1. Please read the following abstract by Hill et al 2022 and answer the following questions.

Hill J, Seguin R, Manda A, Chikasema M, Vaz O, Li Q, Yang H, Gopal S, Smith JS. Prevalence of traditional, complementary, and alternative medicine (TCAM) among adult cancer patients in Malawi. Cancer Causes Control. 2022 Aug;33(8):1047-1057

Purpose: The objective of this study is to document the prevalence of traditional, complementary, and alternative medicine (TCAM) use by adult cancer patients at a national teaching hospital in Malawi. We aim to document the products/therapies used, the reason for use, as well as patient-reported satisfaction with TCAM practitioners and modalities.

Methods: We conducted investigator-administered interviews with adult cancer patients presenting to the Kamuzu Central Hospital (KCH) Cancer Clinic in Lilongwe, Malawi between January and July 2018. The KCH is a national teaching hospital in the capital of Lilongwe, which serves patients with cancer from the northern half of Malawi. Descriptive statistics were used to describe TCAM use and logistic regression was applied to identify predictors of TCAM.

Results: A total of 263 participants completed the survey, of which 70% (n = 183) were female and average age was 45 (SD 14) years old. The prevalence of overall TCAM use was 84% (n = 222), and 60% (n = 157) of participants reported combining TCAM with conventional cancer treatment. The majority of patients used TCAM to directly treat their cancer versus for symptom management. Patients reported using faith-based healing (64%, n = 168), herbal medicine (56%, n = 148), diet change (46%, n = 120), and vitamins/minerals (23%, n = 61). Participants reported the highest satisfaction for physicians among practitioners and diet change for modalities. Female gender was found to be a predictor of TCAM with conventional treatment use, no other significant predictors were observed.

Conclusion: There is a high prevalence of TCAM use among an adult population with cancer in Malawi, and a wide variety in the TCAM modalities used among patients. Additional studies are needed to identify risks and benefits of TCAM use to assist with policy and public health, patient safety, and holistically address the global burden of cancer.

1. What is the smallest unit of observation in the Hill et al. 2022 publication? Please select one.
   1. Individual
   2. Group

1. When were the exposure and outcome measured in the Hill et al. 2022 publication? (from the investigator perspective)
   1. Exposure before outcome
   2. Outcome before exposure
   3. Exposure and outcome at same time

1. Based on study designs you've learned to date, which type of study design best describes the Hill et al. 2022 publication? Use the smallest unit of observation to guide your choice.
   1. Cohort
   2. Cross-sectional
   3. Repeated Cross-sectional
   4. Case Series
   5. Case Control
   6. Ecologic Cross-sectional
   7. Ecologic (Repeated)
   8. Randomized Control Trial
   9. Intervention, (not randomized)