americans c. Asian-Americans d. European-Americans 42. Which of the following states has the largest native American population? a. Colorado b. New Mexico c. California d. Arizona e. Utah 43. The Office of Management and Budget designated racial/ethnic categories on the basis of: a. Socio-political characteristics b. Biologic characteristics c. Skin color d. Observer decision 44. Smoking levels are highest in which of the following groups? a. African-Americans b. Hispanic-Americans c. Asian-Americans d. European-Americans e. Native Americans 45. Among youths aged years, smoking rates are higher in: a. Males b. Females 46. In the U.S., cardiovascular death rates (heart disease) are higher in: a. Males b. Females 47. The leading underlying cause of poor health globally, in the opinion of Dr. Detels, is: a. Tobacco b. Poverty c. Malnutrition 7

8 d. Air and water pollution e. Obesity 8

9 48. The epidemiologic transition in developing countries refers to: a. Simultaneous occurrence of infectious diseases and diseases of affluence b. The increasing prevalence of chronic diseases c. The decline of infectious diseases d. The increasing wealth and attention to public health 49. Globally,over one-third of new HIV infections are occurring in which age group? a. <15 years b years c years d years e. 44+ years 50. The disparity between HIV/AIDS is highest for: a. African-American vs. European-American men b. African-American vs. European-American women c. Hispanic-Americans vs. European-Americans d. Asian-Americans vs. European-Americans 51. The risk of HIV infection is greatest for: a. Women in vaginal intercourse b. Men in vaginal intercourse c. The inserting partner in anal intercourse d. The receptive partner in anal intercourse e. The receptive partner in oral-genital intercourse 52. The major source of continuing transmission of HIV globally is: a. Commercial sex workers b. Men who have sex with other men c. Individuals who do not know they are infected d. Injection drug users e. Plasma donors 53. The most important factor for successful HIV/AIDS intervention in a country is: a. Political will b. Condom availability c. Microbicide availability d. Legalization of commercial sex e. Establishment of methadone maintenance programs 54. One of the success stories in HIV/AIDS intervention globally is that over 60% of HIV-infected mothers to be are now receiving anti-retroviral treatment before or during delivery: 9

10 55. Which of the following types of intervention are most likely to have the greatest impact? a. Behavioral b. Structural c. Political d. Social 56. Which of the following intervention strategies was used most frequently globally for control of both the SARS and H1N1 epidemics before the H1N1 vaccine became available? a. Quarantine and isolation b. Serologic testing c. Treatment of affected individuals d. Testing sick people for the presence of the virus 57. Which of the following is the most important requirement for a successful vaccine? a. Eliciting protective humoral immunity b. Eliciting protective cellular immunity c. Safety d. a. and b. above 58. The factor that played the greatest role in reduction of tuberculosis in the 20 th century was: a. Development of effective treatment b. Vaccination c. Improved sanitation d. Improved housing and reduced crowding e. Reduction of indoor air pollution 59. The primary goal of a vaccine is: a. Prevention of infection b. Prevention of clinical disease c. Prevention of morbidity and mortality 60. Surveillance is an essential first step in confronting an infectious disease outbreak: 61. In infectious diseases, the major objective of public health is to: a. Protect the infected b. Protect the uninfected 10

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12 62. Public health ethics differ from medical and research ethics because it is focused on: a. The patient b. The community c. The participant/subject d. The legislature e. The government 63. Ethics is built on a well-established set of rules that can be invoked to ensure justice and equity: 64. It is ethical to exclude children, mentally impaired persons, the elderly, and pregnant women from research because of the difficulty in conducting research among them: 65. Fertility in the United States has leveled off at approximately 2 per woman since 1990: 66. Health promotion combines educational and environmental support for actions and conditions conducive to good health: 67. The main adverse health outcome of long-term smoking is: a. Cardiovascular and cerebro-vascular diseases b. Lung cancer c. Kidney disease d. Liver disease e. Gastric(stomach) cancer 68. The change of attitudes towards smoking was a key factor in developing structural interventions against smoking: 69. The aging of the population in the United States over the last 50 years is due to: a. Declining birth rates b. Declining mortality rates c. Both of the above 12

