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## Essentials of Biostatistics for Public Health, 2nd Edition

Lisa M. Sullivan, PhD
Chapter 5 Solutions to Problems

1.

A recent study reported that the prevalence of hyperlipidemia (defined as total cholesterol
over 200) is 30% in children 2-6 years of age. If 12 children are analyzed,
a. What is the probability that at least 3 are hyperlipidemic?
P(X > 3) = 1 P(X < 3) = 1 {P(X=0) + P(X=1) + P(X=2)}
12!
0.30 (1 0.3)120
P(X = 0) = 0!(12 0)!
0.0138
12!
0.31 (1 0.3)121
P(X = 1) = 1!(12 1)!
0.0712
12!
0.3 2 (1 0.3)122
2
!
(
12

2
)!
P(X = 2) =
0.1678
= 1- {0.0138 + 0.0712 + 0.1678) =1- 0.2528 = 0.7472.
b. What is the probability that 3 are hyperlipidemic?
12!
0.33 (1 0.3)123
P(X=3) = 3!(12 3)!
0.2397.
c. How many would be expected to meet the criteria for hyperlipidemia?
=np=12(0.3) = 3.6

2.

## Hyperlipidemia in children has been hypothesized to be related to high cholesterol in their

parents. The following data were collected on parents and children.
CHILD
Not Hyperlipidemic
Hyperlipidemic

Both Parents
Hyperlipidemic
13
45

One Parent
Hyperlipidemic
34
42

Neither Parent
Hyperlipidemic
83
6

## a. What is the probability that one or both parents are hyperlipidemic?

P(one or both parents are hyperlipidemic) = (58+76)/223 = 134/223 = 0.600.

## 2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
b. What is the probability that the child and both parents are hyperlipidemic?
P(child and both parents are hyperlipidemic) = 45/223 = 0.202.
c. What is the probability that a child is hyperlipidemic IF neither of his/her parents are
hyperlipidemic?
P(child is hyperlipidemic | neither parent is hyperlipidemic) = 6/89 = 0.067.
d. What is the probability that a child is hyperlipidemic IF both of his/her parents are
hyperlipidemic?
P(child is hyperlipidemic | both parents are hyperlipidemic) = 45/58 = 0.776.
3.

Total cholesterol in children aged 10-15 is assumed to follow a normal distribution with a
mean of 191 and a standard deviation of 22.4.
a. What proportion of children 10-15 years of age have total cholesterol between 180 and
190?
180 191
190 191
P(180 < X < 190) = P( 22.4 < Z < 22.4 ) = P(-0.49 < Z < -0.04)
= 0.4840 0.3121 = 0.1719.

## b. What proportion of children 10-15 years of age would be classified as hyperlipidemic

(Assume that hyperlipidemia is defined as a total cholesterol level over 200)?
200 191
P(X > 200) = P(Z > 22.4 ) = P(Z > 0.40) = 1-0.6554 = 0.3446.

c. If a sample of 20 children are selected, what is the probability that the mean cholesterol
level in the sample will exceed 200?
200 191
P( X > 200) = P(Z > 22.4 / 20 ) = P(Z > 1.80) = 1-0.9641 = 0.0359.
4.

## A national survey of graduate students is conducted to assess their consumption of coffee.

The following table summarizes the data.
Male
Female

145
80

94
121

## Drink Caffeinated Coffee

365
430
2

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
a. What proportion of students drink decaffeinated coffee only?
P(decaffeinated coffee only) = 215/1235 = 0.174.
b. What proportion of coffee drinkers (caffeinated and decaffeinated) are female?
P(female | caffeinated or decaffeinated coffee) = (121+430)/(215 + 795) = 551/1010 =
0.546.
c. What proportion of the females do not drink coffee?
P (do not drink coffee | female) = 80/631 = 0.127.
5.

Among coffee drinkers, men drink a mean of 3.2 cups per day with a standard deviation of
0.8 cups. Assume the number of drinking per day follows a normal distribution.
a. What proportion drink 2 cups per day or more?
2 3.2
P(X > 2) = P(Z > 0.8 ) = P(Z > -1.5) = 1-0.0668 = 0.9332.

