,CONTET
Chapter 1 Community and Public Health: Yesterday, Today, and Tomorrow
Chapter 2 Organizations that Help Shape Community and Public Health
Chapter 3 Epidemiology: The Study of Disease, Injury, and Death in the Community
Chapter 4 Communicable and Noncommunicable Disease: Prevention and Control of
Diseases and Health Care
Chapter 5 Community Organizing/Building and Health Promotion
Chapter 6 The School Health Program: A Component of Community and Public Health
Unit II The Nation’s Health
Chapter 7 Maternal, Infant, and Child Health
Chapter 8 Adolescents, Young Adults, and Adults
Chapter 9 Older Adults
Chapter 10 Disparate Populations and Community and Public Health
Chapter 11 Community Mental Health
Chapter 12 Alcohol, Tobacco, and Other Drugs: A Community Concern
Chapter 13 Health Care Delivery in the United States
Unit III Environmental Health and Safety
Chapter 14 Community and Public Health and the Environment
Chapter 15 Injuries as a Community and Public Health Problem
Chapter 16 Safety and Health in the Workplace
,Chapter 1 — Community and Public Health: Yesterday, Today,
and Tomorrow.
Each question aligns with the chapter theme (history, determinants, epidemiologic
transition, and future trends). Every question has four answer choices (A–D), shows the
correct answer only as Answer: X, includes a deep rationale for the correct answer, and
lists key words.
1. Which historical public health development most directly explains the rapid drop
in urban mortality in many industrializing cities during the late 19th century?
A. Widespread adoption of antibiotics
B. Development of municipal sanitation and clean water systems
C. Introduction of mass immunization campaigns
D. Universal access to primary care clinics
Answer: B
Deep rationale: The late 19th-century mortality decline in industrial cities is most
directly attributable to environmental interventions — notably municipal
sanitation, sewerage, and clean water supply — which interrupted transmission
of waterborne pathogens (eg, cholera, typhoid). Antibiotics and mass
immunizations came later and had less explanatory power for that specific
historical mortality decline; universal primary care was not widespread then.
Sanitation changed population exposure at scale, driving rapid mortality
reductions.
Key words: sanitation, clean water, urban mortality, cholera, typhoid,
environmental interventions
2. In the context of the epidemiologic transition, which pattern best characterizes
Stage 3 (the ‘degenerative and man-made disease’ stage)?
, A. High infectious disease mortality and high fertility
B. Declining infectious disease mortality and rising chronic disease burden
C. Sudden epidemics of novel pathogens with high short-term mortality
D. Predominance of perinatal and nutritional causes of death
Answer: B
Deep rationale: Stage 3 of the epidemiologic transition describes a period when
infectious disease mortality declines and noncommunicable, degenerative
diseases (cardiovascular disease, cancers, diabetes) become the principal
causes of death. This results from improved sanitation, vaccination, and
socioeconomic development combined with lifestyle changes (diet, physical
inactivity). Options A and D describe earlier stages; C describes pandemic
scenarios rather than the steady pattern of Stage 3.
Key words: epidemiologic transition, chronic disease, NCDs, degenerative
diseases, mortality shift
3. A local health department wants to assess current community burden of an acute
infectious disease to inform immediate control measures. Which epidemiologic
measure is most useful for rapid situational assessment?
A. Prevalence proportion
B. Incidence rate (new cases per person-time)
C. Cumulative incidence over past 10 years
D. Lifetime risk
Answer: B
Deep rationale: For acute infectious disease control, incidence (new cases per
unit time) captures the current rate of new infections and supports rapid
response, contact tracing, and assessment of transmission dynamics.
Prevalence is a snapshot of existing cases, less sensitive to recent changes.
Cumulative incidence over 10 years and lifetime risk are not responsive enough
for immediate control decisions. Incidence rate informs real-time assessment of
, outbreak growth or decline.
Key words: incidence, surveillance, outbreak response, new cases, real-time
assessment
4. Which single intervention historically had the greatest immediate effect on
reducing deaths from waterborne infectious diseases in crowded 19th century
cities?
A. Mass childhood vaccination programs
B. Construction of centralized sewer and piped water systems
C. Household antibiotic distribution
D. Enhanced clinical diagnostic laboratories
Answer: B
Deep rationale: Centralized sewerage and piped water systems removed fecal
contamination from drinking water and reduced exposure to cholera and typhoid
at the population level, producing immediate downstream reductions in mortality.
