CPH Exam Flashcards

Q: How many questions are on the CPH exam and how long do I have?

The CPH exam has 200 multiple-choice questions (175 scored and 25 unscored pretest items) in a single-best-answer format. Candidates have 4 hours to complete the exam. An on-screen calculator is provided; no personal calculators are allowed. The exam is offered year-round at computer-based testing centers or via live-online proctoring through Meazure Learning.

Q: What score do I need to pass the CPH exam?

The CPH uses a criterion-referenced scaled score. A scaled score of 500 is required to pass. Scoring is based on overall performance across all 10 domains, not on individual domain scores, so a strong area can offset a weaker one. There is no penalty for guessing, so candidates should answer every question. NBPHE does not publish an official pass rate.

Q: What happens if I fail the CPH exam?

Candidates who do not pass may reapply the day after their exam through the CertCentral portal. The retake fee is $150 per attempt, and a maximum of six attempts is allowed. There is no mandatory waiting period beyond next-day reapplication, and eligibility remains valid indefinitely once approved. 'Take Two' and other bundles include a free retake at initial registration.

Q: What topics does the CPH exam cover?

The CPH exam covers 10 domains (content outline updated August 1, 2024): Data, Analytics, and Informatics (12%); Communication (12%); Disease Prevention and Injury Reduction (11%); Program Planning and Evaluation (11%); Collaboration and Partnership (10%); Health Equity and Social Justice (10%); Leadership (9%); Program and Resource Management (9%); Law and Ethics (8%); and Policy in Public Health (8%).

Q: Who is eligible to take the CPH exam?

Eligibility pathways include: students of CEPH-accredited public health programs identified by their institution; alumni/graduates of CEPH-accredited programs; and standard eligibility (bachelor's degree plus 5 years of public health experience, or a graduate degree plus 3 years of experience). The standard exam fee is $385, with discounts through partner organizations. Recertification requires 30 credits every 2 years and a $95 fee.

Question 1

Mean vs Median vs Mode

Accepted Answer

Three measures of central tendency. Mean = arithmetic average (sensitive to outliers). Median = middle value when sorted (robust to skew). Mode = most frequent value. For skewed data, the median best represents the typical value.

Question 2

Standard Deviation vs Standard Error

Accepted Answer

SD measures how spread out individual data points are around the mean. SE measures how precise the sample mean is as an estimate of the population mean. Formula: SE = SD / sqrt(n). SE shrinks as sample size grows; SD does not depend on n.

Question 3

Empirical Rule (68-95-99.7) for a normal distribution

Accepted Answer

In a normal distribution: ~68% of values fall within 1 standard deviation of the mean, ~95% within 2 SD, and ~99.7% within 3 SD. Used to interpret z-scores and identify unusual values.

Question 4

Interpreting a 95% Confidence Interval

Accepted Answer

If sampling were repeated many times, 95% of the resulting intervals would contain the true population parameter. For a difference or ratio, a CI that excludes the null value (0 for mean difference, 1 for RR/OR) indicates statistical significance at alpha = 0.05.

Question 5

Type I Error (alpha)

Accepted Answer

Rejecting the null hypothesis when it is actually true — a false positive. Its probability equals the chosen significance level (commonly 0.05), meaning a 5% chance of finding an effect that does not exist.

Question 6

Type II Error (beta) and Statistical Power

Accepted Answer

Type II error = failing to reject a false null (false negative). Power = 1 - beta = probability of detecting a real effect. Power rises with larger sample size, larger effect size, and higher alpha.

Question 7

Null and Alternative Hypothesis

Accepted Answer

H0 (null) states no association or no difference exists. H1 (alternative) states an association or difference exists. Reject H0 when p-value < alpha; fail to reject H0 when p-value >= alpha. Failing to reject is not proof that H0 is true.

Question 8

Incidence vs Prevalence

Accepted Answer

Incidence = number of NEW cases in a time period divided by the population at risk. Prevalence = all EXISTING cases (new and old) at a point or period in time. Relationship: prevalence ≈ incidence x average disease duration.

Question 9

Attack Rate

Accepted Answer

The proportion of people exposed who become ill during an outbreak. Formula: (number of new cases among exposed) / (total exposed). Food-specific attack rates compare those who ate vs did not eat a food to identify the source.

Question 10

Case Fatality Rate vs Mortality Rate

Accepted Answer

Case fatality rate = deaths among diagnosed cases / total cases — measures disease severity. Mortality rate = deaths in a total population / population size — measures how common death from the disease is in the population.

Question 11

Relative Risk (RR)

Accepted Answer

Risk in the exposed divided by risk in the unexposed. Used in cohort studies. RR > 1 = increased risk; RR < 1 = decreased risk; RR = 1 = no association. A 95% CI excluding 1 indicates statistical significance.

Question 12

Odds Ratio (OR)

Accepted Answer

Odds of exposure among cases divided by odds of exposure among controls. Used in case-control studies. OR > 1 = exposure associated with disease. OR approximates RR when the disease is rare (rare disease assumption).