## b. What proportion drink no more than 4 cups per day?

4 3.2
P(X < 4) = P(Z < 0.8 ) = P(Z < 1) = 0.8413.

c. If the top 5% of coffee drinkers are considered heavy coffee drinkers, what is the
minimum number of cups consumed by a heavy coffee drinker?
X = + Z = 3.2 + 1.645(0.8) = 4.5 drinks.
d. If a sample of 20 men is selected, what is the probability that the mean number of cups
per day is greater than 3?
3 3.2
P( X > 3) = P(Z > 0.8 / 20 ) = P(Z > -1.12) = 1-0.1314 = 0.8686.
6.

## A study is conducted to assess the impact of caffeine consumption, smoking, alcohol

consumption and physical activity on cardiovascular disease. Suppose that 40% of participants
consume caffeine and smoke. If 8 participants are evaluated, what is the probability that:
2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
a. Exactly half of them consume caffeine and smokes?
8!
0.4 4 (1 0.4) 84
4
!
(
8

4
)!
P(X = 4) =
0.2322.
b. More than 6 consume caffeine and smoke?
P(X > 6) = P(X=7) + P(X=8)
8!
0.4 7 (1 0.4) 87
7
!
(
8

7
)!
P(X=7) =
0.0079
8!
0.4 8 (1 0.4) 88
8
!
(
8

8
)!
P(X=8) =
0.0007
P(X > 6) = P(X=7) + P(X=8) = 0.0079 + 0.0007 = 0.0086.
c. Exactly 4 do NOT consume caffeine or smoke?
8!
0.6 4 (1 0.6) 84
P(X = 4) = 4!(8 4)!
0.2322.
7.

As part of the study described in Problem 6, investigators wanted to assess the accuracy of
self-reported smoking status. Participants are asked whether they currently smoke or not. In
addition, laboratory tests are performed on hair samples to determine presence or absence of
nicotine. The laboratory assessment is considered the gold standard, or truth about nicotine. The
data are as follows:
Self-Reported Non-Smoker
Self-Reported Smoker

Nicotine Absent
82
12

Nicotine Present
14
52

## a. What is the sensitivity of self-reported smoking status?

Sensitivity = P(Smoker | Nicotine Present) = 52/66 = 0.7878.
b. What is the specificity of self-reported smoking status?
Specificity = P(Non Smoker | Nicotine Absent) = 82/94 = 0.8723.

## 2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
8.

A recent study of cardiovascular risk factors reported that 30% of adults meet criteria for
hypertension. If 15 adults are assessed, what is the probability that
a. Exactly 5 meet the criteria for hypertension?
15!
0.35 (1 0.3)155
P(X = 5) = 5!(15 5)!
0.2061.
b. None meet the criteria for hypertension
15!
0.3 0 (1 0.3)150
P(X = 0) = 0!(15 0)!
0.0047.
c. How many would you expect to meet the criteria for hypertension?
=np=15(0.3) = 4.5.

9.

Male
Femal
e
Total

Optimal
22
43

Normal
73
132

Hypertension
55
65

Total
150
240

65

205

120

390

## a. What proportion of the participants have optimal blood pressure?

P(Optimal) = 65/390 = 0.1667.
b. What proportion of men have optimal blood pressure?
P(Optimal | Male) = 22/150 = 0.1467.
c. What proportion of participants with hypertension are male?
P(Male | Hypertension) = 55/120 = 0.458.
d. Are hypertensive status and male gender independent?
Check P(Male | Hypertension) ?=? P(Male)
P(Male | Hypertension) = 0.458 and P(Male) = 150/390 = 0.385
0.458 0.385, not independent.
2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD

10.

Diastolic blood pressures are assumed to follow a normal distribution with a mean of 85 and
a standard deviation of 12.
a. What proportion of people have diastolic blood pressure less than 90?
90 85
P(X < 90) = P(Z < 12 ) = P(Z < 0.42) = 0.6628.

