Community Nutrition in Action An Entrepreneurial Approach 5th Edition by Marie A. - Test Bank

Community Nutrition in Action An Entrepreneurial Approach 5th Edition by Marie A. – Test Bank

 

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Test Bank[1] for Community Nutrition in Action 5e

Chapter 5 – Principles of Epidemiology

 

Ans Page

 

True/False

 

a    139            1.   In the 1990s epidemiological studies established that women could reduce their risk of bearing a child with a neural tube birth defect by increasing their intake of folic acid.

1. true
2. false

 

b    141            2.   Fetal death rate is the same as the infant mortality rate.

1. true
2. false

 

a    141            3.   Maternal mortality rate is based on the number of pregnancy-rated deaths as compared to the number of live births in the same year.

1. true
2. false

 

b    143-145     4.   In the Seven Countries Study, subjects from Finland reported the lowest percentage of calories from saturated fat, but had the highest serum cholesterol levels.

1. true
2. false

 

a    146            5.   It is unrealistic to expect total agreement among the results of epidemiological or clinical studies due to genetic, environmental, and/or social factors.

1. true
2. false

 

a    147            6.   In planning an experimental trial, the investigator identifies a cause-effect comparison to be tested as a research hypothesis.

1. true
2. false

 

a    147            7.   Some of the leading risk factors for heart disease include cigarette smoking, physical inactivity, male gender, and obesity.

1. true
2. false

 

b    151            8.   A retrospective cohort study is one that follows a group into the future.

1. true
2. false

 

a    153            9.   A randomized trial conducted as a double-blind experiment is the most rigorous evaluation of a dietary hypothesis.

1. true
2. false

 

a    155            10. Today, nutritional epidemiology is primarily concerned with major, chronic diseases associated with the Western diet.

1. true
2. false

 

a    156            11. One challenge in studying the relationship of diet to disease is the complexity of our diets.

1. true
2. false

 

a    157            12. The day-to-day variation in an individual’s nutrient intake is called within-person variation.

1. true
2. false

 

b    157            13. The primary method of assessing the available food supply at the national level is based on household food consumption data.

1. true
2. false

 

b    157            14. Food balance sheets measure the food actually ingested by a population.

1. true
2. false

 

a    157            15. Data collected from food balance sheets can be used to formulate agricultural policies concerned with food production and consumption.

1. true
2. false

 

 

Multiple Choice

 

c    138            1.   The epidemiological method was initially used to investigate, control, and prevent epidemics of

1. social problems.
2. chronic diseases.
3. infectious diseases.
4. acute illnesses.

 

a    138            2.   Epidemiology differs from clinical medicine and laboratory science because of its focus on

1. populations.
2. determinants.
3. individuals.
4. diagnosis.

 

d    139            3.   Environmental factors included as determinants of disease in epidemiology include all of the following except

1. geographical location.
2. occupation.
3. living conditions.
4. nutrition status.

 

c    138            4.   The study of the distribution and determinants of health-related states and events in specified populations and the application of this study to the control of health problems is known as

1. morbidity.
2. ecology.
3. epidemiology.
4. vital statistics.

 

d    140            5.   Which of the following statements regarding fetal alcohol syndrome is incorrect?

1. The rate of any alcohol use during pregnancy has declined in the past 10 years.
2. Fetal alcohol syndrome is 100% preventable.
3. The rates of binge drinking and frequent drinking during pregnancy have not declined.
4. All of these statements are true.

 

b    142            6.   What is the most typical way in which epidemiologists work toward controlling and preventing health problems?

1. Development of interventions to alter lifestyles
2. Formulation of health policies
3. Recommendations for environmental changes
4. Development of media campaigns

 

b    140            7.   Figures pertaining to life events, such as births, deaths, and marriages, are known as

1. cohorts.
2. vital statistics.
3. risk factors.
4. statistical inferences.

 

a    142            8.   In epidemiological terms, smoking cigarettes would be an example of a(n) _____ risk factor.

1. behavioral
2. inherited
3. physical
4. environmental

 

d    143            9.   The incidence rate can be determined by _____ studies.

1. incidence
2. cross-sectional
3. nutritional
4. cohort

 

c    143            10. Which of the following occurs first in the epidemiological method?

1. Making comparisons
2. Developing the hypothesis
3. Observing
4. Counting cases or events

 

b    143            11. _____ refers to the fraction or proportion of a group possessing a disease or condition at a specific time.

1. Incidence
2. Prevalence
3. Specificity
4. Selectivity

 

a    143            12. Obtaining vital statistics regarding health and nutrition status from the WHO is an example of which phase of the epidemiologic model?

