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.     

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.     

Ethical issues in primary health care: A survey of practitioners' perceptions

While most health care is provided at the primary care level, little research has been done to document the ethical issues of such care. A stratified random sample of 702 physicians, nurses, physical therapist, and physician assistants within one southeastern state was surveyed to determine the frequency of ethical issues in primary care. The most frequently occurring issue concerned moral decisions about the amount of time to spend with each patient. A comparison of physician and nonphysician professional groups revealed significant differences in frequencies of the issues. Age had a slight impact on the responses, while gender, religion, and region of practice had none. The study showed that the most frequently occurring issues are pragmatic, not dramatic, and center on patient self-determination, adequacy of care and professional responsibility, and distribution of resources.Helen M. Robillard, R.N.-C., M.S.N., is a doctoral student in Organizational Psychology at the University of Michigan, Ann Arbor. Dallas M. High, Ph.D., is Professor in the Department of Philosophy and Associate of the Sanders-Brown Center on Aging, University of Kentucky, Lexington. Juliann G. Sebastian, R.N., M.S.N., is Associate Professor, College of Nursing, University of Kentucky, Lexington. Janet I. Pisaneschi, Ph.D., is Associate Professor and Assistant Dean, College of Allied Health Professions, University of Kentucky, Lexington. Lea J. Perritt, Ph.D., is Assistant Professor, Allied Health Education and Research, College of Allied Health Professions, University of Kentucky, Lexington. D. Mark Mahler, M.D., is Assistant Clinical Professor, Indiana University School of Medicine, Indianapolis. Requests for reprints should be addressed to: Dallas M. High, Ph.D., Professor, Department of Philosophy, University of Kentucky, Lexington, KY, 40506.     

Teaching community-oriented primary care (COPC): A practical approach

To improve education in community-oriented primary care (COPC) and to promote its practice in the community, the University of California's School of Public Health in Berkeley and School of Medicine in San Francisco are collaborating in an innovative program in cooperation with several federally-funded community clinics in the San Francisco Bay Area. The School of Public Health designed a COPC track for graduate public health students from various departments of the school who wished to work in community health care. The track includes a seminar given in the spring of the students' first year in which COPC theory is taught and teams of students working with a faculty advisor and a clinic preceptor design COPC projects for the primary care sites. These projects are then implemented in the summer and fall by students who elect to use this experience to satisfy their fieldwork requirement. This paper is a report of the first year's experience with this collaborative effort.Emilie H.S. Osborn, M.D., M.P.H. is Assistant Professor, Family and Community Medicine, University of California at San Francisco. Norman Hearst, M.D., M.P.H. is Assistant Clinical Professor, Clinical Epidemiology and Family and Community Medicine, University of California at San Francisco. Joyce C. Lashof, M.D., is Dean, School of Public Health, University of California at Berkeley. W. McFate Smith, M.D., M.P.H. is Director, Preventive Medicine Residency, School of Public Health, University of California at Berkeley.This project has been supported in part with Federal funds from the Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Public Health Service, under contract #240-84-0124. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services.     

Cigarette smoking,mortality, institutional and community-based care utilization in an adult community

We evaluated mortality and health services utilization in a prospective study of 630 older residents of a Southern California community. All participants were 65 years or older when initially evaluated in 1973–1975. In addition to being followed for vital status each year, participants were reinterviewed in 1984–1986 and asked about nursing home, hospital, and community-based care for the interim period. Current cigarette use in 1973–1975 was a significant predictor of mortality for both men and women. In addition, former smoking status (before 1973–1975) significantly predicted both mortality and hospital inpatient utilization in men and women combined. However, smoking was not significantly associated with nursing home utilization or use of three categories of community-based care services. More research is necessary to identify the relationship between cigarette smoking and outpatient service use. The findings for mortality and inpatient hospital service utilization reaffirm the hazards of cigarette smoking.Robert M. Kaplan is Professor of Community and Family Medicine and Associate Director of the Cancer Center, University of California, San Diego; Deborah L. Wingard is Associate Professor of Community and Family Medicine, University of California, San Diego; Janice B. McPhillips is Research Analyst, Pawtucket Heart Health Program, Memorial Hospital of Rhode Island; Denise Williams-Jones is Staff Research Associate, Department of Psychiatry, University of California, San Diego, California; and Elizabeth Barrett-Connor is Professor and Chair, Department of Community and Family Medicine, University of California, San Diego.Supported by Grant 1-PO1-AG-03990 from the National Institute of Aging, National Institutes of Health.     