Question 13

Confounding

Accepted Answer

A third variable distorts the true exposure-outcome relationship, making it appear stronger, weaker, or reversed. Controlled through randomization, matching, stratification, restriction, or multivariable regression.

Question 14

Selection Bias vs Information Bias

Accepted Answer

Selection bias = systematic error in who enters or remains in the study (e.g., low response, referral patterns). Information bias = error in measuring exposure or outcome (e.g., recall error, misclassification of disease status).

Question 15

Strength of Study Designs

Accepted Answer

From strongest to weakest: randomized controlled trial (random assignment, best for causation) > cohort (prospective follow-up, measures RR) > case-control (retrospective, measures OR) > cross-sectional (snapshot, prevalence) > ecological (group-level, cannot infer individual risk).

Question 16

Types of Surveillance

Accepted Answer

Passive: providers report cases voluntarily (common, low cost). Active: health department actively seeks cases. Sentinel: selected sites monitor trends (e.g., flu sentinel providers). Syndromic: pre-diagnostic data (ED chief complaints, over-the-counter sales) for early detection.

Question 17

Sensitivity vs Specificity

Accepted Answer

Sensitivity = proportion of true positives correctly identified (true positive rate); high sensitivity is best for screening to rule OUT disease. Specificity = proportion of true negatives correctly identified (true negative rate); high specificity rules IN disease. They trade off against each other.

Question 18

Positive Predictive Value (PPV)

Accepted Answer

Probability that a positive test result is a true case. Formula: true positives / (true positives + false positives). PPV rises with higher disease prevalence and higher specificity; it is not a fixed property of the test.

Question 19

Routes of Exposure and Dose-Response

Accepted Answer

Major routes: inhalation, ingestion, and dermal absorption. A dose-response curve describes how the magnitude of a health response changes with exposure level. Threshold effects show a no-observed-effect level; non-threshold effects (e.g., carcinogens) assume risk exists at any dose above zero.

Question 20

Endemic vs Epidemic vs Pandemic

Accepted Answer

Endemic = baseline, expected level of disease constantly present in a population. Epidemic = cases exceeding the expected baseline in a population over a time period. Pandemic = an epidemic that spreads across multiple countries or continents.

Question 21

Outbreak Investigation Steps

Accepted Answer

Verify the outbreak and diagnosis, establish a case definition, find and count cases, describe by time/place/person, generate hypotheses, test hypotheses with an analytic study, implement control measures, and communicate findings. Done in roughly this order but steps overlap.

Question 22

Screening vs Diagnostic Testing

Accepted Answer

Screening is applied to asymptomatic people to identify those likely to have a condition (high sensitivity prioritized). Diagnostic testing confirms disease in symptomatic or screen-positive individuals (high specificity prioritized). Screening is not a substitute for diagnosis.

Question 23

Medicare vs Medicaid

Accepted Answer

Medicare is a federal program primarily for people 65+ and certain younger people with disabilities or end-stage renal disease. Medicaid is a joint federal-state program for people with low income and limited resources. Both are administered under CMS.

Question 24

Affordable Care Act Key Provisions

Accepted Answer

Insurance exchanges/marketplaces, Medicaid expansion, essential health benefits, prohibition on denying coverage for pre-existing conditions, and dependent coverage to age 26. The federal individual mandate penalty was zeroed out starting in 2019, though some states maintain their own mandates.

Question 25

Cost-Benefit vs Cost-Effectiveness Analysis

Accepted Answer

Cost-benefit analysis monetizes all costs and benefits and compares them in dollars (net benefit). Cost-effectiveness analysis compares cost per health outcome, such as cost per life-year or per QALY gained. CEA is more common in public health because placing dollar values on health outcomes is difficult.

Question 26

Line-Item vs Program Budgeting

Accepted Answer

Line-item budgeting organizes spending by expenditure category (salaries, supplies, travel). Program budgeting organizes spending by program or activity so costs align with objectives and outcomes. Program budgeting supports evaluation of cost-effectiveness.

Question 27

Grant Management Essentials

Accepted Answer

Track only allowable costs per the grant agreement, maintain documentation for audit, meet reporting deadlines, allocate shared costs properly, and avoid supplanting (using grant funds to replace existing budget). Noncompliance can trigger repayment or loss of future funding.

Question 28

Stakeholder Analysis

Accepted Answer

Identify all stakeholders, assess each by interest and influence, and map to a strategy: high influence/high interest = manage closely; high influence/low interest = keep satisfied; low influence/high interest = keep informed; low influence/low interest = monitor. Ensures the right parties are engaged.

Question 29

Health Belief Model

Accepted Answer

Predicts health behavior from perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. People act when they believe a threat is real, the action helps, and the barriers are surmountable.

Question 30

Social Ecological Model

Accepted Answer

Health is shaped across multiple levels: individual, interpersonal, organizational, community, and public policy. Interventions targeting more than one level are more effective than those targeting a single level, because behaviors are influenced by many contexts.