1. Counting cases or events
2. Developing a hypothesis
3. Making comparisons
4. Relating cases or events to the population at risk

 

d    145,147     13. In epidemiological studies, when should the hypotheses be formulated?

1. After the research data have been collected
2. Retrospectively
3. After the research data have been analyzed
4. At the outset of the study

 

a    149            14. _____ bias is the presence of another variable that accounts for the observation.

1. Confounding
2. Measurement
3. Selection
4. Control

 

a    151            15. The most appropriate use of a correlational study is

1. generating hypotheses.
2. drawing conclusions.
3. changing public policy.
4. validating previous studies.

 

a    150            16. _____ studies compare the frequency of events (or disease rates) in different populations.

1. Correlational
2. Cohort
3. Cause and effect
4. Cross-sectional

 

c    151            17. _____ studies examine the relationships among dietary intake, diseases, and other variables as they exist in a population at a particular time.

1. Cohort
2. Correlational
3. Cross-sectional
4. Observational

 

a    152            18. In a _____ study, a group of persons or cases with the disease or condition of interest is compared with a group of persons without the disease or condition.

1. case-control
2. cohort
3. correlational
4. cross-sectional

 

b    153            19. The most rigorous evaluation of a dietary hypothesis is the

1. case-control study.
2. randomized controlled trial.
3. cohort study.
4. cross-sectional study.

 

d    155            20. Nutritional epidemiology

1. has been an area of study for centuries.
2. has always focused on the role of chronic diseases of the so-called Western diet.
3. continues to focus on deficiency diseases.
4. evidence shows that a relatively few risk factors play a key role in the development of chronic disease.

 

d    158            21. A single 24-hour dietary recall

1. is often considered the best method of assessing dietary intake.
2. uses a questionnaire including all important population-specific food sources of the nutrients under investigation.
3. requires the subject to make judgments about their usual food habits.
4. may not give an adequate picture of a specific individual’s usual intake.

 

c    158            22. The diet history method of estimating dietary intake

1. is often considered the best method of assessing dietary intake.
2. uses a questionnaire including all important population-specific food sources of the nutrients under investigation.
3. requires the subject to make judgments about their usual food habits.
4. may not give an adequate picture of a specific individual’s usual intake.

 

b    158            23. The _____ method of assessing intake is time consuming, and the results may not be accurate if subjects modify their eating habits during the time of the study.

1. twenty-four hour recall
2. food record
3. food frequency
4. diet history

 

b    158            24. Methods of assessing household food consumption include which of the following?

1. Records of food wasted, spoiled, or fed to pets
2. Records of number of meals eaten at home or away from the home
3. Per capita data
4. Food disappearance data

 

a    140            25. Which of the following statements regarding binge drinking is false?

1. Rates of binge drinking during pregnancy have declined.
2. Rates of binge drinking remain higher than the Healthy People 2010 objectives.
3. Greater binge drinking occurs in younger unmarried women.
4. Greater binge drinking occurs in non-Hispanic whites who smoke.

 

a    142            26. The relative risk of lung cancer in people with low fruit and vegetable intake compared to those with high intake is about 2.0. This means that the people with

1. low fruit/vegetable intake were at twice the risk of developing cancer.
2. high fruit/vegetable intake were at twice the risk of developing cancer.
3. low fruit/vegetable intake were at no risk of developing cancer.
4. high fruit/vegetable intake were at no risk of developing cancer.

 

c    143            27. Which of the phases of the epidemiology method is illustrated in this statement?

“Many years of investigation have shown that atherosclerosis could be induced in laboratory animals by feeding them a diet rich in fats and cholesterol.”

1. Counting cases or events
2. Making comparisons
3. Observing
4. Relating cases to the at risk population

 

a    147            28. Which of the following are not risk factors for heart disease?

1. High HDL cholesterol, low LDL cholesterol
2. High blood pressure, diabetes
3. Physical inactivity, male gender
4. Smoking, obesity

 

d    149            29. _____ bias may occur if study participants were self-selected or not randomly assigned.

1. Confounding
2. Measurement
3. Sample
4. Selection

 

 

Matching

 

Match the advantage or disadvantage in the left column with its correct type of study. Items will be used more than once.

 

a	152	1.   Relies on recall or existing records about past exposures	a.   case-control study b.   cohort study
a	152	2.   Difficult to select suitable comparison group
b	152	3.   Can calculate and compare rates in exposed and unexposed
b	152	4.   Need to study large numbers of individuals which may take years to accomplish
a	152	5.   Relatively quick and inexpensive as it requires relatively few subjects
b	152	6.   May provide incomplete data from loss to follow-up

 

Match the step in the scientific method in the left column with its correct description in the right column.