Mass vaccination and antibiotics were important later but were not the immediate
drivers in the 19th century urban mortality decline. Laboratories aided
understanding but did not directly interrupt transmission at scale.
Key words: sewerage, piped water, cholera, typhoid, public infrastructure
5. The concept of “herd immunity” was critical to smallpox eradication. Which
combination of features made smallpox uniquely eradicable compared with many
other diseases?
A. High rate of asymptomatic infections and long incubation period
B. Exclusively animal reservoir and complex vector lifecycle
C. No nonhuman reservoir, an effective vaccine that provided durable immunity,
and an identifiable symptomatic case for ring vaccination strategies
D. Highly mutable virus and incomplete vaccine efficacy
, Answer: C
Deep rationale: Smallpox was eradicable because it had no nonhuman reservoir,
infected people showed clear symptoms (facilitating case detection), and the
vaccine produced strong, durable immunity. These features allowed targeted ring
vaccination and surveillance-containment strategies. Asymptomatic infections or
animal reservoirs (A and B) make eradication much harder; high mutability and
incomplete efficacy (D) hinder eradication.
Key words: smallpox eradication, herd immunity, no animal reservoir, vaccine
efficacy, ring vaccination
6. A city that achieved control of many infectious diseases is now experiencing
rising cardiovascular disease and diabetes. Which public health explanation best
accounts for this pattern?
A. Failure of infectious disease surveillance systems
B. Epidemiologic transition driven by demographic aging and lifestyle changes
associated with socioeconomic development
C. Genetic shift in the population predisposing to NCDs
D. Reallocation of public health funding away from chronic disease surveillance
alone
Answer: B
Deep rationale: The observed shift from infectious to chronic disease
predominance is characteristic of the epidemiologic transition associated with
aging populations and lifestyle/dietary changes that accompany socioeconomic
development. While surveillance, genetics, and funding all matter, the broad
population-level pattern is explained primarily by demographic and behavioral
determinants, not a sudden genetic shift or solely surveillance failure.
Key words: epidemiologic transition, aging, lifestyle, chronic disease, NCDs
Chapter 1 Community and Public Health: Yesterday, Today, and Tomorrow
Chapter 2 Organizations that Help Shape Community and Public Health
Chapter 3 Epidemiology: The Study of Disease, Injury, and Death in the Community
Chapter 4 Communicable and Noncommunicable Disease: Prevention and Control of
Diseases and Health Care
Chapter 5 Community Organizing/Building and Health Promotion
Chapter 6 The School Health Program: A Component of Community and Public Health
Unit II The Nation’s Health
Chapter 7 Maternal, Infant, and Child Health
Chapter 8 Adolescents, Young Adults, and Adults
Chapter 9 Older Adults
Chapter 10 Disparate Populations and Community and Public Health
Chapter 11 Community Mental Health
Chapter 12 Alcohol, Tobacco, and Other Drugs: A Community Concern
Chapter 13 Health Care Delivery in the United States
Unit III Environmental Health and Safety
Chapter 14 Community and Public Health and the Environment
Chapter 15 Injuries as a Community and Public Health Problem
Chapter 16 Safety and Health in the Workplace
,Chapter 1 — Community and Public Health: Yesterday, Today,
and Tomorrow.
Each question aligns with the chapter theme (history, determinants, epidemiologic
transition, and future trends). Every question has four answer choices (A–D), shows the
correct answer only as Answer: X, includes a deep rationale for the correct answer, and
lists key words.
1. Which historical public health development most directly explains the rapid drop
in urban mortality in many industrializing cities during the late 19th century?
A. Widespread adoption of antibiotics
B. Development of municipal sanitation and clean water systems
C. Introduction of mass immunization campaigns
D. Universal access to primary care clinics
Answer: B
Deep rationale: The late 19th-century mortality decline in industrial cities is most
directly attributable to environmental interventions — notably municipal
sanitation, sewerage, and clean water supply — which interrupted transmission
of waterborne pathogens (eg, cholera, typhoid). Antibiotics and mass
immunizations came later and had less explanatory power for that specific
historical mortality decline; universal primary care was not widespread then.
Sanitation changed population exposure at scale, driving rapid mortality
reductions.
