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1. Lung cancer is the most preventable cause of death in the United States. Which of the following is the second most preventable?
A. Heart disease
B. Cerebrovascular diseases
C. Suicide
D. Homicide
E. Motor vehicle accidents
The answer is: C
Suicide is the eighth leading cause of death in the general population. Next to lung cancer, it is the second most preventable. Several factors support this claim. The majority of suicidal patients have behavioral or psychiatric disorders that can be treated effectively, and 67% of persons who kill themselves have consulted their physician in the month before the suicide (40% the prior week). Fifty-four percent have been treated for a psychiatric illness in the year before the suicide, and 31% in the final month. This means that physicians, if properly trained, could identify the self-destructive behaviors and the high-risk factors and intervene preventively. It also speaks to the pressing need for more mental health support in the United States.
2. According to recommendations issued by the U.S. Public Health Service, which of the following statements regarding vaccination against smallpox is true?
A. Pregnant women should be vaccinated in the first trimester
B. Persons who have eczema should be vaccinated soon after diagnosis
C. Persons who have immune deficiencies should be vaccinated every 5 years
D. Persons traveling abroad need not be vaccinated
E. Children should be vaccinated before they begin school
The answer is: D
Routine vaccination of infants and children for smallpox has been discontinued in the United States, both because the risk of contracting the disease is so low and because the complications of smallpox vaccination, including generalized vaccinia eruption, postvaccinal encephalitis, and fetal vaccinia, are significant. Owing to the extremely effective eradication of smallpox worldwide by the World Health Organization, U.S. citizens traveling abroad no longer require vaccination. Pregnancy, immune deficiencies, and eczema and other chronic dermatitides are contraindications to smallpox vaccination.
3. Which of the following is the most common cause of spontaneous hypothyroidism in the U.S.?
A. Iodine deficiency
B. Lithium
C. Hashimoto's thyroiditis
D. Propylthiouracil
E. Toxic multinodular goiter
The answer is: C
Hypothyroidism can result from several causes including congenital defects, chronic autoimmune thyroiditis (Hashimoto's thyroiditis), medications (thionamides, lithium, iodine), other iatrogenic causes, iodine deficiency, and hypothalamic or pituitary insufficiency. Chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the U.S.
4. A 16-year-old female is unmarried, a high school dropout, and nine months pregnant. She has had no prenatal care. Which of the following is the most likely fetal risk or deficit she can expect for her baby?
A. Neurologic defects
B. Low birth weight
C. Increased infant mortality risk
D. Evidence of malnutrition
E. Increased birth defects
The answer is: B
Teenage mothers are most likely to have infants born with low birth weights. The main contributing factors to low birth weight are the lack of both prenatal care and good nutrition. In 1991, fewer teenage mothers were receiving early prenatal care than in 1980. Low birth weight is a major cause of infant deaths, neurological defects, and childhood illnesses. Of 1991 mothers between the ages of 15 and 19, 47% received no early prenatal care, and of the mothers under the age of 15, 64% received no early prenatal care. Eighty-one percent of first births to these teenagers were born out of wedlock, compared with 33% in the early 1960s. More than one-third of sexually active adolescent girls become pregnant at some time during their adolescent years. Fifty-one percent will give birth and 97% of these mothers will choose to keep their babies. Teenage mothers are twice as likely to drop out of school, less likely to attain postsecondary education, less likely to gain realistic employment, more likely to rely on welfare, less likely to get married, and more likely to divorce if they do marry.
5. Empirical findings about patterns of disease and illness include which of the following?
A. A large range of symptoms (e.g., headache, upset stomach, and sore muscles) is found in the general population on any given day
B. Many persons experiencing symptoms of disease or illness seek medical care
C. Individual persons show stereotyped reactions to the presence of many disease symptoms D. Persons interpret the meaning of their own unexpected physiologic changes with relatively little communication with others
The answer is: D
Symptoms of physical illness that might be defined simply as perceived or subjective changes of one's bodily state play a key role in health care. Such perceived changes, combined with observable signs, are the only way that the presence of illness can be detected. An understanding of how these symptoms and signs are interpreted by the average person is important for the practicing physician. The traditional view concerning the frequency of symptoms states that the illness experience constitutes a relatively infrequent or unusual event. In recent years, however, there have been a number of studies of symptom prevalence in normal populations; this evidence shows that there is a sizable number of clinically serious problems reported in supposedly healthy populations. Various empirical studies have reported that a wide range of symptoms—including headaches, upset stomachs, sore muscles, chest pains, nasal congestion, watering eyes, ringing in the ears, racing heart, dizziness, flushed face, sweating hands, and shortness of breath—occurs frequently and that many if not most people experience some of these symptoms much of the time. Behavioral scientists have also found that only a small number of people experiencing such problems ever seek professional care. In most cases, the mere presence of symptoms does not prompt a person to seek professional assistance. Illness becomes an everyday typical experience, and the treated case actually represents only the tip of a clinical iceberg. It is further evident that the experience of unexpected physiologic arousal (symptoms) places a person in a position of needing and seeking information from others to help give meaning to what he or she is experiencing. Thus, when unexpected physiologic changes occur, research findings suggest that we seek out explanations or attributions from our memory and through the advice of others.
6. European Americans compared with African Americans have a higher prevalence of which of the following?
A. Hypertension
B. Insulin-dependent diabetes mellitus
C. Obesity
D. Tuberculosis
E. Coronary and cerebral arterial disease
The answer is: B
Ethnic origin and race are major factors in certain diseases. Insulin-dependent diabetes mellitus is more frequent in whites than in African Americans and is even less common in blacks born and living in Africa. Non-insulin-dependent diabetes is twice as high in African Americans and Native Americans. The prevalence of hypertension in African Americans is 2 to 4 times that in whites, especially among African American women, with a parallel increase in end-stage renal disease. The mechanism is unclear at this point, but is thought to be related to selective survival, diet (sodium intake), social stress, occupational insecurity, and genetics. The higher prevalence of obesity is related to diet and socioeconomic status. The incidence and prevalence of tuberculosis is twice as high in African Americans as in whites. Genetic factors may play a dominant role, in addition to economic deprivation, overcrowding, and poor nutrition. Stroke and coronary mortality rates are higher in African Americans than in whites, a fact thought to be related to the higher prevalence of hypertension, diabetes, and obesity. Other diseases with significant ethnic and racial associations are osteoporosis (white women); cancer of the esophagus, stomach, pancreas, lung, cervix, and prostate (African Americans); cirrhosis (Hispanics); and arthritis and connective tissue disorders (whites). These differences emphasize the importance of understanding demographic and ethnic factors.