13 d. Neither of the above 70. The leading factor contributing to the declining death rate in those aged years in the U.S. is a decline in deaths due to: a. Heart disease b. Cerebrovascular diseases c. Cancer d. Chronic respiratory diseases e. Diabetes 71. Strategies to reduce falls among the elderly include: a. Promotion of physical activity b. Reducing the number of drugs taken by individuals c. Improved design of housing for the elderly e. a. and b. above 72. The primary goal of Healthy People 2010 is to increase the number of years healthy life as opposed to increasing the number of years of life: 73. Exclusive breastfeeding of children for the first six months of life decreases the infant mortality rate by: a. 10% b. 50% c. 75% d. 100% 74. Pregnant women in developing nations face the following public health problems concerning nutrition: a. Poor nutrition prior to getting pregnant b. Poor nutrition during pregnancy c. Consuming less in order to have easier deliveries e. a. and b. above 75. Successful efforts to reduce smoking include: a. Taxation of cigarettes b. Physician counseling c. Social pressure 76. Public health has the responsibility to guarantee good health for all: 13

14 77. Tobacco companies target kids and adolescents with messages regarding smoking because people who start smoking earlier in life are more likely to continue smoking throughout their lifetime: 78. Now that countries such as the United States have greatly increased regulation and litigation against those that manufacture and produce cigarettes, smoking consumption has decreased worldwide: 79. If passed without substantial changes, House Bill 3200 will do all of the following, EXCEPT: a. Mandate health insurance for all b. Require all employers to provide health care coverage or pay into a trust fund c. Expand Medicare eligibility d. Regulate the health care exchange and small group insurance markets 80. Currently, the economic burden of illness in the United States is highest for which of the following? a. HIVAIDS b. Alzheimer s disease c. Cardiovascular disease d. Cancer e. Occupational diseases and injuries 81. The highest frequency of unintentional injuries among workers in the U.S. occurs among: a. Elderly workers b. Women c. Workers in the first year of a new job d. Young workers 82. The media is a major resource for promoting public health: 83. Which of the following health care groups experiences the highest rate of nonfatal violence? a. Nurses b. Physicians 14

15 c. Mental health professionals d. Occupational health professionals e. Technicians 84. The primary functions of public health include: a. Assessment b. Policy-setting/advising c. Provision of medical services d. a.,b. and c. above e. a. and b. above 85. Epidemiology uses time, place, and person to describe the relationship of agent, host and environment : 86. The largest proportion of financing for health in the U.S. in 2004 was provided by: a. Employer health plans b. Out-of-pocket payments c. The U.S. government d. Private health insurance 87. Today, nearly 50% of healthcare is financed by this source and continues to grow in proportion to other sources: a. Out-of-pocket payments b. Private health insurance c. Government d. Other private 88. In Canada and the U.K., healthcare is financed publicly. If the United States moved towards 100% public finance, which system would we be more similar to and why? a. Canada, because our National Health Service would deliver care to all b. The U.K., because private providers make up the largest proportion c. Canada, because healthcare is provided by both private and public providers d. The U.K., because care delivery is shared by a balanced public/private partnership 89. Unions in the United States have been gaining strength in the last three decades: 90. Covering your mouth and nose when sneezing is an example of self-protection against H1N1 influenza: 15

16 91. Which of the following agents has become resistant to multiple drugs? a. Schistosomiasis b. N. gonorrhoeae (gonorrhea) c. Syphilis d. H1N1 e. All of the above 92. Which of the different public health approaches is used to modify intake for prevention and control of micronutrient deficiencies? a. Dietary diversification b. Fortification c. Supplementation 93. Disability at age 65 years is a. Decreasing b. Increasing rapidly c. Increasing slightly d. Steady 16