 

c	148	7.   Problem is identified	a.   experiment b.   hypothesis & prediction c.   observation & question d.   results & interpretations e.   theory
b	148	8.   A tentative solution to the problem is formulated
a	148	9.   A study is designed and conducted to collect relevant data
d	148	10. Conclusions are drawn based on collected data
e	148	11. Integrates conclusions of supported hypotheses

 

Match the definitions in the left column with the appropriate terms in the right column.

 

c	143	12. The number of existing cases of a disease in a given population	a.   risk b.   confounding factor c.   prevalence d.   determinants e.   case f.    cohort g.   incidence h.   case-control study i.    vital statistics j.    food balance sheets
g	143	13. The number of new cases of a disease during a specific time period in a defined population
f	144	14. A well-defined group of people who are studied over a period of time
j	157	15. National accounts of the annual production of food, changes in stocks, imports/exports, and food distribution
a	142	16. The probability that people will acquire a disease
h	152	17. A type of observational analytic study
b	149	18. A “hidden” characteristic that is distributed differently in the study and control groups that may cause an association that the researchers attribute to other factors
d	139	19. Causes and factors that affect the risk of disease
i	140	20. Figures pertaining to life events
e	142	21. A particular instance of a disease or outcome of interest

 

 

Essay Questions

 

138-139     1.   Define epidemiology and its relationship to community nutrition.

 

Epidemiology is the study of the distribution and determinants of health-related states and events in specified populations and the applications of this study to the control of health problems. The epidemiologist works to identify the causes of disease and to propose strategies for controlling or preventing health and nutrition problems.

 

139            2.   Describe two examples of how the results of epidemiological studies have impacted the nutritional status of Americans.

 

• The relationship between adequate folic acid consumption and the lowered risk of neural tube defects led to the national policy of all grain products being fortified with folic acid.
• The relationship between diets low in fruits and vegetables and an increased risk of certain types of cancer led to an approved health claim on food labels.

 

140-141     3.   Describe three vital statistics used by epidemiologists to monitor a population’s health status.

 

• Crude birth rate is the ratio of the number of live births during the year as compared to the average midyear population multiplied by 1000.
• Crude death rate is the number of deaths during the year as compared to the average midyear population multiplied by 1000.
• Age-specific death rate is the ratio of the number of deaths to people in a particular age group as compared to the average midyear population in a specified age group multiplied by 1000.
• Cause-specific death rate is the ratio of the number of deaths due to a particular cause during the year as compared to the average midyear population multiplied by 1000.
• Infant mortality rate is the number of deaths of infants under the age of 1 as compared to the number of live births in the same year multiplied by 1000.
• Neonatal mortality rate is the number of deaths of infants under the age of 28 days during the year as compared to the number of live births in the same year multiplied by 1000.
• Fetal death rate is the number of fetal deaths (>20 weeks gestation) during the year as compared to the number of live births and fetal deaths in the same year multiplied by 1000.
• Maternal mortality rate is the number of pregnancy-related deaths during the year as compared to the number of live births in the same year multiplied by 100,000.

 

143            4.   Explain prevalence rates and how they differ from incidence rates.

 

The prevalence rate is the fraction or proportion of a group possessing a disease or condition at a specific time, whereas the incidence rate is the fraction or proportion of a group initially free of a disease or condition that develops the disease or condition over a period of time. By calculating and comparing rates, epidemiologists can determine the strength of the association between risk factors and the health problem being studied.

 

149-150     5.   Discuss two ways in which data collected may not be valid.

 

Two possible explanations for incorrect or invalid results include:

• They are biased due to a systematic error in measuring one or more outcome variables or there were systematic differences in the populations studied.
• The results are due to chance and do not represent the true state of affairs; that is, the observations made arose from random variations within the sample.

 

151-153     6.   Compare and contrast the major strengths and limitations of cohort studies and case-control studies.

 

A comparison of the major strengths and limitations is presented in Table 5.5 in the text. Essentially, a cohort study may provide complete data on the cases and stages of a disease in which calculations and comparisons can be made between those who were exposed and not exposed. These studies tend to be expensive and take many years to complete, thus increasing the amount of non-response data and limiting the control of confounding variables. Case-control studies are relatively quick and inexpensive studies that are an excellent way to study rare diseases and diseases with long latency periods. Oftentimes, existing records can be utilized on a relatively few study subjects. Limitations of this type of study include that the mechanism of the disease is not studied, with validation of data difficult to achieve.