7. The stress of the Iraqi missile attacks on Tel Aviv residents during the January 1991 Gulf War triggered an increase in myocardial infarctions treated in intensive care units of Tel Aviv medical centers. It also caused an increase in the sudden death rate. On the day of the first missile strike, the cardiovascular mortality rate increase was greater for which of the following populations?
A. Women than men
B. Men than women
C. Elderly than middle-aged
D. Active duty military versus civilians
E. Disabled military versus disabled civilians
The answer is: A
In assessing the mortality rate of the population of Israel, the first day of the missile attack resulted in an increased mortality rate that was greater for women than for men. Comparisons were made to the week before the attack and to the same period of time one year earlier. As might be expected, the increased mortality rate was centered mainly in the Tel Aviv area and was attributed to cardiovascular disease. Several studies of premyocardial infarction (MI) activity found that stressful mental or physical events can trigger the onset of a heart attack. However, the risk of an MI after an episode of anger was found to be more than twice as high as other stressful triggers, even a missile attack.
8. Which of the following countries has the highest infant mortality rate?
A. United States
B. Hong Kong
C. Canada
D. Greece
E. Spain
The answer is: A
Of the countries listed in the question, the United States has the highest infant mortality rate. In 1988 the rate was 9.95 per 1000 births and in 1993 it was 8.37 per 1000 births. The 1993 infant mortality rate was lowest in Japan (4.35), followed by Finland (4.40), Singapore (4.68), Hong Kong (4.76), Sweden (4.84), Norway (5.11), Denmark (5.40), Switzerland (5.55), Germany (5.84), and Ireland (5.99). Of the countries listed in the question, Hong Kong ranked fourth lowest, Canada fourteenth, Spain twentieth, Greece twenty-fourth, and the United States ranked twenty-fifth out of the 37 countries where records of infant mortality rates are kept. In terms of the annual percent change (improvement), 17 of the 24 countries with lower infant mortality rates than the United States were able to achieve a higher annual percentage improvement than the United States. This raises serious questions with regard to availability and quality of United States health care systems. Within the United States, the 1995 mortality rate for blacks was 2.4 times as high as it was for whites. Ten years ago, the infant mortality rate was 2.1 times higher for black infants. This change represents a worsening health care direction rather than an improvement.
9. A 19-year-old European American male in Miami has been shot by another 19-year-old male on the street in his neighborhood. The odds are that the shooter was from which of the following groups?
A. European American
B. Asian American
C. Cuban American
D. African American
E. Mexican American
The answer is: A
The vast majority of homicides are intraracial rather than interracial. In other words, Asian Americans tend to kill Asian Americans, European Americans tend to kill European Americans, and African Americans tend to kill African Americans. The most common homicide committed in the United States is by an acquaintance and is usually over a love triangle, money, or property. Males are 9 times as likely to commit violent crimes, but the rate of violent crimes for females is increasing.
10. Which of the following is the single most significant source of preventable disease and premature death?
A. Environmental pollution
B. Crime and homicide
C. Auto and home accidents
D. Poor nutrition
E. Cigarette smoking
The answer is: E
Each U.S. Surgeon General's report since 1964 has emphasized that the single most significant source of preventable illness and premature death is cigarette smoking. The excess annual toll is estimated to exceed 350,000 people, more than all American lives lost in all wars during the twentieth century. Environmental pollution, crime and homicide, auto and home accidents, and poor nutrition are all significant sources of preventable illness and premature death, but smoking is considered the most significant.
11. International statistics on the per capita consumption of absolute alcohol in liters show which country to rate the highest?
A. Finland
B. United States
C. Russia
D. Spain
E. France
The answer is: E
The highest per capita alcohol consumption by regions is in Australia and New Zealand, North America, and Europe. These regions are the most economically developed, share similar cultural heritages, and have a long history of acceptance and use of alcohol. France has the highest per capita consumption of alcohol (13.3 L) and Spain is third with 11.8 L per capita. The U.S. ranks sixteenth with 8.0 L per capita per year, Finland thirty-sixth with 6.9 L, and Russia fiftieth with 5.2 L per capita. Other countries with the highest per capita consumption include Barbados, Luxembourg, Argentina, and Portugal. In the past 10 years, France has shown a significant decrease in per capita consumption and seven other countries have shown a small decrease. This has been attributed to changes in some consuming populations, economic trends, recent efforts of governments to deal with alcohol problems, and an increased awareness of health-related risks.
12. Which of the following is the most underutilized area of health care by the poor and lower socioeconomic class in the United States?
A. Emergency care
B. Prenatal care facilities
C. Physician office visits
D. Preventive care
E. Medical clinics
The answer is: D
Class differences in health care utilization are by far most prominent in the area of preventive care. The poorer and lower socioeconomic individuals receive less preventive care, even though it may be available through public insurance programs and free clinics. They receive fewer immunizations, fewer physical examinations, less dental care, less prenatal care, and less screening for heart disease and cancer.
Women of low-income families receive one-third less prenatal care, and low-income children are 4 times less likely to have ever had a routine physical examination. Thus, many potential or existing health problems are not detected or treated until the disease or disability has reached a serious stage of development, cost, and disability.
Among the poor, going to the doctor is apt to be seen as an unaffordable luxury. Studies in Germany and Great Britain have disclosed similar behavioral patterns. A major portion of the disparity in health and life expectancy between the affluent and the poor is attributed to these behavioral patterns. It is a fact that people at the lower levels of societies throughout the world have the poorest health of all people.
