Evaluating Mediation in Longitudinal Multivariate Data: Mediation Effects for the Aban Aya Youth Project Drug Prevention Program

This study illustrates a method to evaluate mediational mechanisms in a longitudinal prevention trial, the Aban Aya Youth Project (AAYP). In previous studies, interventions of AAYP were found to be effective in reducing the growth of violence, substance use and unsafe sex among African American adolescents. In this article, we hypothesized that the effects of the interventions in reducing the growth of substance use behavior were achieved through their effects in changing intermediate processes such as behavioral intentions, attitudes toward the behavior, estimates of peers’ behaviors, best friends’ behaviors, and peer group pressure. In evaluating these mediational mechanisms, difficulties arise because the growth trajectories of the substance use outcome variable and some of the mediating variables were curvilinear. In addition, all of the multivariate mediational measures had planned missing data so that a score from the multiple items for a mediator could not be formed easily. In this article, we introduce a latent growth modeling (LGM) approach; namely, a two-domain LGM mediation model, in which the growth curves of the outcome and the mediator are simultaneously modeled and the mediation effects are evaluated. Results showed that the AAYP intervention effects on adolescent drug use were mediated by normative beliefs of prevalence estimates, friends’ drug use behavior, perceived friends’ encouragement to use, and attitudes toward the behavior. Aban Aya investigators include: Shaffdeen A. Amuwo, Ph.D., Clinical Associate Professor, Associate Dean for community, Government and Alumni Affairs, University of Illinois at Chicago; Carl C. Bell, M.D., Professor, Psychiatry & Public Health; and CEO, Community Mental Health Council; Michael L. Berbaum, Ph.D., Director, Methodology Research Core, Institute for Health Research and Policy, University of Illinois at Chicago; Richard T. Campbell, Ph.D., Professor, Biostatistics; and Methodology Research Core, Institute for Health Research and Policy, University of Illinois at Chicago; Julia Cowell, R.N., Ph.D., Professor, Nursing (now at Rush University); Judith Cooksey, M.D., Assistant Professor, Public Health (now at University of Maryland); Barbara L. Dancy, Ph.D., Associate Professor, Nursing, University of Illinois at Chicago; Sally Graumlich, Ed.D., Senior Research Associate, Institute for Health Research and Policy, University of Illinois at Chicago; Donald Hedeker, Ph.D., Professor, Biostatistics, Public Health; and Methodology Research Core, Institute for Health Research and Policy, University of Illinois at Chicago; Robert J. Jagers, Ph.D., Associate Professor, African American Studies and Psychology (now at University of Michigan); Susan R. Levy, Ph.D., Professor, Public Health, University of Illinois at Chicago; Roberta L. Paikoff, Ph.D., Associate Professor, Psychiatry, University of Illinois at Chicago; Indru Punwani, D.D.S., Professor, Pediatric Dentistry, University of Illinois at Chicago; Eisuke Segawa, Research Specialist, Institute for Health Research and Policy, University of Illinois at Chicago; Roger P. Weissberg, Ph.D., Professor, Psychology, University of Illinois at Chicago.     

Physician assistant graduates: Factors related to rural-urban practice location

The purpose of this study is to examine the influence of selected individual and background characteristics and values of physican assistant (PA) graduates on practice location. Information was gathered through a survey of graduates practicing as physician assistants from the first four classes of the University of Kentucky's Clinical Associate Program. No significant differences were found in rural-urban practice location by examining sociodemographic characteristics of graduates or residential background of graduates and their spouses. The only exception was that female graduates tended to practice in urban locations more than did male graduates. However, differences were found between rural- and urban-based graduates in the importance they placed on selected characteristics of communities.Dr. Gairola is Assistant Professor, Clinical Associate Program, Medical Center Annex II, Room 110, University of Kentucky, Lexington, KY 40536.This research was supported by grant number 5021PE14174-03 from the Bureau of Health Professions, Division of Medicine, Health Resources Administration.     