 

156-157     7.   Explain how the complexity of our diets creates challenges in studying the relationship of diet to disease.

 

• The complexity and diversity of chemicals found in the foods and supplements we consume
• The need for long-term dietary intake to be examined
• The variety of foods consumed throughout the year
• The variety of foods consumed day-to-day (within-person variation)

 

157            8.   Explain why the day-to-day variation in an individual’s nutrient intake can have important implications for nutritional epidemiologic studies.

 

If only one day’s intake is determined, then, the true long-term nutrient intake may be misrepresented, leading to a false assessment of nutritional status.

 

157-158     9.   Differentiate among the methods of collecting food consumption data at the national, household, and individual levels.

 

The primary method of assessing the available food supply at the national level is based on food balance sheets. Food balance sheets measure the food available for consumption from imports and domestic food production, less the food “lost” through exports, waste, or spoilage, on a per capita basis. It is not a measure of actual food consumption, but availability.

Methods of assessing household food consumption consider the per capita food consumption of the household, taking into account the age and sex of persons in the household (or institution), the number of meals eaten at home or away from home, income, shopping practices, and other factors.

Four different methods used to assess food consumption at the individual level include: diet history, 24-hour dietary recall, food record or diary, and food frequency questionnaire. Dietary recalls are appropriate for assessing the intakes of groups of people, but a single 24-hour recall may not give an adequate picture of a specific individual’s usual intake. Food records are often considered the best method of assessing dietary intake, but they are time consuming, and the results may not be accurate if subjects modify their eating habits during the time of the study. Diet histories can provide detailed information, but they require subjects to make judgments about their usual food habits. Food frequency questionnaires provide less detailed information, but are well suited for use with large groups.

 

161            10. List four reasons for reading journal articles on a regular basis, and explain how you might become a better professional from reading these articles.

 

• To impress others
• To keep abreast of professional news
• To understand pathophysiology
• To find out how a seasoned health practitioner handles a particular problem
• To find out whether to use a new or an existing diagnostic test, survey instrument, or educational tool with your patients or clients
• To learn the clinical features and course of a disorder
• To determine the etiology or causation of a disorder
• To distinguish useful from useless or even harmful therapy
• To sort out claims concerning the need for and the use, quality, and cost-effectiveness of clinical and other health care
• To be titillated by the letters to the editor

Answers regarding how the student thinks he/she may become a better professional as a result of reading professional articles will vary.

 

 

Short Answer

 

149            1.   Define confounding factors. List three possible confounding factors in an epidemiological study.

 

Confounding factors are “hidden” factors or characteristics that are distributed differently in the study and control groups and may cause an association that the researchers attribute to other factors. Possible confounding factors include: age, gender, race, ethnicity, and dietary or lifestyle factors.

 

151            2.   Can data derived from an ecological study accurately yield a conclusion that consumption (or lack thereof) of a specific nutrient can lead to the development of a given disease? Why or why not?

 

No; the data from an ecological study cannot be used to draw these conclusions as the dietary data obtained are based on population food disappearance data and are therefore not particularly specific.

 

151            3.   What is the main difference between a retrospective and prospective cohort study?

 

A retrospective cohort study examines previous data in an effort to look back in time to reconstruct exposures and health outcomes, whereas prospective cohort studies follow a group into the future.

 

 

Case Scenario

 

In its study of disease progression, epidemiology uses a variety of tools, including clinical, microbiological, pathological, demographic, sociological, and statistical, in a rigorous, scientific approach. Based on the epidemiologic method, answer the following questions.

 

139,148     a.   Make an observation of the diet-cancer relationship.

 

Answers will vary, but could include the following:

Those consuming a low-fiber, low-antioxidant, low–fruit and -vegetable diet are at an increased risk.

 

145-146     b.   Develop a hypothesis to be tested that is relevant to the diet-cancer relationship.

 

Answers will vary; however, in an experimental trial, the investigator will need to identify a cause-effect comparison.

 

151-152     c.   Would a cohort study be appropriate to investigate your hypothesis? Why or why not?

 

Answers will vary; however, in many situations a cohort study could be appropriate.

 

158            d.   What role might the community nutritionist play in this study?

 

Answers will vary, but could include the following:

• Identifying nutritional problems within the community
• Interpreting the scientific literature for the public and other health professionals
• Critically evaluating the scientific literature before formulating new nutrition policies or offering advice about eating patterns

 

[1] By Melanie Tracy Burns of Eastern Illinois University