13. A 48-year-old male executive has had confirmed ischemic heart disease for several years. His symptoms are exacerbated significantly by stress. He agreed to join a controlled experimental program of 500 patients with heart disease to test the prevention of stress-related illness and death in patients with heart disease (the Ischemic Heart Disease Life Stress Monitoring Program). The experimental program was successful in lowering the stress on a case-by-case basis. This patient was much improved after the first year and the cardiac mortality rate in the experimental group had decreased by which of the following
A. 10%
B. 20%
C. 30%
D. 40%
E. 50%
The answer is: E
Nancy Frazer-Smith (University of Montreal) conducted a controlled experimental study involving 500 patients with heart disease who were very stressed. For half of the group, she designed an experimental program with the hypothesis that life-stress often precedes myocardial infarction (MI) and recurrent heart attacks. The experimental group received regular telephone follow-up to monitor their stress status and home visits by the project nurse to assess the causes of increased distress and to work with the patients to help resolve and reduce the high level of stress through counseling, emotional support, and stress reduction therapy. The control group received the best traditional medical care. After a year, the behavioral intervention resulted in a reduction of cardiac deaths by 50%. Furthermore, the reduced death rate persisted for six months after the program ended. Reduction of MI reoccurrences persisted for seven years after the program. It was concluded that the stress reduction program provided needed social and emotional support to reduce stress, depression, and feelings of helplessness and distress, thus reducing physiologic arousal and its damaging effects on the cardiovascular system. An additional conclusion, perhaps of equal importance, was the need for individualized tailoring of prevention and intervention for each patient.
14. Which of the following factors is most highly associated with the etiology of violence?
A. Family instability
B. Lack of education
C. Poverty
D. Crowded living conditions
E. Race
The answer is: C
Those most prone to violence are male, young, and poor. Poverty is also overrepresented among victims of homicide, and women who are poor are more likely to be raped or attacked than other women. Other factors related to poverty—minimal education, poor health, family instability, and overcrowded and inadequate housing—are all highly associated with violence. While the age-adjusted homicide rates for some races are higher than others, race itself is not considered to be a major etiologic factor.
15. Cancer screening and early detection of cancer are important public health goals. Which of the following factors is most likely to lead to effective participation?
A. Convenience
B. A friend's opinion
C. Knowing and understanding the seven warning signs of cancer
D. Mass media appeals
E. Perceived risk
The answer is: E
Cancer screening and early detection are important defenses against the disease and can enhance the treatment potential. Yet it has proved difficult to achieve consistent participation in such programs. Individuals who perceive and believe themselves to be at greater risk are more apt to undergo cancer screening. Friends' opinions are of next importance, but a person will still avoid or postpone screening unless they perceive and believe that they are at risk. Mass media appeals to inform the public, detailing the seven warning signs of cancer, and improving the convenience and access to proper screenings are all helpful, but are still not sufficient. The problem of lack of participation in screenings is not limited to just mammograms or breast self-examination, but also exists for testicular, skin, colon, lung, and most other potential sites of cancer. Most cancers are relatively slow developing, which can provide further incentive for procrastination, and the phenomenon of denial and fear of knowing the truth encourages the delay.
16. Ethnic differences in response to pain are attributable primarily to which of the following factors?
A. Differences in pain threshold
B. Differences in subjective experience of pain
C. Intellectual ability to grasp the significance of a disease
D. Cultural traditions of stoicism or emotionalism
E. Experimental bias
The answer is: D
There are no ethnic differences in threshold for the sensation of pain. The ethnic response to pain, however, is highly variable and is conditioned by cultural factors. The ethnic significance and traditions of emotionalism or stoicism regarding pain are major factors in accounting for this variable response to pain.
17. Which of the following is the psychosocial factor that best predicts the development of coronary heart disease and death?
A. Stress
B. Explosive and accelerated speech
C. Impatience and urgency
D. Aggressiveness
E. Hostility
The answer is: E
The most important aspect of coronary-prone behavior is hostility; it has been identified as the major risk factor for coronary heart disease and death. Stress, when measured as perceived stress rather than measuring stressors, is a major risk factor for many illnesses and diseases. Impatience, a sense of urgency, explosive speech, and aggressiveness all are important factors in a type A personality, along with hostility. But recent studies have shown that hostility and anger are very powerful risk factors not only for a coronary, but also for death.
18. You are the physician managing the pregnancy of a young woman who is a heavy social drinker. She is resistant to abstaining from alcohol during the pregnancy, and you want to impress upon her the risk of fetal alcohol syndrome. For a pregnant woman who drinks 2 to 4 oz of 80 proof alcohol daily, the risk is what percent?
A. 2%
B. 5%
C. 10%
D. 20%
E. 30%
The answer is: C
Fetal alcohol syndrome can occur as the result of chronic heavy drinking by a pregnant woman. Symptoms may include severe retardation of intrauterine growth, premature birth, microcephaly, and other deformities such as congenital eye and ear problems, heart defects, extra fingers and toes, and patterns of disturbed sleep. It is the most prevalent cause of defective cerebral development. Most recent research suggests a 10% risk of this syndrome if the pregnant woman drinks as little as 2 to 4 oz of hard liquor daily. It is estimated that 6000 infants a year suffer from the effects of fetal alcohol syndrome.
19. Which of the following countries has the lowest prevalence of HIV/AIDS infection?
A. Canada
B. Cuba
C. Netherlands
D. Norway
E. Sweden
The answer is: B
HIV infection and AIDS is rare in Cuba (0.00009% of adult population). This is attributed to the fact that it is regarded as a public health issue and that nearly everyone over 15 years of age has been tested for HIV. Those who have tested positive (several hundred persons) have been quarantined and publicly supported, similar to the way the U.S. used to quarantine persons infected with tuberculosis and leprosy. The Netherlands government encourages a program of voluntary information, condoms, and needle exchange among IV drug users, who have a prevalence of about 30% HIV infection. This has helped reduce the prevalence of HIV/AIDS, but has not controlled the infection. Canada, Norway, and Sweden have a significantly lower prevalence of HIV infection than the U.S., but like the U.S. they are not able to reduce or control the prevalence of HIV infection with voluntary
20. Adolescent suicide is a major public health problem. The three leading causes of death among adolescents are listed below. Which is the correct rank order with regard to incidence from highest to lowest?
A. Accidents, homicide, suicide
B. Suicide, homicide, accidents
C. Homicide, accidents, suicide
D. Accidents, suicide, homicide
The answer is: A
During adolescence, there is a marked increase in the number of suicides. Adolescents account for 6000 of the 28,000 yearly suicides in the United States. Boys are 3 times more likely to commit suicide than are girls, and boys typically choose more violent acts than the more passive methods used by girls. Suicide is the third leading cause of death among adolescents, exceeded only by accidents and homicides. It is thought that suicide attempts represent an adolescent's final call for help and attention. These attempts are all too often successful. During the period between 1970 and 1980, the rate of suicide for adolescent males increased 40% and is still rising. The suicide rate for females is also continuing to rise. Studies show that 60% of adolescents who commit suicide live with only one parent. Suicide risk is also associated with depression, with families in which one or more members has a chronic illness, with a family history of suicide, and with long-standing family and social problems throughout childhood. Suicide can be precipitated by another suicide in a peer group, by a loss of a loved one, and by an adolescent suicide seen on television. A substrate of psychopathology generally exists.