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     

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.     

Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996–2003

Methamphetamine/amphetamine (MA)-related morbidity and mortality has been increasing in the United States. MA use is associated with high-risk sexual behavior and syringe-sharing practices. Homeless and marginalized housed persons (H/M) have high rates of substance use and mental health disorders. Little is known about trends of MA use among the H/M. The objective of this study was to quantify increases in MA use among H/M in San Francisco and to determine which demographic and behavioral subgroups have experienced the greatest increases in MA use. We conducted serial cross-sectional population-based studies in three waves: 1996–1997, 1999–2000, and 2003 and studied 2,348 H/M recruited at shelters and lunch lines. The main outcome was self-reported current (30-day) MA use. We found a tripling of current MA use among H/M persons from 1996 to 2003, with a sevenfold increase in smoked MA use. MA use doubled to tripled in most demographic and behavioral subgroups, whereas it quadrupled in those under age 35, and there was a fivefold increase among HIV-infected persons. The increase in MA use among H/M places a vulnerable population at additional increased risk for HIV infection and MA-use related morbidity and mortality. Among HIV-infected H/M, the increase in MA use has important public health implications for the development and secondary transmission of drug-resistant HIV caused by synergistic neurocognitive decline, poor adherence to HIV medications, and increased sexual risk behavior. Clinicians caring for H/M persons should inquire about MA use, refer interested MA users to MA dependence treatment programs and provide targeted HIV sexual risk reduction counseling. For HIV-infected H/M MA users, clinicians should closely monitor adherence to HIV or other chronic medications, to avoid unnecessary morbidity and mortality. Further research is needed to elucidate the most effective prevention and treatment for MA use and dependence among the H/M. Das-Douglas and Bangsberg are with the Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA; Das-Douglas, Bangsberg, and Hahn are with the Epidemiology and Prevention Interventions Center, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Das-Douglas and Bangsberg are with the Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA; Colfax is with the Epidemiology Section, AIDS Office, San Francisco Department of Public Health, San Francisco, CA, USA; Moss is with the Epidemiology and Biostatistics, University of California, San Francisco, USA.     

Some influences on public participation in a genetic screening program

To identify the psychosocial factors associated with voluntary cooperation in mass genetic testing, stratified random samples of 500 participants and 500 nonparticipants were drawn from an identified at-risk population for Tay-Sachs disease. Participants were relatively younger and better educated, reported higher levels of perceived susceptibility to being a carrier, and also stated more often that the impact of learning of being a carrier would be low. Participants were also more likely to indicate they would not alter plans for future progeny. Recommendations are made for enhancing participation in future genetic screening programs of this type.Dr. Becker is Associate Professor, Departments of Pediatrics (School of Medicine) and Behavioral Sciences (School of Hygiene and Public Health), The Johns Hopkins University, Edwards A. Park Building, Room B172, The Johns Hopkins Hospital, 601 North Broadway, Baltimore, Maryland 21205. Dr. Kaback is Associate Professor, Departments of Pediatrics and Medicine, and Associate Chief, Division of Medical Genetics, School of Medicine, University of California at Los Angeles. Dr. Rosenstock is Professor and Chairman, Department of Health Behavior, School of Public Health, University of Michigan. Ms. Ruth is Chairman, Department of Community Health Nursing, School of Nursing, University of Maryland.     

Health care needs for children of the recently homeless

Thirty families were surveyed at a shelter for the homeless in San Diego, California concerning the health care status and needs of their children. 56.7% of the families had no regular source of health care and 46.6% were not covered by any form of health coverage. Children whose families had a regular source of health care were more likely to have reported better health and more frequent checkups. Also, increased duration of homelessness was predictably correlated with poorer reported health of the children. Though the families sampled were representive of those recently made homeless i.e. less than six months, needs were identified that would be applicable to all homeless families. The most frequent needs the families expressed for their children were: general nonemergency clinics (76.7%), emergency services (66.7%), and dental services (66.7%). Nutritional and dietary counseling were chosen by 43.3% and only 6.7% of the parents rated social and psychological services as needed.Dale Hu, M.D. is Resident-in-Proventive. Medicine, Johns Hopkins University, Baltimore. Maryland. Ruth M. Covell, M.D. is Associate Dean and Clinical Professor Community and Family Medicine, University of California, San Diego, La Jolla, California; Jeffrey Morgan, M.D. is on staff at the Comprehensive Health Center, San Diego, CA; and John Arcia is a fourth year medical student, University of California, San Diego.     