Correlates of a measure of coping in older veterans: A preliminary report

Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N=240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.Rodney M. Coe, Ph.D., is Professor, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri, 63104; James C. Romeis, Ph.D., is Associate Professor, Center for Health Services Education and Research, St. Louis University and Coordinator, Health Services Research and Development, St. Louis VA Medical Center, St. Louis, Missouri, 63104; Boxiong Tang, MD., M.P.H., is a doctoral student in the Center for Health Services Education and Research, St. Louis University, St. Louis, Missouri 63104; and Fredric D. Wolinsky, Ph.D., is Professor, Department of Sociology, Texas A&M University, College Station, Texas, 77842.Supported in part by the Small Grants Program, Great Lakes Regional HSR&D Field Program of the Department of Veterans Affairs and NIA Grant AG00302.     

A baseline evaluation of family support programs

This paper presents a baseline evaluation of four demonstration family support programs located in communities identified as having a disproportionate number of families at risk for malfunctioning. In this baseline evaluation, a one year cohort of 422 family support participants were assessed along key dimensions of parenting known to contribute to child well-being and potentially to the incidence of child abuse or child neglect. These dimensions include parents' attitudes toward child rearing, knowledge of child development, level of perceived social support, and level of depression.Black participants and teenage parents had more punitive attitudes toward child rearing, less knowledge of child development, and less perceived social support than white or older parents. Overall, attitudes, knowledge, level of perceived social support and depression are inter-related in accordance with previous clinical observations and developmental theory, e.g., depressed parents are less knowledgeable, more punitive and have less support than nondepressed parents. The results of the baseline evaluation suggest that the demonstration projects are successful in reaching some subgroups of families at risk for parenting problems.Janet Reis, Ph.D. is Assistant Professor, Center for Health Services and Policy Research, 629 Noyes Street, Northwestern University, Evanston, Illinois 60201. Linda Barbera-Stein, Ph.D. is Assistant Research Professor, Center for Health Services and Policy Research, Northwestern University. Elicia Herz, Ph.D. is Assistant Research Professor, Center for Health Services and Policy Research, Northwestern University. John Orme, Ph.D. is Assistant Professor, School of Social Work, Louisiana State University. Susan Bennett, M.A. is Research Associate, Center for Urban Affairs and Policy Research, Northwestern University.This work was supported in part by a contract from the Illinois Department of Children and Family Services and the Pittway Charitable Fund to the Center for Health Services and Policy Research, Northwestern University. Special thanks are given to Dr. Edward Zigler for his early guidance on this project. An earlier version of this work was presented at the American Public Health Association, Washington, D.C., November 1985.     

Teenage pregnancy in an urban hospital setting

Recent research suggests that adverse consequences of teenage pregnancy are largely a function of social background factors and adequacy of prenatal care. This study examines the situation of young mothers with new babies in a low income, urban environment. The study explores the relationship between age and ethnicity and various life circumstance and life style differences which might effect long term developmental outcome. 475 Hispanic and black mothers were interviewed using a structured questionnaire. The majority are poorly educated, single parents. Educational attainment is higher for blacks than for Hispanics and for older mothers than for younger. Older mothers are more likely to be living with the father, to be married, and to have received adequate prenatal care. Hispanic parents are more likely than Blacks to be planning to live together. Hispanic mothers are more likely than blacks to be planning to be the primary caretaker for their babies. Adequacy of prenatal care is related to both prematurity and low birth weight. The implications of these findings are discussed in relation to pregnancy prevention and parenting education programs.J. Kent Davis, Ph.D. is Chief of Psychological Services and Assistant Professor in the Department of Pediatrics at the New York Medical College, Valhalla, New York. Raymond Fink, Ph.D. is Professor in the Department of Community Medicine at the New York Medical College, Valhalla, New York. Benamana Rajegowda, M.D. is Associate Professor in the Department of Pediatrics at the New York Medical College and Director of the Neonatal Intensive Care Unit at the Lincoln Medical and Mental Health Center, Bronx, New York. Arun Yesupria, M.D. is Chairman of STAT Clinical Laboratories in India. Rasila Lala, M.D. is Assistant Professor in the Department of Pediatrics at the New York Medical College and an attending Neonatologist at Lincoln Medical and Mental Health Center, Bronx, New York.     