21. Studies of pain response among different American ethnic groups disclosed that, for disorders of equivalent objective severity, the degree of open and vocal response to pain was greatest in which of the following groups?
A. "Old American" and Jewish
B. Italian and Jewish
C. Irish and Old American
D. Jewish and Irish
E. Italian and Old American
The answer is: B
Studies have revealed that American Italians and Jews were much more likely to be open and vocal about their discomfort than were Americans of Irish or Old American descent (the classification Old American refers to persons having several generations of ancestors born in the United States). The Italians focused on the pain itself, whereas the Jews tended to worry about what the pain portended for the future. The Irish seemed to deny the existence of the pain, whereas the Old Americans described the pain in detail in a detached and scientific manner. Pain was measured both by a person's subjective ratings of discomfort on a scale from 1 to 10 and by responses on a standardized questionnaire.
22. A Stanford University community health education study evaluated the effects of an educational campaign on reduction of cardiovascular risk factors. One community was exposed to mass media education, another received both mass media education and behavior modification training, and a third served as a control group. The most impressive results included which of the following
A. Cigarette smoking, egg consumption, and cholesterol levels declined equally in both test communities
B. The control community made important achievements
C. The mass media campaign plus the behavioral modification training achieved the most significant results
D. It is better to focus on one public medium of communication at a time
E. The mass media campaign had the most impact
The answer is: C
The Stanford University community health education study evaluated the relative effects of an intensive multifactor health education campaign on the reduction of cardiovascular risk factors. The study developed a multimedia campaign to encourage people to lose weight, increase exercise, stop smoking, and change their diet. One town was exposed to a large-scale mass media campaign, another received the mass media campaign coupled with behavioral modification training for high-risk individuals, and a third served as a control community. Both test communities decreased cigarette smoking, egg consumption, and cholesterol levels. The community with the mass media campaign plus behavioral modification training achieved the most impressive results. The findings of the study clearly indicate that health beliefs and attitudes can be modified in natural settings as well as in research laboratories. Two problems were emphasized: the powerful countervailing pressures in society that promote smoking and eating of nonnutritional foods and the resistance to change created by the sedentary state of our highly automated society.
23. Which of the following is the fourth leading cause of death in early adolescence (10 to 14 years old) and the second leading cause of death in late adolescence and young adulthood?
A. Unintentional injury
B. Overdose of drugs or alcohol
C. Homicide
D. Suicide
E. Motor vehicle accidents
The answer is: D
Suicide is relatively uncommon before puberty. It is the fourth leading cause of death from ages 10 to 14 and becomes the third leading cause of death (after motor vehicle accidents) from the ages of 18 to 24. The highest rates of suicide are found in white and Native American males. It is important to recognize that for every suicide there are between 20 to 50 attempted suicides; attempts are more frequent among females. Drug ingestion is the most common method for attempted suicide in adolescents, but it is usually not fatal. Fatal suicide usually involves firearms, hanging, or jumping from heights. The most common behavioral and psychosocial factors include a family history of suicide, alcohol and substance abuse, conduct disorders, depression, anxiety states, and knowing someone who has attempted or committed suicide. Precipitating factors include acute stress, trouble with the law, trouble at school (e.g., cheating or truancy), substance abuse, pregnancy or fear of pregnancy, hypochondriasis, social isolation, and anxiety. Physicians should recognize that the most important underlying psychological factor in suicidal adolescents is depression, with feelings of hopelessness, low self-esteem, despair, and somatic complaints.
24. College students are considered to be at risk for AIDS because of which of the following?
A. Frequent sexual contact
B. A sense of vulnerability
C. Poor educational efforts regarding safe sex
D. A lack of knowledge about risks
The answer is: A

AIDS did not spread initially among college students, but they are now considered increasingly to be at risk. College students feel that the campus is a protected environment; however, they are at risk because of their frequent sexual contact. Also, they are less apt to practice safe sex because they still have a sense of invulnerability that was characteristic of their adolescence and because of their belief that their partners will let others know if they have AIDS. Some also believe that only homosexuals and drug users get AIDS. They need to know that AIDS cuts across all educational levels and that educated people do get AIDS. Some studies show that college students already have the knowledge about risks, but that their beliefs in the safety of the campus, in their student colleagues, and in their own invulnerability prevent them from practicing safe behavior.
25. Of the following positive effects that are the result of aerobic exercise, which is the most significant positive effect on health?
A. Reduction of obesity
B. Increased physical work capacity
C. Reduction of hypertension
D. Improved cardiovascular fitness
E. Improved cholesterol level
The answer is: D
Aerobic exercise consists of moderate- to high-intensity exercise done over a long enough period of time to require a reasonable amount of endurance. The exercise does not have need to be strenuous, but it does require that a certain level of effort be exerted. In general, when the level of respiration is deepened and the cardiac rate is increased, the exerciser is engaged in aerobic exercise. An aerobic level can be achieved by walking briskly, riding a bike, or swimming. Most recommendations are to exercise three to five times a week for 25 to 45 min. Exhaustion is not the goal of aerobic exercise. Short duration exercises such as weight lifting and sprinting have less effect on general fitness because they utilize short-term stores of glycogen, rather than the long-term energy conversion accomplished with aerobics. The most significant effect from aerobics is an increase in fitness of the cardiovascular system, establishing a significant reduction in coronary risk. Other documented effects include improvements in efficiency of the cardiorespiratory system, physical work capacity, control of hypertension, cholesterol levels, glucose tolerance, stress tolerance, health habits, mood, diet, optimization of body weight, maintenance of muscle tone and strength, less depression, reduction of cigarette smoking and alcohol consumption, and a general feeling of well-being.
26. In a study of over 15,000 obese women with coexisting health problems, any amount of intentional weight loss over a period of one year had the greatest reduction in the mortality rate for those women with which of the following health problems?
