Public Health Exam

Spring 2021 MPH Comprehensive Exam

MPH-EH Degree

We are all waiting with great anticipation for the successful rollout of the Covid -19 vaccination program. As distribution with its’ inherent problems grinds on, several questions must be answered about epidemiological trends, vaccine hesitancy, workforce readiness, and vaccine distribution to vulnerable populations. Please answer the following questions from the perspective of a public health professional in the middle of a crisis.

Please remember to answer all section and subsection questions. Exams submitted with sections or subsections missing will not be graded.

Section A. Epidemiology and Biostatistics

Assume you have conducted an investigation of the COVID-19 infections and vaccinations and you have obtained the following data (the data are hypothetical).

i. Complete the following table, using 2018 US population estimates of 331 million people to calculate the cumulative incidence for COVID-19 cases per 100,000 and report the absolute change in incidence. Summarize the geographic differences in incidence and change in incidence from March to April 2020.

State	Reported new cases MARCH	Incidence per 100,000 MARCH	Reported new cases APRIL	Incidence per 100,00 APRIL	Change in incidence
New York	76,876		78,176
New Jersey	44,416		43,154
Michigan	18,970		18,900
Louisiana	16,284		19,713
California	15,865		15,991

ii. Create an epidemiological curve and describe the trend from the U.S. COVID-19 case data below. Ensure you note the peak for reported cases in the month of December.

Date	Number of reported COVID-19 cases
12/1/20	122,134
12/2/20	124,503
12/3/20	125,231
12/4/20	124,600
12/5/20	129,103
12/6/20	135,200
12/7/20	151,400
12/8/20	187,672
12/9/20	201,210
12/10/20	210,300
12/11/20	189,200
12/12/20	187,690
12/13/20	184,300
12/14/20	179,200
12/15/20	171,230
12/16/20	168,993
12/17/20	166,789
12/18/20	177,698
12/19/20	162,230
12/20/20	151,330
12/21/20	148,932
12/22/20	140,771
12/23/20	138,389

iii. Consider a case-control study design to collect real world efficacy data on the COVID-19 vaccine. As the investigator in charge of this study, describe how you would select cases and controls. What are some ways you can limit bias in this study? Identify and describe any important confounding variables that you would consider exploring in the primary association between COVID-19 vaccination and acquisition of disease.

iv. Compute and interpret the Odds Ratio for the results of the case control study below.

Received COVID-19 Vaccine		Cases	Controls	Total
	Yes	300	2,800	3,100
	No	4,700	2,200	6,900
	Total	5,000	5,000	10,000

Section B. Biostatistics

Assume that you are given a hypothetical dataset (see 2021SP_Bio_data.csv) along with the following data codebook. Use the given data and codebook to complete the following tasks. You MUST use YOUR OWN WORDS to write up the statistical report and do NOT directly copy the materials from MPH 503 handouts and lecture notes.

Codebook

Variable	Label	Values
ID	Participant ID	Case number
Vaccine	Acceptance of any COVID-19 vaccine	0=Yes 1=No
Education	Education	1=No high school 2=High school 3=Some college 4=College 5=Graduate/Professional
Gender	Sex	1=Male 2=Female
Employment	Are you currently employed?	0=Yes 1=No
Age	How old are you?	1=18-24 2=25-34 3=35-44 4=45-54 5=55+

As misinformation about COVID-19 has spread across media outlets, it is important for public health officials and policy-makers in the United States to plan on effective messaging and interventions to educate correct knowledge of COVID-19 prevention, treatment, and vaccination. Immunization programs are only successful when there are high rates of acceptance and coverage. As the primary investigator, you plan to assess the current vaccine acceptance landscape and discuss related findings with the public health professionals and lay audiences.

i. Suppose that you are interested in examining differences in demographic factors and attitude toward the acceptance of a COVID-19 vaccine. Your research team has surveyed to determine if there is an association between gender and willingness to receive the COVID-19 vaccine. Analyze the data using any statistical software of your choice. (Note: significance level = 0.05)

a. Report and interpret your statistical results, as well as create tables/figures in accordance with the APA guideline for professional audiences. (Note: Your report MUST contain indications of proper assumption tests for the proposed analysis, describe relevant results of descriptive statistics, and discuss conclusions from inferential statistics.)

ii. Suppose that you are interested in investigating differences in socioeconomic factors and attitudes toward the acceptance of a COVID-19 vaccine. Your research team has conducted a survey to determine if there is an association between employment status and willingness to receive the COVID-19 vaccine. Analyze the data using any statistical software of your choice. (Note: significance level = 0.05)

a. Report and interpret your statistical results, as well as create tables/figures in accordance with the APA guideline for professional audiences. (Note: Your report MUST contain indications of proper assumption tests for the proposed analysis, describe relevant results of descriptive statistics, and discuss conclusions from inferential statistics.)

iii. Overall, based upon the findings above, how do you present your findings to lay audiences (including policy-makers)?

a. Present and discuss your analytical results and potential impact for the lay audiences and health policy-makers (with the supportive arguments from the scientific evidence based on the peer-reviewed literature).

Section C. Environmental Health

Congratulation! You just got hired as a Public Health Coordinator in the newly created section at the Sangamon County Health Department that provides an awareness campaign for COVID-19 vaccination. As a public health professional, you need to design a policy statement based on a system’s thinking model to identify the target population and advertise your program to influence those communities getting vaccinated.

i. Considering how infectious disease is transmitted into the environment and among people, please draw a system thinking diagram that includes all components such as elements, interconnection, and causal loop such as negative and positive feedback. Please include environmental health aspects of COVID-19 such as the source of this disease, its transmission, health implication, and preventive measures. Please use MS Word or PowerPoint to draw the detailed diagram. After sketching the systems thinking diagram, explain each element and interconnections.

ii. Using the above framework, please write a one-page policy statement that includes preventive measures such as vaccination, mask-wearing, social distancing and practicing good hygiene to safeguard peoples’ health and well-being and limit widespread outbreaks.

Section D. Public Health Education

You have been hired by the Macon County, Alabama Health Department to address fear reduction and promote COVID-19 vaccination among the area’s constituents. How will your knowledge of the community impact your approach? Using protection motivation theory explain how you would create an intervention to encourage people who are vaccine-hesitant to pursue vaccination. Be certain to label the constructs and the specific strategies you will use.

Section E. Public Health Policy

Is it possible to mandate a COVID-19 vaccination, including a mandate for adults vs. a mandate for children? Are there any circumstances (community, institutional, essential personnel) under which you would consider a mandatory vaccination policy? Please explain why or why not. Why might this be different than the Measles, Mumps, and Rubella vaccination requirements? To successfully answer this question, you must consider the ethical, legal, and political ramifications. Address all three types of ramifications in your answer.

Section F: MPH-EH Core Question:

During the unprecedented times caused by the novel coronavirus disease, information and guidance from health organizations is rapidly evolving. However, a focus must also be on proper and effective risk management and communication. This is especially the case during pandemics that have high rates of infection, significant morbidity, lack of therapeutic measures, and rapid increases in cases.

1. As a risk assessor with the World Health Organization (WHO) in England, UK, you have been charged with communicating the risk of COVID 19 to residents living in the city of London. Please create a sample risk communication material that will include pertinent information for your target population.

2. Considering the significance of your risk communication efforts, you may be faced with different constraints. Please discuss at least 3 categories of constraints you may face while completing your task.

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