Problems in the development of a rural primary care center

For 18 months between July 1973 and December 1974, the development of a primary care center for a rural Appalacian county engaged the efforts of local community leaders and the Department of Community Medicine of the University of Kentucky College of Medicine. This case study discusses some of the major events and factors contributing to this unsuccessful endeavor. The local cultural and sociomedical circumstances, including economic and political forces, and the errors in institutional relations and communication are analyzed. Many of the community problems encountered, at both the local and regional levels, are common to various rural areas. Considerations discussed in some detail include medical care payment mechanisms, rural economics, and local sociocultural systems. These community health problems, and the broader health policy issues that they represent, must be addressed before any significant changes or advances can be made in health care in rural America.Drs. Cowen and Hochstrasser are Professors in the Department of Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky 40506. Dr. Friedericks is Associate Clinical Professor, Christian Mission, Nepal. Dr. Payne is with the Hazard Appalachian Hospital, Hazard, Kentucky.     

Primary medical care for elderly patients part II: Results of a survey of office based clinicians

Evidence of the degree of fit between the special needs of the elderly and the service mix and payment level of ambulatory services offered under the Medicare program is presented in this second part of a two-part study of geriatric office care. Results from interviews with a focus group of 60 practicing clinicians, incorporating diversity of geography and practice setting, are described and compared with the view of geriatricians. Between 30 and 57% of the clinicians are aware of negative effects of Medicare's benefit structure on specific aspects of their practice.Marianne C. Fahs, Ph.D., M.P.H., is Assistant Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Charlotte Muller, Ph.D., is Professor of Economics and Sociology, City University of New York Graduate School, and Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Malvin Schechter, M.S., is Assistant Professor of Geriatrics Ritter Department of Geriatrics and Adult Medicine, Mount Sinai School of Medicine.Supported by a conference grant from the National Center for Health Services Research, Herbert C. Traxler, Ph.D., project director.A briefer version of this paper was presented at the annual meeting of the Association for the Social Sciences in Health, Las Vegas, Nevada, 1986.The research assistance of Helen Hooke is gratefully acknowledged.     

Self-reported referral patterns in practices of Family/General Practitioners,Internists, and Obstetricians/Bynecologists

A profile of referrals can help to define the characteristics of a physician's practice. Self-reported referral patterns in the practices of Family/General Practitioners (FP/GP), Internists (IM), and Obstetricians/Gynecologists (OB/GYN) in Maryland were assessed with a questionnaire mailed to an area sample of 1,715 physicians. A 65% response rate was obtained after three mailings (weighted N=1,487). Self-reported referrals received per month averaged 16% of patients seen (six percent FP/GP, 13% OB/GYN, 23% IM), and were more frequent among self-employed, younger, metropolitan and female physicians who spent less time in patient care. Self-reported referrals made per month averaged ten percent (10% FP/GP), 11% IM, and eight percent OB/GYN), and were higher for physicians in metropolitan areas. The correlation between percentage referrals received and percentage referrals made was r=.19 (r=.03 FP/GP, r=.21 IM, r=.25 OB/GYN). Self-reported practice referral patterns are similar to referrals reported in prior studies, and can be used to consider specialty differences in referral behavior of physicians.Jeffery Sobal, Ph.D., M.P.H. is an Assistant Professor in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Herbert L. Muncie, Jr., M.D. is an Associate Professor in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Carmine Valente, Ph.D. is the Director of the Center for Health Education, Inc., 1204 Maryland Avenue, Baltimore, Maryland, 21201. David M. Levine, M.D., Sc.D. is a Professor in the Department of Medicine at the Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. Bruce R. DeForge, M.A. is a Research Associate in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Requests for reprints should be addressed to: Jeffery Sobal. The authors would like to thank the Department of Family Medicine at the University of Maryland School of Medicine (Grant 2D32PE13000 from the U.S. Department of Health and Human Services), the Center for Health Education, Inc., Johns Hopkins University School of Hygiene and Public Health, Blue Cross/Blue Shield of Maryland, Inc., and the Medical and Chirurgical Faculty of the State of Maryland for support for this research. An earlier version of this paper was presented at the annual meeting of the North American Primary Care Research Group.     