A. Pulmonary disease
B. Cardiovascular disease
C. Diabetes mellitus
D. Breast and colon cancer
E. Sleep apnea
The answer is: D
A study of over 15,000 obese women of the same age and each with a coexisting health problem found that any amount of intentional weight loss resulted in a 40 to 50% reduction in mortality rates for breast cancer and colon cancer. Intentional weight loss also produced a 10% decrease in cardiovascular disease, and a 20% decrease in the all-cause mortality rate, and a 30 to 40% decrease in diabetes mortality rate. Another study of 28,000 women age 40 to 64 found that intentional weight loss resulted in a 25% reduction in all causes of cardiovascular and cancer mortality rates. Research shows that thinner men and women live longer and that severe obesity is associated with increased illness and death.
The principles of behavior modification are the basis of many weight reduction programs. Operant conditioning and cognitive restructuring are effective for weight loss. The primary behavioral techniques employed include analyzing the antecedents of eating, the act of eating, the consequences of eating, and keeping a diet diary of food, timing, events, and feelings. Other than pills and surgery, which are very controversial and frequently dangerous, the three most effective treatments for obesity are all behavioral: behavior modification, diet, and exercise. The most effective technique for weight loss is a balance of all three treatments.
The revised third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) offer an improvement over earlier psychiatric classifications. Their major advantage is that they do which of the following?
A. Identify mental illness as a disease
B. Deal with predisposing factors
C. Confirm and support the nosologic system
D. Present an all-inclusive classification system
E. Present a multiaxial classification system
The answer is: E
The DSM presents the official classification schema of mental disorders. Serious problems of validity and reliability were associated with the first two editions of DSM. The major advantage that began with the revised third edition was that it allowed for a multiaxial classification. Earlier classifications were one-category systems, with the patient receiving only one diagnostic label or category. DSM-IV now provides the possibility that a patient with several disorders can be scored or classified with multiaxial diagnoses. The broad dimensions or axes are as follows: I. clinical psychiatric syndromes and other conditions; II. personality disorders (adults) and specific developmental disorders (children and adolescents); III. physical disorders; IV. severity of psychosocial stressors; and V. highest level of adaptive function during the past year.
The term learning disabilities most often refers to problems in learning which of the following?
A. To do arithmetic
B. To read
C. To write compositions
D. Eye-hand coordination
E. Achievement orientation
The answer is: B
Learning disability is the label given to children who show a discrepancy between their estimated academic potential and their actual level of academic performance. Failure to learn academically does not necessarily imply general impairment in intellectual capacity, but it can seriously affect broad adaptive functioning. Most persons with learning disabilities show a largely selective deficit, despite apparently normal schooling exposure, seemingly normative family settings, appropriate motivational predispositions, intact sense organs, adequate physical status, and normal intelligence; yet they fail to learn with normal proficiency. Research studies show that the criterion of failure to learn to read is the most frequent manifestation of a learning disability. This form of learning disability is generally known as dyslexia and is a problem of major proportions, especially during adolescence.
Persons of low socioeconomic status (SES) are more likely to display which of the following sick role behaviors or outcomes?
A. Less self-medication
B. More interest in medical care when ill
C. Shorter hospital stays
D. Greater responsiveness to future objectives than to crises
E. Increased mortality rates from cancer once it occurs
The answer is: E
Socioeconomic status is a powerful predictor of individual sick role behavior. Studies have documented that persons of low SES use more self-medication, stay in the hospital for a longer period of time, have a greater responsiveness to crises than to future objectives, planning, or chronic conditions, and are more apt to die from cancer once it occurs. They also have less interest in medical care when they are ill, are more apt to see nonmedical personnel for treatment, and demonstrate less adherence to schedules.
Which of the following chronic illnesses is the most common reason for lost work days in the United States?
A. Gastrointestinal upset from poor eating habits
B. Continuing episodes of premenstrual stress
C. Chronic pain in the absence of discernable physical causes
D. Frequent attacks of migraine and tension headaches
E. Accidents and injuries acquired on the job
The answer is: C
The most common reason for lost workdays in the United States is individual chronic pain in the absence of discernable physical causes. Chronic pain often leads to a variety of pain-related behaviors that can maintain the pain experience. When an individual experiences chronic pain, the person makes real changes in his environment (e.g., reducing physical activity, favoring certain movements, etc.) in an attempt to guard or prevent reoccurrences of the pain. These alterations in behavior and changes in lifestyle become an actual part of the pain problem, and in effect tend to reinforce the pain experience at the same time that the patient is trying to overcome it. Thus, the original problem can become very complex and attempts to behaviorally avoid the pain can interfere with attempts to treat or reduce the original pain or discover its physical source.
Which of the following social variables is most closely linked to infant mortality rates?
A. Poverty
B. Education of mother
C. Education of father
D. Occupation of father
E. Marital status of
The answer is: A
Poverty, the most important social variable in the infant mortality rate, is linked to an almost 50% greater risk of both neonatal and postnatal death. Other social variables—such as the educational level, occupation, or income of either the mother or father, or whether the parents are married—can influence the risk of infant death, but none is as powerful as poverty. Poverty is also a major contributor to adult morbidity and mortality rates.
Reducing alcohol use and abuse through primary prevention was most effectively accomplished by which of the following?
A. Strong driving under the influence (DUI) laws
B. Raising the minimum drinking age
C. Increasing the tax on all alcoholic beverages
D. Enforcing illegal alcohol sales and trafficking laws
E. Community and school education programs
The answer is: C
Primary prevention of alcohol abuse is more effective and less costly than secondary or tertiary prevention. A major tax increase on all alcoholic beverages has most often resulted in reduced consumption of alcohol. This tax increase also reduces many of the direct and indirect consequences of alcohol consumption, such as automobile accident injuries and deaths, violence, cirrhosis, cardiomyopathy, and depression. Increasing the minimum drinking age has been effective in reducing the traffic mortality rate for our youth, but has had no effect on drivers older than 21 years of age. Programs such as Mothers Against Drunk Drivers (MADD), revocation of licenses, enforced punishment for illegal alcohol sales, and educational programs have had some impact, but are inadequate alone. The complexity of the problem of alcohol abuse and the need to involve legal, medical, and educational dimensions has been illustrated.
At a church supper in Nova Scotia, the following meal was served: baked beans, ham, coleslaw, eclairs, and coffee. Of the 30 people who attended, 4 senior citizens became ill in 3 days; 1 eventually died. Two weeks after attending the church supper, a 19-year-old girl gave birth to a baby who rapidly became ill with meningitis and died in 5 days. Epidemiologic investigation revealed the following percentages of people who consumed the various food items: baked beans, 30%; ham, 80%; coleslaw, 60%; eclairs, 100%; and coffee, 90%. Microbiologic analysis revealed no growth in the baked beans, ham, or coffee; many Gram-positive beta-hemolytic, short, rod-shaped bacteria in the coleslaw; and rare Gram-positive cocci in the eclairs. Which of the following is the most likely cause of this outbreak?