Key words: sanitation, clean water, urban mortality, cholera, typhoid,
environmental interventions
2. In the context of the epidemiologic transition, which pattern best characterizes
Stage 3 (the ‘degenerative and man-made disease’ stage)?
, A. High infectious disease mortality and high fertility
B. Declining infectious disease mortality and rising chronic disease burden
C. Sudden epidemics of novel pathogens with high short-term mortality
D. Predominance of perinatal and nutritional causes of death
Answer: B
Deep rationale: Stage 3 of the epidemiologic transition describes a period when
infectious disease mortality declines and noncommunicable, degenerative
diseases (cardiovascular disease, cancers, diabetes) become the principal
causes of death. This results from improved sanitation, vaccination, and
socioeconomic development combined with lifestyle changes (diet, physical
inactivity). Options A and D describe earlier stages; C describes pandemic
scenarios rather than the steady pattern of Stage 3.
Key words: epidemiologic transition, chronic disease, NCDs, degenerative
diseases, mortality shift
3. A local health department wants to assess current community burden of an acute
infectious disease to inform immediate control measures. Which epidemiologic
measure is most useful for rapid situational assessment?
A. Prevalence proportion
B. Incidence rate (new cases per person-time)
C. Cumulative incidence over past 10 years
D. Lifetime risk
Answer: B
Deep rationale: For acute infectious disease control, incidence (new cases per
unit time) captures the current rate of new infections and supports rapid
response, contact tracing, and assessment of transmission dynamics.
Prevalence is a snapshot of existing cases, less sensitive to recent changes.
Cumulative incidence over 10 years and lifetime risk are not responsive enough
for immediate control decisions. Incidence rate informs real-time assessment of
, outbreak growth or decline.
Key words: incidence, surveillance, outbreak response, new cases, real-time
assessment
4. Which single intervention historically had the greatest immediate effect on
reducing deaths from waterborne infectious diseases in crowded 19th century
cities?
A. Mass childhood vaccination programs
B. Construction of centralized sewer and piped water systems
C. Household antibiotic distribution
D. Enhanced clinical diagnostic laboratories
Answer: B
Deep rationale: Centralized sewerage and piped water systems removed fecal
contamination from drinking water and reduced exposure to cholera and typhoid
at the population level, producing immediate downstream reductions in mortality.
Mass vaccination and antibiotics were important later but were not the immediate
drivers in the 19th century urban mortality decline. Laboratories aided
understanding but did not directly interrupt transmission at scale.
Key words: sewerage, piped water, cholera, typhoid, public infrastructure
5. The concept of “herd immunity” was critical to smallpox eradication. Which
combination of features made smallpox uniquely eradicable compared with many
other diseases?
A. High rate of asymptomatic infections and long incubation period
B. Exclusively animal reservoir and complex vector lifecycle
C. No nonhuman reservoir, an effective vaccine that provided durable immunity,
and an identifiable symptomatic case for ring vaccination strategies
D. Highly mutable virus and incomplete vaccine efficacy
, Answer: C
Deep rationale: Smallpox was eradicable because it had no nonhuman reservoir,
infected people showed clear symptoms (facilitating case detection), and the
vaccine produced strong, durable immunity. These features allowed targeted ring
vaccination and surveillance-containment strategies. Asymptomatic infections or
animal reservoirs (A and B) make eradication much harder; high mutability and
incomplete efficacy (D) hinder eradication.
Key words: smallpox eradication, herd immunity, no animal reservoir, vaccine
efficacy, ring vaccination
6. A city that achieved control of many infectious diseases is now experiencing
rising cardiovascular disease and diabetes. Which public health explanation best
accounts for this pattern?
A. Failure of infectious disease surveillance systems
B. Epidemiologic transition driven by demographic aging and lifestyle changes
associated with socioeconomic development
C. Genetic shift in the population predisposing to NCDs
D. Reallocation of public health funding away from chronic disease surveillance
alone
Answer: B
Deep rationale: The observed shift from infectious to chronic disease
predominance is characteristic of the epidemiologic transition associated with
aging populations and lifestyle/dietary changes that accompany socioeconomic
development. While surveillance, genetics, and funding all matter, the broad
population-level pattern is explained primarily by demographic and behavioral
determinants, not a sudden genetic shift or solely surveillance failure.
Key words: epidemiologic transition, aging, lifestyle, chronic disease, NCDs