Evaluation of a primary health care program for the poor

This paper examines the success in implementing a major program involving a partnership between public and private providers to deliver primary health care services to the poor. In 1985, the 69th Texas Legislature passed the Primary Health Care Services Act, authorizing the Texas Department of Health to contract for or directly provide primary health care services in those parts of the state that are medically underserved and have large numbers of people in poverty. This paper evaluates the potential impact of the projects with respect to access and cost. The study revealed that the basic concept of allowing local public and private providers to develop projects reflecting their community's unique needs and resources was successful. The approach lead to a wide variety of different types of projects, but the basic goals and activities of the projects are consistent with the legislation. The evaluation identified three major program areas that could be improved: (1) patient monitoring and follow-up to ensure the accessibility of the priority primary care services, (2) the need for the development of projects in other high need areas of the state, and (3) greater efficiency in service delivery.Charles E. Begley, Ph.D. is an Assistant Professor at the School of Public Health, The University of Texas Health Science Center at Houston, P.O. Box 20186, Houston, Texas 77225.Lu Ann Aday, Ph.D. is an Associate Professor at the School of Public Health, The University of Texas Health Science Center at Houston.Roy McCandless is a Faculty Associate, Center for Health Policy Studies, School of Public Health, The University of Texas Health Science Center at Houston.The research on which this paper is based was supported by the Bureau of Dental and Chronic Disease Prevention, Texas Department of Health. The authors wish to acknowledge the substantial contributions of Margaret Frank, M.H.S. and Kiyoko Parrish, M.P.H., Faculty Associates with the Center for Health Policy Studies, in the development and conduct of this research.     

Dietitians' beliefs about the importance of health promotion practices

Registered dietitians throughout the state of Delaware (N=146) were surveyed by mail to assess their beliefs about the importance of health promoting behaviors to the health of the average person. Respondents were instructed to rate each of 25 health promotion practices on a Likert scale. Results were compared with investigations of other health care providers. Eating a balanced diet was rated among the top five items. Taking vitamin supplements received the lowest mean rating. Results of the present study compared well with the beliefs of pharmacists and physicians. Ratings by other registered dietitians from an earlier study tended to be more conservative. Dietitians are supportive of health promotion and disease prevention. Their current role in health promotion activities needs further investigation.Connie E. Vickery, Ph.D., R.D., is Associate Professor, Department of Nutrition and Dietetics, College of Human Resources of the University of Delaware, Newark.Nancy Cotugna, Dr.P.H., R.D. is Assistant Professor, Department of Nutrition and Dietetics, College of Human Resources of the University of Delaware, Newark. Acknowledgment Special thanks are extended to theJournal of Allied Health for permission to reproduce the 1985 data contained in Table 3.     

Prevalence of alcohol consumption among older persons

Percent prevalences of alcohol consumption were determined in a cross-sectional study of randomly chosen residents of San Diego County, California aged 45 years and over. The study sample (N=2,105) showed statistically significant drinking differences between Whites (n=819), Blacks (n=629), and Mexican-Americans (n=657). Overall, the highest prevalence of drinking occurred among the White elderly. The common belief that socioeconomic conditions are inversely associated with a high prevalence of drinking was not supported in this sample. Statistically significant differences in age-specific and sex-specific percent prevalences of alcohol intake were also found. There was a generally decreasing prevalence of alcohol consumption with advancing age, which existed regardless of ethnicity. Initial empirical measures and a better understanding of drinking correlates will identify those elderly persons at risk and provide the basis for future interventions in the areas of applied epidemiology and health promotion.Craig A. Molgaard, Ph.D., M.P.H. is Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; Chester M. Nakamura is M.P.H., Medical Student, Tulane University School of Medicine; E. Percil Stanford, Ph.D. is Director, University Center on Aging, San Diego State University; K. Michael Peddecord, Dr.P.H. is Associate Professor, Division of Health Service Administration Graduate School of Public Health, San Diego State University; Deborah J. Morton, M.A. is Research Associate, University Center on Aging, San Diego State University.This study was supported in part by the National Institute of Mental Health, Grant No. 1R01MH37067-01A2     