A. Staphylococcus aureus
B. Listeria
C. Clostridium perfringens
D. Clostridium botulinum
E. Nonmicrobiologic
The answer is: E
There have been a number of outbreaks of food poisoning caused by Listeria monocytogenes. Listeria is a common inhabitant of farm animals and can be readily isolated from silage, hay, and barnyard soil. Humans at the extremes of age are most susceptible to Listeria infection but only recently has food been implicated as a vehicle. In the outbreak in Nova Scotia, it is likely that the cabbage used for the coleslaw was fertilized with animal droppings and not properly washed prior to consumption. Major Listeria outbreaks associated with cheese have been seen in the United States and most likely have originated from contaminated milk. Epidemiologic investigation often will provide data on attack rates in such outbreaks. The eventual solution of the problem always lies in a combination of epidemiologic, microbiologic, and clinical information. For example, in the Nova Scotia case, it should not be assumed that the eclairs were the culprit based on the fact that everyone ate them.
The risk for hypertension is greatest among which of the following?
A. Whites of lower socioeconomic status
B. Blacks of lower socioeconomic status
C. Whites of higher socioeconomic status
D. Blacks of higher socioeconomic status
E. Upwardly mobile middle-class whites
The answer is: B
Genetic factors alone cannot account for the high prevalence of hypertension among various racial, social, and cultural groups. Compared with that among whites, the prevalence of hypertension among blacks is significantly higher. Hypertension is more prevalent among poor American blacks, however, than among blacks of middle and upper classes.
Higher socioeconomic status (SES) is positively correlated with an increased incidence of which of the following?
A. Breast cancer
B. Coronary artery disease
C. Stroke
D. Lung cancer
E. Hypertension
The answer is: A
Socioeconomic status (SES) is a major factor influencing morbidity and mortality rates. While there have been marked improvements in life expectancy over the past 50 years, there is greater morbidity and mortality among individuals of lower SES than those of higher SES. While behavioral risk factors play a major role in disease etiology and subsequent morbidity and mortality, they do not entirely explain the differences in disease prevalence. Coronary artery disease, stroke, lung cancer, and hypertension are only a few of the diseases experienced more frequently in persons of lower SES. In addition to lower income, lack of education is also a prominent factor in increased morbidity and mortality. Physicians must understand that lower SES influences the etiology and prognosis of disease through greater environmental exposure to toxins, an increase in behavioral risk factors, less access to health care, and less compliance with recommended regimens, among other factors
Over the past decade, which one of the following had the greatest increase?
A. Pregnancy rate for teenagers
B. Poverty rate for children under age 18
C. Infants born weighing less than 2500 g
D. Mortality rates for chronic obstructive pulmonary disease
E. Mortality rates for lung cancer
The answer is: D
In the past decade, the mortality rate for chronic obstructive pulmonary diseases has increased 25% so that it now is the fourth leading cause of death in the United States. For women, the increase was more than 58%. The increase was relatively small for white males (5%). For black males and females under 55 years of age, the mortality rate was 2 times that for white males and females. Lung cancer mortality rates increased over 12%, but for women the increase was 40%. The percent of low weight births (less than 2500 g) increased slightly from 6.7 to 7.3% of all live-born infants. The percent of low weight births increased to 6% for infants of white mothers and to 13% for infants of black mothers. The poverty rate for children under age 18 declined to 20%, but considering that they make up less than 30% of the population, they constitute 40% of the poor; for black children it was 3 times that for white children and for Hispanic children it was 2.4 times that for white children. The pregnancy rates for teenagers declined for the fourth consecutive year to 56.8 births per 1000 teens between the ages of 15 and 19.
Gastric carcinoma is most common in which one of the listed geographic locations?
A. Canada
B. France
C. Japan
D. United Kingdom
E. United States

The answer is: C
There are marked differences in the incidence of various types of cancer in different parts of the world. The highest rates for gastric carcinoma are found in Japan, Chile, China, and Russia, while it is much less common in the United States, the United Kingdom, Canada, and France. The high rates for gastric cancer in Japan might be related to dietary factors, such as eating smoked and salted foods. Other examples of geographic variations in the incidence of neoplasms include nasopharyngeal carcinoma, liver cancer, and trophoblastic disease. Nasopharyngeal carcinoma, associated with the Epstein-Barr virus, is rare in most parts of the world, except for parts of the Far East, especially China. Liver cancer is associated with both hepatitis B infection and high levels of aflatoxin B1. It is endemic in large parts of Africa and Asia. Trophoblastic diseases, including choriocarcinoma, have high rates of occurrence in the Pacific rim areas of Asia. In contrast, Asian populations have a very low incidence of prostate cancer.
Which of the following health professions has the highest number of trained practitioners in the United States?
A. Registered nurses
B. Nurse practitioners
C. Physician assistants
D. Physicians
E. Pharmacists
The answer is: A
The number of registered nurses (RNs) has more than doubled over the past 30 years. In the last 15 years, the number of employed RNs increased from 1.4 million to over 2 million in 1992. Yet a shortage of RNs still remains with more personnel needed to operate new technology and care for sicker patients. Inferior wages and a lack of respect and authority may dissuade prospective nurses from obtaining licenses. The shortage of RNs could worsen with managed care corporations attempting to use more nurses as an economy/profit motive.
Nurse practitioners have continued to increase in numbers and to gain responsibility. Some are becoming even more specialized in the new role of nurse clinician. This role more fully uses the skills and capabilities of the well-trained nurse, similar to the duties of a physician assistant. Thus, the nurse practitioner appears to be moving in the direction of incorporating some of the physicians' tasks of patient care, especially primary care.
The physician assistant (PA) has evolved into a paramedical practitioner over the past 30 years, providing patient care under the supervision of a licensed physician. Today many PAs are working almost as colleagues of physicians, especially in direct primary care, health behavior, and prevention. There are now over 25,000 PAs in the United States, which is 100% more than 10 years ago. There are 50 accredited educational programs for PAs, some as difficult to gain admission to as medical schools. Corporate medicine is attracted to PAs as they seek to reduce costs in hospital and patient care.