## b. What proportion have diastolic blood pressures between 80 and 90?

80 85
90 85
P(80 < X < 90) = P( 12 < Z < 12 ) = P(-0.42 < Z < 0.42)
= 0.6628 0.3372 = 0.3256.

c. If someone has a diastolic blood pressure of 100, what percentile is he/she in?
100 85
12 ) = P(Z < 1.25) = 0.8944, 89.44th percentile.
P(X < 100) = P(Z <

11.

Consider the data described in Problem 10. If a sample of 15 participants are sampled, what
is the probability that their mean diastolic blood pressure exceeds 90?
90 85
P( X > 90) = P(Z > 12 / 15 ) = P(Z > 1.61) = 1-0.9463 = 0.0537.

12.

Data from a large national study reports that 10% of pregnant women deliver prematurely. A
local obstetrician is seeing 16 pregnant women in his next clinic session.
a. What is the probability that none will deliver prematurely?
16!
0.10 (1 0.1)160
P(X = 0) = 0!(16 0)!
0.1853.
b. What is the probability that fewer than 3 will deliver prematurely?
P(X < 3) = P(X=0) + P(X=1) + P(X=2)

## 2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
16!
0.10 (1 0.1)160
0
!
(
16

0
)!
P(X = 0) =
0.1853
16!
0.11 (1 0.1)161
1
!
(
16

1
)!
P(X = 1) =
0.3294
16!
0.12 (1 0.1)162
2
!
(
16

2
)!
P(X = 2) =
0.2745
P(X < 3) = P(X=0) + P(X=1) + P(X=2) = 0.1853 + 0.3294 + 0.2745 = 0.7892.
c. What is the probability that none will deliver prematurely if in fact the true percentage
who deliver prematurely is 5.5%?
16!
0.055 0 (1 0.055)160
P(X = 0) = 0!(16 0)!
0.4045.
d. If the true percentage is 10% and this obstetrician has 146 pregnant women under his
care, how many would be expected to deliver prematurely?
=np=146(0.1) = 14.6
13.

The following table cross classifies women in the study by their body mass index (BMI) at
16 weeks gestation and whether they had preterm delivery.
Preterm
Full Term

BMI < 30
320
4700

BMI 30-34.9
80
480

BMI 35+
120
300

## a. What is the probability that a woman delivers preterm?

P(preterm) = 520/6000 = 0.0867.
b. What is the probability a women has BMI <30 and delivers preterm?
P(BMI < 30 and preterm) = 320/6000 = 0.0533.
c. What proportion of women with BMI 35+ deliver preterm?
P(preterm | BMI > 35) = 120/420 = 0.2857.
d. Are BMI and preterm delivery independent? Justify.
Check P(preterm | BMI > 35) ?=? P(preterm)
2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
P(preterm | BMI > 35) = 0.2857 and P(preterm) = 0.0867
0.2857 0.0867, not independent.
14.

In the study described in Problem 13, suppose BMI at 16 weeks gestation has a mean 28.5
with a standard deviation of 3.6 and BMI is assumed to follow a normal distribution. Find the
following:
a.

## The proportion of women with BMI> 30.

30 28.5
3.6 ) = P(Z > 0.42) = 1-0.6628 = 0.3372.
P(X > 30) = P(Z >

b.

## The proportion of women with BMI>40.

40 28.5
3.6
P(X > 40) = P(Z >
) = P(Z > 3.19) = 0.

c.

The BMI that separates the top 10% from the rest.
X = + Z = 28.5 + 1.282(3.6) = 33.11.

15.

Suppose we want to estimate the mean BMI for women in pregnancy at 20 weeks gestation.
If we have a sample of 100 women and measure their BMI at 20 weeks gestation, what is the
probability that the sample mean is within 1 unit of the true BMI if the standard deviation in BMI
is taken to be 3.6?
( 1)
P (-1 < X < +1) = P( 3.6/ 100

( 1)
3.6/ 100 )

## = P(-2.78 < Z < 2.78) = 0.9973 0.0027 = 0.9946.

16. Diastolic blood pressures are approximately normally distributed with a mean of 75 and a
standard deviation of 10.
a. What is the 90th percentile of diastolic blood pressure?
X = + Z = 75 + 1.282(10) = 87.82.