Health care provider and family acceptance of a rural community-based nursing service for chronically ill children

Health care providers' and families' overall acceptance of a community-based nursing program was assessed in relationship to their perceptions of the program nurses' (1) accessibility, (2) professional competence, and (3) personal qualities. Perceptions were measured by questionnaires completed by 139 health care providers and 140 families. Overall, providers indicated that the program has been of benefit to both the children it serves and the medical community. The majority of families felt that the nurses were helpful to them despite a few complaints related to poor availability.Barbara A. Cook, M.S., is an Assistant in the Department of Pediatrics, University of Florida, Gainesville, FL. Jeffrey P. Krischer, Ph.D., is Professor and Chief of the Division of Epidemiology and Biostatistics, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL. Randy Kraft, B.A.E., is Health Educator, Florida Association of Pediatric Tumor Programs, Inc., Gainesville, FL. Address requests for reprints to Barbara Cook, M.S., Department of Pediatrics, 1105 West University Avenue, Suite 200, Gainesville, FL 32601. This research was supported in part by Children's Medical Services, Florida State Department of Health and Rehabilitative Services and in part by the Robert Wood Johnson Foundation.     

Differences in physician prevention practice patterns for white and minority patients

A telephone survey of 120 randomly selected primary care physicians in New York City was completed in October, 1984 (response rate =90%) concerning physicians' recommendations for health promotion and disease prevention. Responses from physicians with 50% or more Black and Hispanic patients were compared with responses from physicians with 50% or more White patients. The former were found to be less likely to follow guidelines from nationally recognized organizations for health promotion and disease prevention, although they were just as likely to value the importance of prevention in primary care. For example, physicians with predominantly Black and Hispanic patient populations were significantly less likely to recommend screening mammography (7% versus 23%) or recommend influenza vaccination for patients 65 or older (48% versus 74%) when compared with physicians with predominantly White patient populations. Factors that appeared to contribute to the difference in prevention practice patterns include physician training and education, the socioeconomic status of the patients, and the time physicians spend with patients. Differences in quality of preventive care provided to minority patients may be an additional factor in the disparity between the health status of White and non-White Americans.Donald H. Gemson, M.D., M.P.H. is Assistant Professor of Clinical Public Health, Jack Elinson, Ph.D. is Professor Emeritus, and Peter Messeri, Ph.D. is Assistant Professor at the Columbia University School of Public Health, Division of Sociomedical Sciences, 600 West 168th Street, New York, New York 10032.We are grateful to the New York City Division of the American Cancer Society, and to Don Charbonneau, former Director of Professional Education at the Division, for their gracious support. We are indebted to Mrs. Raie Bauman and Ms. Lesley Field, R.N., for their expert interviewing skills, and to Athilia Siegmann, M. Phil., for technical assistance.     

Behaviors of treated hypertensive patients and patient demographic characteristics

The relationships between self-reported hypertension-related patient behaviors and patient demographic characteristics were examined in a sample of 2,044 patients being treated for hypertension in 111 primary care medical practices. The patient behaviors of sodium intake, weight, alcohol, exercise, relaxation and adherence to medication regimen could be predicted to some extent by patient demographic characteristics. Whether patients recalled receiving advice from their physicians about these behaviors could also be predicted by patient demographic characteristics. Patients demographically similar to physicians, i.e., male, younger, more educated and White, reported receiving more advice from their physicians. Patients with behavioral problems who received relatively less advice from their physicians included: less educated younger patients whose sodium intake was relatively high; younger and less educated overweight women; overweight Black patients; and older women who exercised less than average.Jeanne M. Tschann, Ph.D. is an Assistant Research Psychologist, University of California, San Francisco, Department of Medicine, San Francisco, California. T. Elaine Adamson, M.P.H. is Specialist, University of California, San Francisco, Department of Medicine, San Francisco, California. Thomas J. Coates, Ph.D. is Associate Professor in Residence, University of California, San Francisco, Division of General Internal Medicine, San Francisco, California. David S. Gullion, M.D. is Associate Clinical Professor, University of California, San Francisco, Department of Medicine, San Francisco, California.Supported by the National Heart, Lung and Blood Institue Grant R18 HL31305.     