Pharmacists are the third largest health profession group in the United States with over 150,000 members, ranking behind only nurses, with 2 million members, and physicians, with about 650,000 members in the United States and about 140,000 foreign medical graduates. The number of physicians remains relatively constant, but there is an increasing demand for pharmacists, especially in the hospital setting.
Which of the following is the most common cause of dementia in the United States?
A. Infectious (viral or bacterial) dementia
B. Multi-infarct dementia
C. Alzheimer's disease
D. Dementia with basal ganglia disease
E. Dementia with psychiatric disorders
The answer is: C
Dementia is a "falling away of the mind." The prevalence of severe dementia is 1.0 to 1.3%, and 15% of persons aged 65 years or older suffer from dementia. The most common cause of dementia is Alzheimer's disease, which constitutes 50 to 60% of all dementias. Onset is very slow, and prevalence increases with age (5% at age 65 to 20 to 50% at age 90). It is familial and progresses from stage 1, where speech and memory are affected and a depressive mood is common. In stage 2 there is progression of cognitive and memory deterioration and sensory aphasia; patients often lose their way, and constructional abilities and other praxic functions decline. In stage 3 sphincter control is lost, limbs become rigid and flexed, speech is lost or limited to verbigeration or echolalia, and death usually ensues from aspiration pneumonia or urinary tract infection. Multiple small cerebral infarctions are the second most common cause of dementia (10%) and are related to arteriosclerosis, hypertension, diabetes mellitus, and smoking. Multi-infarct dementia has a relatively sudden onset. The gradual degeneration from Pick's disease (cause unknown) accounts for 5% of the dementias. Next in frequency are dementias associated with disease of the basal ganglia (Huntington's, Parkinson's, and Wilson's), hydrocephalic dementias (with an excess of spinal fluid in the cranial cavity), and dementias associated with infections (e.g., viral dementias of AIDS and bacterial dementias like that of syphilis). Psychiatric dementias sometimes occur in elderly patients who have a major depression with melancholia and with psychomotor slowing and bowed posture, but these can be reversed by cyclic antidepressants or electroconvulsive therapy.
In research involving follow-up of patients in treatment, the greatest bias in the results is from which of the following?
A. Sampling error
B. Attrition
C. Incomplete questionnaire
D. Lack of internal validity responses
E. Lack of compliance
The answer is: B
The biggest single problem of follow-up design studies is loss through attrition, representing the loss of valuable data and information. Most studies try to prevent sampling bias at the beginning of the study, although it is a frequent bias in medical research, especially when psychosocial factors are ignored. There are many reasons for loss to follow-up (e.g., patients change addresses or fail to respond to questionnaires or phone calls), but it is such a significant source of bias (and disappointment) that follow-up methods should be developed as a part of the original design. Regretably, many AIDS studies suffer from such loss to follow-up bias. Incomplete questionnaires and lack of compliance result in bias, but they can be controlled by planning for adequate follow-up and supervision. Internal validity is confirmed early in a study design when it is determined that results appear to be accurate and the methods and analysis bear up under scrutiny.
You are involved with an obesity study of 40 highly motivated middle-aged women who are enrolled in a weight reduction program. The study requires that you attempt to secure the most reliable diet data on the type and quantity of food they have been eating during the week before their regular weekly visits. You enhance the accuracy of this dietary information with which of the following?
A. Open-ended questionnaire
B. Structured questionnaire
C. Detailed telephone interview
D. Daily diet diary
E. Personal phone call from you the day before the visits
The answer is: D
Questionnaires and interviews are the most frequently used methods of securing personal information and attitudes but the resulting data, recalled from autobiographical memory, have been found to be less reliable than self-recorded diary data. This is especially true when attempting to secure sensitive and personal information. Patients who wish to cooperate attempt to be as accurate and honest as they can be in their recall for questionnaires, but the passage of time and the intrusion of daily activities tends to dull and distort the reporting of specific information. The more sensitive the information, such as the consumption of restricted foods or alcoholic beverages, the more there is an inclination to "forget" or report less accurately. Observing and recording behavior in diaries for three- to four-day periods results in the highest validity. A seven-day span has been shown to be reasonably accurate for a well-motivated person.
During the first year after myocardial infarction, the majority of patients exhibit which of the following responses?
A. Extensive disturbances in objective state
B. Very little physical distress
C. Perception of selves as not disabled
D. Change of mood and depression
E. A second heart attack
The answer is: D
After myocardial infarction a patient experiences many psychosocial and physical responses, even a full year after the acute attack. The most frequent response is a change in mood, leading to depression and anxiety. Also, a majority report experiencing moderate physical distress, extensive disturbances in subjective states, contradictions between patients and their families in assessing the patient's level of activity, the perception of themselves as disabled, and personal lives that have not returned to normal. These factors must be recognized to achieve a successful rehabilitation.
Selecting a sample from a population of patients so that each person has an equal chance of being included in a study is accomplished through what type of sampling?
A. Convenience sampling
B. Systematic sampling
C. Random selection
D. Prevalence sampling
E. Stratified sampling
The answer is: C
The procedure of random selection, or random sampling, is the best known method of ensuring that each member of a total population has an equal chance of being selected for inclusion in a study. This method ensures a truly representative sample (cross-section) of the population and will avoid selection bias. It can be achieved by using a table of random numbers.
Convenience sampling is essentially gathering the sample from a readily available group, such as patients who attend a clinic or answer a bulletin board announcement. Very little generalization can be made from such a group, unless the study is focusing on a specific mechanism that does not vary much within a population.
Systematic sampling involves using a pattern to select a representative population, such as choosing every second or third patient.
Prevalence sampling is a general term. Prevalence refers to the frequency or prevalence of a condition or disease in the population being tested.
Stratified sampling involves selecting a sample from a population that has been stratified according to a certain characteristic, such as socioeconomic status, education, or occupation. This can be used when it is necessary to be certain that a particular group or characteristic is represented within the population being studied.
Several selection strategies can be combined, such as randomly drawing a group from each stratified sample to select a stratified random sample.
If current patterns of smoking persist, which of the following is the estimated number of U.S. persons age 1 to 17 in 1995 who will die prematurely from smoking-related diseases?