Question 31

Transtheoretical Model (Stages of Change)

Accepted Answer

Stages: precontemplation, contemplation, preparation, action, maintenance, (termination). Interventions are most effective when matched to a person's stage (e.g., raise awareness in precontemplation, support skills in action).

Question 32

Social Determinants of Health

Accepted Answer

Conditions in which people are born, grow, live, work, and age — including income, education, housing, and environment. These structural factors are major drivers of health disparities and often matter more than clinical care for population health outcomes.

Question 33

Health Equity vs Health Equality

Accepted Answer

Equality gives everyone the same resources regardless of need. Equity gives people what they need to reach their full health potential, removing unfair and avoidable differences. Equity targets root causes of disparities rather than uniform distribution.

Question 34

Cultural Competence

Accepted Answer

The ability to work effectively with people of diverse backgrounds. Includes awareness of one's own bias, knowledge of other cultures, and skills to adapt communication and practice. Improves trust, reduces disparities, and supports equitable service delivery.

Question 35

Four Ethical Principles (Beauchamp & Childress)

Accepted Answer

Autonomy: respect a person's self-determination. Beneficence: act for the benefit of others. Non-maleficence: do no harm. Justice: fair and equitable distribution of benefits and burdens. These guide public health and clinical decision-making.

Question 36

Elements of Informed Consent

Accepted Answer

Disclosure of risks, benefits, and alternatives; capacity to understand and decide; voluntariness (free of coercion); and comprehension. Required for research enrollment and many clinical procedures. Documented consent is the record, not the process itself.

Question 37

Role of the IRB

Accepted Answer

An Institutional Review Board reviews research involving human subjects to protect their rights and welfare. It approves studies before enrollment, requires informed consent, minimizes risks, and monitors ongoing research. IRB approval is required regardless of funding source.

Question 38

HIPAA Privacy Rule

Accepted Answer

Protects the use and disclosure of protected health information (PHI) by covered entities (health plans, providers, clearinghouses). Applies the minimum necessary standard for non-routine disclosures and requires patient authorization for many secondary uses. Public health reporting is an permitted exception.

Question 39

Public Health Authority and Quarantine

Accepted Answer

State police power allows government to restrict individual liberty to protect population health — isolation of infected people and quarantine of exposed contacts. Requires due process, the least restrictive means, and clear evidence of necessity.

Question 40

Needs Assessment

Accepted Answer

A systematic process to identify gaps between current and desired conditions and prioritize where to act. Uses existing data, key informant interviews, surveys, and focus groups. Drives program planning by defining the target population and its priorities.

Question 41

Logic Model Components

Accepted Answer

Inputs (resources), activities (what is done), outputs (products and services delivered), and outcomes (short, intermediate, and long-term changes). A logic model links program activities to intended results and identifies evaluation indicators.

Question 42

Process vs Outcome Evaluation

Accepted Answer

Process evaluation assesses whether a program was implemented as planned — reach, dose delivered, fidelity, and participant satisfaction. Outcome evaluation assesses whether the program achieved its intended effects — short-term knowledge change and long-term health impact.

Question 43

Formative vs Summative Evaluation

Accepted Answer

Formative evaluation occurs during program development to improve design and delivery. Summative evaluation occurs after completion to judge overall effectiveness and inform decisions about continuation, expansion, or scale-up.

Question 44

SMART Objectives

Accepted Answer

Objectives should be Specific, Measurable, Achievable, Relevant, and Time-bound. SMART objectives make evaluation possible by defining exactly what success looks like and when it should be achieved.

Question 45

Evidence-Based Public Health

Accepted Answer

Using the best available research evidence, combined with community input and contextual data, to develop and implement programs. Moves decisions beyond anecdote and habit toward interventions with demonstrated effectiveness in similar settings.

Question 46

Risk Communication Principles

Accepted Answer

Be first and fast, acknowledge uncertainty, be transparent, provide actionable guidance, and tailor messages to the audience. Trust is built before a crisis, not during one. Listening and two-way dialogue matter as much as messaging.

Question 47

Health Literacy

Accepted Answer

The degree to which people can obtain, process, and understand health information needed to make decisions. Plain language (around a 6th grade reading level) improves comprehension. Limited health literacy is linked to poorer health outcomes and higher costs.

Question 48

Communication Channels

Accepted Answer

Mass media (broad reach, low control), interpersonal (two-way, supports behavior change), social media (rapid, interactive), and community channels (trusted local voices). Match the channel to the audience, objective, and message complexity.

Question 49

Systems Thinking

Accepted Answer

Treating a problem as part of an interconnected whole rather than isolated parts. Emphasizes feedback loops, unintended consequences, and leverage points. Well suited to complex public health problems where interventions in one area affect others.

Question 50

Coalition Building

Accepted Answer

Diverse stakeholders united around a shared goal. Strengths: pooled resources, broader reach, shared ownership, and greater legitimacy. Requires clear governance, defined roles, mutual benefit, and sustained communication to survive member turnover and competing priorities.

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