Aids education practices among Massachusetts physicians

Physicians have a major role to play in the prevention of AIDS transmission. Promotion of health behaviors needs to be expanded beyond the traditional AIDS high risk populations; however, little information is available on the AIDS education practices of physicians. A survey of Massachusetts physicians in four specialty groups, Family Medicine Practitioners, Internists, Obstetricians/Gynecologists and Pediatricians, was conducted to determine the extent of their AIDS education practices. Three hundred and ninety one physicians returned the questionnaire for an overall response rate of 66%. Sixty three percent (63%) of the physicians surveyed educate patients they believe to be at least at moderate risk for AIDS transmission or exposure. However, neither physicians screening for patients' AIDS risk status nor the content of the AIDS education was uniform. Also, very few physicians have received specific training in AIDS education. A number of practice, patient, and physician characteristics were found to be related to educational practices. This study suggests that a more comprehensive screening of patients' participation in AIDS risk behaviors be conducted as part of medical history taking, and that more comprehensive education be provided to those patients determined to be at least at moderate risk for AIDS transmission or exposure.Ruth A. Carretta, M.P.H. is an Analyst with the Outside Health Resource Utilization Program, Harvard Community Health Plan, Boston, Mass. 02215; Thomas W. Mangione, Ph.D. is Associate Professor of Public Health, Boston University School of Public Health, Boston, MA 02118 and Senior Research Fellow, Center for Survey Research, University of Massachusetts — Boston, Boston, MA 02116; Presley F. Marson, M.D., M.P.H. is a student at the Boston University School of Public Health, Boston, MA 02118; S.S. Darmono, M.D., M.P.H. is a student at the Boston University School of Public Health, Boston, MA 02118. Requests for reprints should be addressed to: Thomas W. Mangione, Ph.D., Center for Survey Research, University of Massachusetts — Boston, 100 Arlington St. — Suite 210, Boston, MA 02116.This study was conducted as part of a course offered by the Boston University School of Public Health. This research was also supported in part from funds from the Boston University School of Public Health and the Center for Survey Research at the University of Massachusetts — Boston.We would like to acknowledge the contributions of Patricia M. Demers, R.N., M.S., M.P.H., Efstratios Demetriou, M.D., Elizabeth A. Harvey, Ph.D., Suzanne Moore, M.P.H., R.N.C., Ph.D. candidate, and Nancy Salitsky, R.N., M.P.H. for their assistance in the design of the questionnaire, data collection, input into the analysis, and editorial advice; Kathleen Butterfield, Jean F. Saint-Elme, M.D., M.P.H., and Anneke Suparwati, M.P.H. for their assistance in design of the questionnaire and data collection; and Carmen Arroyo for creating the data entry program and providing the data analysis runs.     

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.     

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.     

Clinical validation of a nutritional risk index

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.John M. Prendergast, MD, MPH is Medical Director, Program on Aging, Mercy Hospital, Pittsburgh, PA 15219; Rodney M. Coe, PhD is Professor, Department of Community Medicine, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center (GRECC), VA Medical Center, St. Louis, MO 63104; M. Noel Chavez, PhD, RD is Assistant Professor, Department of Community Health Sciences, School of Public Health, University of Illinois, Chicago, IL 60612; James C. Romeis, PhD is Associate Professor, Center for Health Services, Education and Research, St. Louis University and Coordinator, Health Services Research and Development, VA Medical Center, St. Louis, MO 63104; Douglas K. Miller, MD is Assistant Professor, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO 63104; Fredric D. Wolinsky, PhD is Professor, Department of Sociology, Texas A&M University, College Station, TX 77843.This project was supported in part by grant #84-017 from the Veterans Administration and by K07-AG-00302 and K04-AG00328 from the National Institute on Aging.     