Body Mass Index and perceived weight status in young adults

Body Mass Index (BMI) was calculated from self-reported height and weight for 1,123 university students who returned a questionnaire mailed to a 10 percent random sample of the entire undergraduate population of a large midwestern university. Seventeen percent of the females and 20 percent of the males were determined to be in excess of normal BMI standards. However, significantly more women (40%) considered themselves overweight in comparison to men (24%). Also, significantly more women (53%) than men (20%) reported experiencing discomfort due to excessive weight. Inaccurate perceptions of body image are common among individuals with eating disorders. There is a higher incidence of eating disorders among college-age women than among their male peers. A distorted body image as reflected by perceived overweight may serve as a marker for individuals at risk for eating disorders.John P. Sciacca is Assistant Professor of Health Education; Amy C. Brown is Assistant Professor of Food and Nutrition Science; both are in the Department of Health, Physical Education, Recreation, Food and Nutrition Science, School of Health Professions, Northern Arizona University, Flagstaff, AZ 86011.Christopher L. Melby is Associate Professor of Nutritional Science, Dept. of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523. Gerald C. Hyner is Associate Professor of Health Promotion and Paul L. Femea is Associate Professor of Nursing, both at Purdue University, West Lafayette, IN 47906.     

A comparison of health promotion practices of general practitioners and residency trained family physicians

Physicians who specialize in family medicine and general practice have the potential to assume a major role in helping patients change their health promotion practices. Little is known about the proportion of routine consultation time devoted to primary prevention counseling or the factors that influence the provision of this kind of patient education. A survey of General and Family Practitioners was conducted to determine the extent to which these physicians perform health promotion counseling as well as their perceptions regarding constraints affecting their efforts, confidence in their ability to change patient's behaviors, and the training required to enhance their efforts. Differences, with respect to their health promotion practices, between General and Family Practitioners, were also examined. One hundred and ninety-five physicians completed the survey for a response rate of 68%. When year of graduation from medical school was controlled there was little difference in the health promotion practices of General and Family Practitioners. This study suggests residency training in the specialty of family medicine does not provide residents with the knowledge, confidence and skills to perform health prevention counseling at a level different than that practiced by General Practitioners.Linda Attarian M.P.H. is a Research Associate at the Department of Family Medicine, University of North Carolina, Chapel Hill. Michael Fleming M.D. is Assistant Professor in the Department of Family Medicine, University of North Carolina, Chapel Hill. Patricia Barron, M.P.H. is a Research Associate at the Department of Family Medicine, University of North Carolina, Chapel Hill. Victor Strecher Ph.D. is Assistant Professor in the Department of Health Education, University of North Carolina, Chapel Hill.     

The fate of the non-marital child: A challenge to the health system

Non-marital births present serious social and economic issues to American communities. This study examined attitudes and behaviors of low income unmarried young parents toward paternity establishment and the role of health care professionals in promoting paternity establishment. One hundred twenty-six matched dyads of young, impoverished unmarried fathers and mothers with a child age one year or less participated in face-to-face interviews, focusing on family, peer and community influences on paternity decision making. The representative sample was derived from a metropolitan county's AFDC and paternity files in Minnesota. While less than one-third of fathers lived with the mother and child, two-thirds were present at the child's birth. Eighty-five percent of fathers acknowledged fathering the child, 80% provided care and nurturance of the baby, and 86% indicated that the father's name on the birth certificate was important. Only 29% of White fathers and 20% of African-American fathers regarded marriage to the mother as a possibility, and less than one-third sought to establish paternity through the courts. Nonetheless, 52% of White and 63% of African-American fathers had signed the Declaration of Parentage at the hospital, although presentation of the Declaration by health personnel was haphazard. Presentation of the Declaration should become standard procedure within health settings, with paternity establishment removed from the court setting and permitted through signing of the Declaration. This would capitalize on the high level of interest in paternity establishment expressed by fathers, other than through formal court procedures, around the time of the baby's birth.Michael D. Resnick, Ph.D., is Associate Professor, School of Public Health and Department of Pediatrics, and Director of the National Adolescent Health Resource Center, University of Minnesota; Esther Wattenberg, MA., is Professor, Center for Urban and Regional Affairs and School of Social Work, University of Minnesota; Rose Brewer, Ph.D., is Associate Professor, African-American and African Studies, University of Minnesota.Support for this study was provided by the Ford Foundation.     