A. 1 million
B. 2 million
C. 3 million
D. 4 million
E. 5 million
The answer is: E
With the advent of vaccinations and antibiotics to treat and prevent infectious illnesses and with the changes in health care and health behavior practices, the life expectancy for both men and women has increased by 50% since 1900. The high incidence of death from diseases such as influenza, pneumonia, diphtheria, tuberculosis, and gastrointestinal infections has been reduced to less than 5% of 1900 levels. These infectious diseases have now been replaced by many other diseases caused by lifestyle and behavior. Increased numbers of deaths are now caused by or facilitated by preventable behavioral factors such as smoking, poor diet, substance abuse, lack of exercise, and stressful conditions. A reduction in heart disease has been made over the past few decades, but levels have not yet reached those of 1900. On the other hand, mortality rates from cancer have tripled since 1900. The number of AIDS cases has continued to increase over the past 15 years, with the greatest increases occurring in the heterosexual and adolescent populations.
The major causes of death, serious illness, and disability in the United States today are chronic disease and violence. Together they account for approximately 90% of all deaths. A measure of the relative impact of various diseases and lethal forces is the concept of potential years of life lost, which highlights the loss to society as a result of youthful or early death. The most recent life expectancy tables indicate that three categories—diseases of the circulatory system, cancer, and accidents and violence—account for about what percent of potential years of life lost in the United States?

A. 40%
B. 50%
C. 60%
D. 70%
E. 80%
The answer is: D
The major causes of death, serious illness, and disability in the United States today are chronic disease and violence. Chronic diseases account for 75 to 80% of all deaths. Accidents, suicide, and homicide account for another 10%. Another measure of the relative impact of various diseases and lethal forces is the concept of potential years of life lost, which highlights the loss to society as a result of youthful or early death. The most recent life expectancy tables indicate that three categories—diseases of the circulatory system, cancer, and accidents and violence—account for about 72% of the potential years of life lost in the United States. Two chronic disease categories—diseases of the circulatory and musculoskeletal system—account for 38% of conditions causing disability and limitations of major activity. Behind most chronic diseases, disabilities, and premature deaths are many environmental and behavioral factors that are potentially amenable to change or prevention. Although the etiology is usually multidimensional, it is now recognized that environmental threats and individual behavior play a major role. It is estimated that about 80% of all cancer among men and 75% among women is attributable to environmental or behavioral factors or a combination of both. This percentage represents a great potential for prevention. The individual and societal lifestyle patterns and behaviors that constitute the major behavioral risk factors involved in chronic disease and severe disability include cigarette smoking, alcohol and other drug abuse, poor nutrition, lack of adequate physical activity, irresponsible use of motor vehicles, irresponsible use of guns and other manifestations of violence, the apparent decline of family health and social supports, sexual promiscuity or carelessness about contraception, and excessive television viewing. Information alone is insufficient for change, so health education must be directed at devising the most effective strategies for changing and then maintaining the individual and group behavior that promotes health and prevents disease. In spite of the apparent simplicity with which behavior is sometimes regarded, it is nevertheless one of the most difficult attributes of human beings to change, and one of the most complex issues is attempting to understand the biopsychosocial components and mechanisms of behavior. Yet most behavior is learned, and if something can be learned, then it should be possible to unlearn it and substitute and practice a more health-promoting behavior. A component of behavioral change that is often ignored is the environmental context under which a specific behavior is learned, the environmental context that maintains the behavior, and the changes that must be made in the environmental context if the behavior is going to be changed. Behavioral and risk profiles are important, but so is the environmental context within which a person lives.
Which of the following is the leading cause of death in the elderly (age 65 and older)?
A. Cancer
B. Cerebrovascular disease (stroke)
C. Suicide
D. Heart disease
E. Chronic obstructive pulmonary disease
The answer is: D
Heart disease is the leading cause of death both in the general and the elderly population. Cancer ranks second and cerebrovascular disease ranks third among the elderly. The fourth leading cause of death for persons age 65 and over is chronic obstructive pulmonary disease, followed by pneumonia, diabetes, and accidents. Suicide is an important cause of death, especially among elderly depressed males, but it is not among the 10 leading causes for persons age 65 and over.
Over the past decade, which of the following diseases showed the greatest decrease in rate of mortality?
A. Diseases of the heart
B. Cerebrovascular diseases
C. Breast cancer
D. Unintentional injuries
E. Motor vehicle crashes
The answer is: B
The greatest decrease in mortality rates was for stroke. It is still the third leading cause of death, but it has declined 25% during the past 15 years. This continues the downward trend begun even more rapidly in the 1970s and 1980s. The rate for black persons over 45 years of age is still 3 times that for white persons. Heart disease, still the leading cause of death, declined 18% in the past 15 years, also continuing the downward trend of the 1970s. Asian persons have one-third the rate of mortality from heart disease than white persons, and black persons' mortality rate is 21% higher. The mortality rate for unintentional injuries declined during the early 1980s, but has increased over the past decade. The mortality rate for motor vehicle crashes declined 14%, but began to climb again during the last five years. For breast cancer, the mortality rate has decreased by 10% over the past 15 years for white women, but increased 16% for black women.
A 25-year-old mother, looking tired and harassed, brings her 5- and 7-year-old daughters to see you for rather severe colds and 100° F temperatures. She apologizes for not having brought them in for the past two years, but tells you that she just could not afford it. You notice that the daughters look pale, underweight, and somewhat undernourished. In talking with the mother, you learn that her husband abandoned her two years ago and her only means of support is a job as a clerk in a busy discount store. You wonder how many other families in your practice are in this difficult situation. Later that day, you call the headquarters of the American Academy of Family Physicians and learn that, in America, which of the following is the percentage of youngsters living with just one parent?
A. 5%
B. 10%
C. 15%
D. 20%
E. 25%
The answer is: E
Single parenthood has become a major health and social problem in America. One child in four (25%) in the United States lives with only one parent. Forty-seven percent of single mothers live below the poverty level, as compared with 8% of families headed by two parents. When mothers become single, their household income is precipitously reduced due to loss of the spouse's income and less training and lower pay for working women. Generally, the situation continues to decline, depending in part on the number of children in the family. The married poor family with children usually is able to work themselves out of poverty, while the poor single parent is not. The number of single parent men has increased from 10% to 15% in the last decade.
Of the leading causes of premature death of adults in the United States, which of the following could most effectively be reduced by using behavioral strategies and technologies?
A. Heart disease
B. Lung cancer
C. Unintentional injuries
D. Violence and homicide
E. Diabetes mellitus
The answer is: B
Up to one-half of the premature mortality rate has been attributed to lifestyle and behavior in both the United States and Canada. Lifestyle refers to single and collective aspects of long-term patterns of individual behavior that incl