Hepatitis B Awareness,Testing, and Knowledge among Vietnamese American Men and Women

Southeast Asians have higher rates of liver cancer than any other racial/ethnic group in the United States. Chronic carriage of hepatitis B virus (HBV) is the most common underlying cause of liver cancer in the majority of Asian populations. Our objectives were to describe Vietnamese Americans’ awareness of hepatitis B, levels of HBV testing, and knowledge about hepatitis B transmission; and to compare the HBV knowledge and practices of men and women. A community-based, in-person survey of Vietnamese men and women was conducted in Seattle during 2002. Seven hundred and fifteen individuals (345 men and 370 women) completed the questionnaire. Eighty-one percent of the respondents had heard of hepatitis B (76% of men, 86% of women) and 67% reported HBV testing (66% of men, 68% of women). A majority of the participants knew that HBV can be transmitted during sexual intercourse (71% of men, 68% of women), by sharing toothbrushes (67% of men, 77% of women), and by sharing razors (59% of men, 67% of women). Less than one-half knew that hepatitis B is not spread by eating food prepared by an infected person (46% of men, 27% of women), nor by coughing (39% of men, 25% of women). One-third of our respondents did not recall being tested for HBV. Important knowledge deficits about routes of hepatitis B transmission were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns for Vietnamese immigrant communities. These efforts might be tailored to male and female audiences. Victoria M. Taylor is Full Member, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. John H. Choe is Acting Instructor, Department of Medicine, University of Washington, Seattle, Washington. Yutaka Yasui is Professor, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta. Lin Li is Research Associate, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Nancy Burke is Assistant Professor, Comprehensive Cancer Center, University of California, San Francisco, California; and J. Carey Jackson is Associate Professor, Department of Medicine, University of Washington, Seattle, Washington.     

The use of telemarketing in the community-wide prevention of heart disease: The Pawtucket Heart Health Program

The marketing of preventive health behaviors is typically accomplished through various broadcast, print, and other mass media channels. By making randomly-dialed telephone calls to 4,000 residents of Pawtucket, RI, volunteers of the Pawtucket Heart Health Program succeeded in registering nearly 400 individuals for risk factor reduction groups or self-help behavior change kits. Additionally, community awareness of the program was an indirect benefit of this telemarketing. Telemarketing is an interactive and inexpensive approach to marketing preventive health behaviors.Rick Schwertfeger, M.A.T. is the Director of the Education Department at Valley Regional Hospital, Claremont, NH 03743. John P. Elder, Ph.D., M.P.H. is an Assistant Professor at the Graduate School of Public Health, San Diego State University, San Diego, CA 92182. Robert Cooper, B.A. is a Health Promotion Specialist at the Pawtucket Heart Health Program, Pawtucket, RI 02860. Thomas M. Lasater, Ph.D. is the Co-Principal Investigator and Richard A. Carleton, M.D. is the Principal Investigator of the Pawtucket Heart Health Program The Memorial Hospital/Brown University Program in Medicine, Pawtucket, RI 02860. This research was supported by grant HL23629 from the National Heart, Lung and Blood Institute, DHHS. Correspondence should be sent to John P. Elder, Graduate School of Public Health, San Diego State University, San Diego, CA 92182.     

The 1974 reorganization of the British National Health Service: An analysis

The British National Health Service was reorganized on April 1, 1974, for the first time since its formation in 1948. The Reorganization attacked one serious problem: the anomalous separation of the general practitioners (and other nonhospital, non-local authority ambulatory services), hospitals, local government authority public health services, and teaching hospitals into different administrative units with different boundaries. These services are now integrated into one structure. However, other important problems will not be affected substantially.Dr. Jonas is Associate Professor of Community Medicine in the Health Sciences Center, State University of New York, Stony Brook, New York 11794. Dr. Banta is Associate Professor of Community Medicine at the Mount Sinai School of Medicine of the City University of New York and Robert Wood Johnson Health Policy Fellow in the Institute of Medicine, National Academy of Sciences, Washington, D.C. An earlier version of this paper was presented by Dr. Jonas at the American Public Health Association annual meeting, San Francisco, California, November 8, 1973. Dr. Banta is grateful to the Milbank Memorial Fund, whose support made possible visits to Britain in 1970, 1971, and 1974. The authors would like to thank Drs. Brian Abel-Smith, Peter Draper, Geoffrey Gibson, Wilfred Harding, David Stark Murray, and Julian Tudor-Hart for the helpful comments they made on the earlier paper by Dr. Jonas and also Dr. John Brotherston for his contributions to this work.     