Role disagreement in primary care practice

To measure the extent of disagreement on roles between nurse practitioners (NPs) and physicians working together and to look for characteristics of joint practices that are associated with disagreement, patient vignettes were sent to 15 NP/M.D. dyads, and both M.D.s and NPs were asked how appropriate it would be for them and for their co-practitioner to provide care for the problem presented in each vignette. Measures of disagreement on patient care roles were developed by comparing responses within the dyad. For all practices, there was moderate agreement on roles, and this agreement seemed to favor a complementary practice. Disagreement on the NP's role was most often in the direction of NP feeling capable of providing more care than the M.D. felt she could provide. Various factors, such as job satisfaction, age differences between providers, and training level of the NP, were associated with the disagreement that was found. Some disagreement on roles exists between NPs and M.D.s practicing together. Resolution of these differences may lead to greater job satisfaction and more effective interaction between providers.The authors are with the University of North Carolina, Chapel Hill where Dr. Davidson is an Assistant Professor of Medicine in the Division of General Medicine and Clinical Epidemiology, Dr. Earp is an Assistant Professor of Health Education in the School of Public Health and Dr. Fletcher is Co-Chief of the Division of General Medicine, Associate Professor of Medicine and Clinical Epidemiology, and Director of the Robert Wood Johnson Clinical Scholars Program. Reprints may be obtained from Richard Alan Davidson, M.D., M.P.H., Department of Medicine, 3041 Old Clinic Building, University of North Carolina, Chapel Hill, North Carolina 27514. This work was presented at the American Federation for Clinical Research Meetings, May, 1980. This project was supported in part by the Robert Wood Johnson Clinical Scholars Program. The authors would like to acknowledge the assistance of David McKay in the planning of this study.     

The religious community as a partner in health care

In-depth structured interviews were conducted with spokespeople for 176 inner-city churches regarding perceptions of existing community problems, number of currently offered church-based social and health programs, and potential interest in church sponsorship of new maternal and child health programs. The sample of respondents represented 78% of the 227 churches located in a low-income, primarily black urban area with 150,000 residents. The typical church participating in the survey was Baptist with a congregation of 100 to 500 people, most of whom were not community residents. The leading community problems identified by the clergy were, in descending order: lack of jobs, teenage pregnancy, gang crime, school drop-outs, and hunger. The perception of community problems matched the church services offered as measured by the number of food and clothing pantries. Few churches had ongoing programs for neighborhood youths. Although many of these same churches expressed interest in expanding services for mothers, adolescents and children, few perceived themselves as having the necessary staff, funds, or technical expertise to conduct such programs.Lynn M. Olson, Ph.D. is Assistant Professor, Center for Urban Affairs and Policy Research. Northwestern University, 2040 Sheridan Road, Evanston, Illinois 60208.Janet Reis, Ph.D. is Assistant Professor, School of Nursing. State University of New York at Buffalo, Buffalo, New York.Larry Murphy, Ph.D. is Associate Professor, Institute for Black Religious Research. Garrett-Evangelican Seminary, Evanston, Illinois.Jennifer H. Gehm, B.A. is Research Analyst, Center for Health Economics Research, Boston, Massachusetts.This work is supported in part by grants to the Center for Health Services and Policy Research, Northwestern University; The Ford Foundation; The Chicago Community Trust; and The Field Foundation of Illinois. An earlier version of this paper was presented at the Annual Meeting of the American Public Health Association, Las Vegas, Nevada, September 1986.