Showing papers in "Health services reports in 1973"

Developing brushing performance in second graders through behavior modification.

Abstract: DENTAL HEALTH EDUCATION in school classrooms traditionally puts primary emphasis on knowledge gain, with little emphasis on the behavioral objective of improved dental health practices. This fact was pointed out clearly in the nationwide School Health Education Study (1). The study indicated that although children of all ages receive some form of dental health instruction in a majority of public schools in the United States, by the sixth grade students have extremely low scores in praetices related to dental health. Thus, as in other areas of health behavior, a real difference exists between dental health knowledge and dental health practices. The common didactic or demonstration approach to dental health education in school classrooms has consisted of a single session conducted by the teacher, a dentist, or both, or by a hygienist, most often during National Children's Dental Health Week. Podshadley and Shannon (2) recently documented that single-lecture demonstration sessions do not, however, result in a longlasting improvement in oral hygiene practices. While the conclusions in their investigation did not "rule out the possibili,ty of a cumulative improvement in oral hygiene practices" as a result of single annual dental health education programs, these authors recommended that a program with a "more comprehensive approach for teaching the importance of, and methods for, achieving good oral hygiene" be developed. They also recommended rigorous evaluation of the effectiveness of such programs. Dr. Martens is associate professor, Ms. Frazier is assistant professor, Mrs. Hirt is instructor, Dr. Meskin is professor, and Mr. Proshek is instructor in the Division of Health Ecology, School of Dentistry, University of Minnesota. This paper was presented at the 49th General Session of the International Association for Dental Research in Chicago, March 1971. Tearsheet requests to Leslie V. Martens, DDS, Division of Health Ecology, School of Dentistry, University of Minnesota, Minneapolis, Minn. 55455.

Recruiting physicians for rural practice

Abstract: A NUMBER of excellent studies have correlated the choice of a rural location for medical practice with certain characteristics of physicians (1-4). Researchers have shown that smalltown physicians are more likely to be the sons of farmers and to have grown up in a rural environment. But they are known also to be a group of older physicians, most of whom made their decision to locate some years ago. Therefore, the findings of Bible, Champion, Hassinger, and others on the reasons why physicians decide on a rural practice have to be considered as descriptions of the situation at a point in the recent past and not necessarily as the definitive answers to the question of what physicians might be looking for in a rural practice today. If ideas regarding recruitment of more physicians to rural areas are limited to what is suggested by the findings of this body of research, the prospects are anything but bright. For example, Parker and Tuxill in their study of metropolitan and smalltown physicians in an area of upstate New York found that the most important factors influencing those physicians who had gone into practice in a small community were the idea of living in a small community, the likelihood of developing a busy practice earlier, and their perception of the need of a small community for another physician (5). These researchers concluded that "the pool of new physicians then possibly interested in small-community practice seems largely restricted to physicians coming from small communities who like small-community living, feel the need for physicians in those communities, and wish to establish a busy practice early. With our present educational and population trends, this will be a small pool" 1(6). The question of what physicians may be looking for in a rural practice is interesting, but it is an important question only if the answers can be related in some way to an effective intervention strategy. If it were found that most health professionals (or their families) are looking for opera, professional football, or a local branch of Neiman Marcus, that would be interesting,(and discouraging for rural areas) but not terribly important. It is not possible to change the geography of the country, nor can we influence the marriages of physicians whose spouses may disagree with them over the importance of some of these factors. There are, however, some actions that may be taken in order to capitalize on the findings of research and maximize the pool of potential health professional recruits for rural areas. I shall Dr. Madison is associate professor of medical care organization, department of family medicine, School of Medicine; and director, rural services research unit, Health Services Research Center, University of North Carolina. The paper is based on his presentation to a symposium, "What Health Professionals Look For in a Rural Practice -A Researcher's Point of View," at the 26th National Conference on Rural Health of the American Medical Association, held in Dallas, Tex., March 29, 1973. Tearsheet requests to Donald L. Madison, MD, University of North Carolina School of Medicine, Chapel Hill, N.C. 27514.

Use of mental health services by poverty and nonpoverty members of a prepaid group practice plan.

Abstract: Dr. Weiss is associate professor of sociology and urban studies, Portland State University. Dr. Freeborn is associate director and Ms. Lamb is research assistant at the Health Services Research Center, Kaiser Foundation Hospitals, Portland. This research was supported in part by grants HS 0023 and CH 00235 from the Department of Health, Education, and Welfare and by the Kaiser Foundation Hospital's Community Services Program fund. Tearsheet requests to Sara Lamb, Kaiser Foundation Hospitals, Health Services Research Center, 4708 S.E. Hawthorne Blvd., Portland, Oreg. 97215.

Computer record linkage on a survey population.