Social support and human development: Issues in theory,research, and practice

The physical and psychological correlates and consequences of social support have received much attention in the past decade. To date, however, much research on social support has not been guided by an integrated theoretical or conceptual framework. In this report, a life span developmental perspective is suggested for the study of social support. The discussion addresses numerous conceptual, theoretical, and empirical concerns related to the investigation of support. Implications for designing, implementing, and evaluating support-related interventions are highlighted.Cathleen M. Connell, Ph.D. is a Research Fellow in the Department of Internal Medicine, Division of Lipid Research, at the Washington University School of Medicine. Anthony R. D'Augelli, Ph.D. is an Associate Professor of Human Development and Family Studies at The Pennsylvania State University.This research was funded in part by a National Institute on Aging pre-doctoral training grant to The Pennsylvania State University (#T32-AG00048) and a National Heart, Lung, and Blood Institute post-doctoral training grant, Nutrition-Behavioral Cardiovascular Disease Prevention (#5T32-HL07456) to the Washington University School of Medicine.     

The treatment of patients with insulin-requiring diabetes mellitus by primary care physicians

The extent to which a sample of community based, primary care physicians follow current standards of care for the treatment of non-obese, insulin-requiring patients as defined and recently published by the American Diabetes Association (ADA) was studied. A total of 212 physicians responded with 191 indicating that they treat one or more non-obese, insulin-requiring patients. Of this sample, 97% used multiple injection, mixed insulin regimens. However, over 70% also used single injection regimens. Whereas 94% prescribed self-monitoring blood glucose (SMBG), only 31% did so for more than 75% of their patients and 37% did so for less than 50%. Twenty-five percent of respondents did not obtain HbA1 values on their patients. For respondents who do collect HbA1, only 28% did so for over 75% of their patients and 30% for less than 50%. Physicians with fewer patients were more likely to prescribe single injection insulin regimens (P=.02). Recent graduates from medical school also used HbAl's more frequently than earlier graduates (p=.001). These data suggest that while care practices recommended by the ADA are being implemented by primary care physicians, they are significantly under-utilized.David G. Marrero is an Associate Scientist, Medicine and Pediatrics; Naomi S. Fineberg is Associate Professor Medicine; Carl D. Langefeld is a statistician Medicine; Charles M. Clark is Professor Medicine; all in the Indiana University School of Medicine, Indianapolis, Indiana.Patricia S. Moore is research nurse, The Regenstrief Institute for Health Care, Indianapolis, Indiana.This study was supported by NIH Grant No. PHS P60DK20542-12, 50-825-80 (OTR), National Institutes of Diabetes, Digestive and Kidney Disease, and the Regenstrief Institute.The authors wish to thank Frank Vinicor, MD, Gary Ingersoll, Ph.D., and Michael Golden, MD for their helpful comments and suggestions. We also thank Debbie Mercier for typing numerous drafts.     

Hospital record studies as a tool for staff education: A participatory research project in Guatemala

This study examined the educational outcomes of a participatory research project in Guatemala. Using a 33.33% systematic sample of records covering an 11 year period, hospital data were collected on 9500 admissions from a small private hospital. Analysis of the data was performed by the local hospital staff and professional researchers. Interpretation of the information was primarily concerned with hospitalization trends, sociodemographic and economic characteristics, and cultural beliefs. Two of the major impacts of the study were that hospital physicians developed a stronger data orientation and gained an increased awareness of public health issues. The participatory research process led staff members to identify areas of further research and modify health education and community outreach programs.Patricia O'Connor, M.A. is Adjunct Research Instructor, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Robert R. Franklin, M.D., M.P.H. & T.M. is Associate Professor of Epidemiology, Tulane University School of Public and Tropical Medicine, Carroll H. Behrhorst, M.D. is Adjunct Visiting Professor of International Health, Tulane University School of Public Health and Tropical Medicine.The authors wish to thank the Andrew W. Mellon Foundation, the Matilda Geddings Gray Foundation, and the Roger Thayer Stone Center for Latin American Studies for their generous support of this research. Special thanks to Mark Connolly and Darin Portnoy for their participation in data abstraction and analysis.