Health, Medicine, and Social Epidemiology (9A) Practice Test

A county compared influenza vaccination rates among adults by immigration status (US-born vs foreign-born). Rates were 49% vs 37%, respectively. Foreign-born respondents reported concerns about eligibility, fear of documentation checks, and fewer regular sources of care. The county plans to offer vaccines at community sites with explicit no-ID requirements and partnerships with trusted local organizations. Based on social epidemiology emphasizing legal and institutional barriers as determinants of healthcare use, what outcome is most likely?

A city introduced a sugar-sweetened beverage (SSB) excise tax and evaluated changes in SSB purchases across neighborhoods, using policy spillover and substitution as the core concept. After 6 months, SSB purchases decreased by 18% in high-income neighborhoods and 7% in low-income neighborhoods. Surveys suggested that low-income residents more often purchased untaxed SSBs in adjacent jurisdictions and had fewer nearby stores offering low-cost unsweetened alternatives. Which outcome is most likely if the city pairs the tax with subsidies for unsweetened beverages in stores located in low-income neighborhoods?