Abstract: W ITH the preceding poetic words, Halbert L. Dunn began a discussion of the general subject of record linkage in a paper published in 1946 (1). Since that time the theory of record linkage has been well documented (2-11), but only a few reports (12-18) give the practical procedures and the results of an application of a computer record linkage operation. None of the authors cited attempted to measure the accuracy of the process on other than a sample basis. For long-term studies of important problems, public health workers have available a vast resource in the certificates of births, marriages, divorces, and deaths which are registered and filed routinely and which can be utilized by application of electronic computer techniques (19). Identified populations which have been studied for other purposes can become the basis for mortality studies through a search of death records, if this procedure can be carried out efficiently and inexpensively. An example of the way in which a population of 8,000 adults, surveyed in 1965, was followed by a search of the death records for the succeeding 5 1/2 years is described in this paper. A comparison of the results is made with the expected number of deaths calculated from agespecific death rates. In 1965 the Human Population Laboratory completed a survey of health and ways of living in Alameda County, Calif. (20). The survey population consisted of all adults (age 20 or over or under 20 if ever married) living in a probability sample area of 4,735 housing units in the county. Persons living in 97 percent of the households were enumerated, and 86 percent of those enumerated fflled out questionnaires (respondents). Mrs. Belloc is a research specialist in the Human Population Labor&tory and Mr. Arellano is a biostatistician with the California Tumor Registry, California State Department of Public Health, Berkeley. This study was supported by Public Health Service grant No. HS 00368, National Center for Health Services Research and Development, and contract No. NIH-69-5-Biometry Branch, Etiology, National Cancer Institute. Tearsheet requests to Nedra B. Belloc, Human Population Laboratory, 2151 Berkeley Way, Berkeley, Calif. 94704.

Is there a future for local health departments

Abstract: Dr. Hanlon is Assistant Surgeon General and Coordinator for Public Health Programs. The paper is based on speeches he gave at the annual meetings of the National Association of Counties in Dallas, Tex., on July 23, 1973, and the Texas Gulf Coast Public Health Association in Galveston on September 21, 1973. Tearsheet requests to John J. Hanlon, M.D., Room 18A-30, Parklawn Bldg., 5600 Fishers Lane, Rockville, Md. 20852.

The influence of the changes in maternal age, birth order, and color on the changing perinatal mortality, Baltimore, 1961-66.

Abstract: Studying the effects of a change in the distribution of birth during a period of declining fertility may help reveal the nature of the impact of possible future declines on the perinatal mortality rate. These data from Baltimore also can help clarify the impact of the changes in the changing color composition of urban populatons on the evolution of the perinatal mortality rate in large US cities. In many such cities Baltimore among them the population that is nonwhite has been increasing steadily and most likely will continue to do so and the perinatal mortality rate is considerably greater among nonwhite than white infants. In addition since nonwhite fertility is substantially higher implying a different distribution of births these data provide an opportunity to determine how much the color differential in birth distribution influences the color differential in perinatal mortality. Special tabulations of matched births (single and multiple) and deaths cross classified by color single year of mothers age and single birth order that occurred to residents of Baltimore City in the years 1960-62 and 1965-67 were obtained. Ages were grouped into 5 categories: under 20 20-24 25-49 30-34 and 35 and over. Parity was grouped only at the upper end combining 6th and higher order births. To reduce the influence of chance fluctuations and to increase the number of births and deaths among young multipara and old primipara in the study data 3-year averages (1960-62 and 1965-67) centering on 1961 and 1966 were calculated. From 1955-57 to 1960-62 the perinatal mortality rate in Baltimore increased by 2.9% for all births and by 1.5% for whites. The rate for nonwhites fell during this period by 2.1%. The trend during the subsequent 5 years was reversed for the white and the overall perinatal rates and continued for the nonwhite rate with the rate of change increasing considerably. With respect to the overall rate the percentage of all births that were nonwhite increased less rapidly from 1961-66 than during the preceding 5 years. These percentages were 41 in 19956 48 in 1961 and 52 in 1966. Thus the inflating effect on the perinatal rate of the increase in the relative number of higher risk nonwhite births was less pronounced during the early 60s than the 1950s contributing to the reversal in the trend of the perinatal rate for the whole city. By 1969 58% of all births were of nonwhite infants indicating a substantial acceleration in this trend after 1966 which would have tended to dampen any further drop in the citys perinatal rate. But the change in the distribution of births by race fails to help explain the reversal of the trend of the perinatal rate for whites between the late 1950s and the early 1960s nor can it be revelent to the acceleration of the fall in the rate for nonwhites. The accelerated fall in the birthrate for whites as well as the continued quick decline in the birthrate for nonwhites between 1966-69 suggest that change in the age-parity distribution probably continued to have substantial depressing effects on the perinatal mortality rates of both groups.

Health behavior and health needs of urban Indians in Minneapolis.

Abstract: . . . Indians living in urban areas have often lost out on the opportunity to participate in other programs designed for disadvantaged groups. . .. The biggest barrier faced by those Federal, State, and local programs which are trying to serve urban Indians is the difficulty of locating and identifying them. Lost in the anonymity of the city, often cut off from family and friends, many urban Indians are slow to establish new community ties. Many drift from neighborhood to neighborhood; many shuttle back and forth between reservations and urban areas. Language and cultural differences compound these problems.