## 2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
b. If we consider samples of 20 patients, what is the 90th percentile of the mean diastolic
blood pressure?
X = X + Z X = 75 + 1.282(10/20) = 77.87.

## 2012 Jones & Bartlett Learning, LLC

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD

17. The following table displays the number of children in a local town classified as normal
weight, overweight and obese by year in school.
Elementary
Middle
Junior High
High School
Total

Normal Weight
50
30
50
30
160

Overweight
120
45
50
85
300

Obese
80
45
40
85
250

Total
250
120
140
200
710

## a. What proportion of the children are obese?

P(Obese) = 250/710 = 0.352.
b. What proportion of the elementary school children are overweight or obese?
P(Overweight or Obese| Elementary) = (120+80)/250 = 0.80.
c. What proportion of the normal weight children are in high school?
P(High School| Normal Weight) = 30/160 = 0.188.
18. In a primary care clinic, 25% of all patients who have appointments fail to show up. Each
clinic session has 10 scheduled appointments.
a. What is the probability that half of the patients fail to show up?
10!
0.25 5 (1 0.25)105
P(X = 5) = 5!(10 5)!
252(0.00098)(0.2373) = 0.0589.
b. What is the probability that all patients show up?
10!
0.25 0 (1 0.25)100
P(X = 0) = 0!(10 0)!
1(1)(0.0563) = 0.0563.
c. In a week, there are 10 clinic sessions how many patients would you expect to fail to
show up?
10 (0.25) = 2.5

## 2012 Jones & Bartlett Learning, LLC

10

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
19. High density lipoprotein (HDL) in healthy males follows a normal distribution with a mean
of 50 and a standard deviation of 8.
a.

## What proportion of healthy males have HDL exceeding 60?

60 50
8 ) = P(Z > 1.25) = 1-0.8944 = 0.1056.
P(X > 60) = P(Z >

b.

## What proportion of healthy males have HDL lower than 40?

40 50
8
P(X < 40) = P(Z <
) = P(Z < -1.25) = 0.1056.

c.

## What is the 90th percentile of HDL in healthy males?

X = + Z = 50 + 1.282(8) = 60.3.

20. The following table summarizes data collected in a study to evaluate a new screening test for
ovarian cancer. A total of 200 women were involved in the study 50 had ovarian cancer
and 150 did not. The results are tabulated below.
Screening Test

a.

Positive
Negative

Ovarian Cancer
28
22
50

23
127
150

## Find the sensitivity of the screening test.

Sensitivity = P(Test Positive | Ovarian Cancer) = 28/50 = 0.56.

b.

## Find the false positive fraction of the screening test.

False Positive = P(Test Positive | Free of Ovarian Cancer) = 23/150 = 0.15.

c.

What proportion of women who screen positive actually have ovarian cancer?
P(Ovarian Cancer | Test Positive) = 28/51 = 0.55.

21. An experimental drug has been shown to be 75% effective in eliminating symptoms of
allergies in animal studies. A small human study involving 6 participants is conducted. What
is the probability that the drug is effective on more than half of the participants?

## 2012 Jones & Bartlett Learning, LLC

11

Essentials of Biostatistics for Public Health, 2nd Edition
Lisa M. Sullivan, PhD
P(X > 3) = P(4) + P(5) + P(6) = 0.2966 + 0.3560 + 0.1780 = 0.8306.
6!
0.75 4 (1 0.75) 64
P(X = 4) = 4!(6 4)!
(15)(0.3164)(0.0625) = 0.2966.
6!
0.75 5 (1 0.75) 65
5
!
(
6

5
)!
P(X = 5) =
(6)(0.2373)(0.25) = 0.3560.
6!
0.75 6 (1 0.75) 66
6
!
(
6

6
)!
P(X = 6) =
(1)(0.1780)(1) = 0.1780.

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