Lewis H. Margolis

Coalition building for prevention: lessons learned from the North Carolina Community-Based Public Health Initiative.

This article examines the four-year development of the North Carolina Community-Based Public Health Initiative consortium (NC CBPHI). The NC CBPHI consisted of four separate county coalitions and differed in both its agenda and membership from the many examples of coalitions described in the literature. This article presents and describes evaluation findings that identify six factors as important in coalition functioning and success in the CBPHI coalitions. These factors are: participation, communication, governance and rules for operation, staff/coalition member relationships, technical assistance and skills training, and conflict recognition and containment. Selected CBPHI coalition activities are also described and implications for public health practitioners are presented.

Childhood injuries in North Carolina: a statewide analysis of hospitalizations and deaths

We report the nature and causes of childhood injuries leading to hospitalization or death in North Carolina. Based on an 89 per cent sample of 1980 hospital discharges of children between 0 and 19 years of age, the overall annual rate of trauma-related hospitalizations was 80 per 10,000. The rate varied from 119 per 10,000 for the 15-19 year age group to 56 per 10,000 for children between ages 5 and 9. Hospitalization rates are lower than those reported elsewhere, although death rates, based on a seven-year period, are higher in the data reported here. Potential reasons for these differences are suggested.

Barriers to implementation of a prenatal care program for low income women.

By the middle of the second year of the Michigan Prenatal/Postpartum Care (PPC) program to provide pregnancy-related services to low income women who were ineligible for Medicaid or other insurance, only 25 per cent of the participating health departments were enrolling greater than 90 per cent of contracted potential clients. Using a survey of program directors and relevant state documents, we identified several barriers to successful implementation: institutional (program complexity, high levels of administrative concerns along with low levels of communication between local health departments and providers); economic (inadequate resources for provider reimbursement, outreach, transportation, high-risk pregnancies, or administrative overhead); psychological (servicing populations with multiple and hard to care for problems, potential discomfort of low income women with traditional providers); and informational (insufficient information about the program infiltrating the target community).

Characteristics of child safety seat users

Direct observation of child restraint use was combined with interviews and mail questionnaires to measure prevalence of various child restraint practices and factors related to use of child safety seats and seat belts for children under the age of four. Trained observers assessed multiple dimensions of child restraint practices for a sample of motorists entering fast-food parking lots in Michigan. On-site interviews and follow-up questionnaires measured sociodemographic, attitudinal, belief, and behavioral characteristics related to restraint use. Ninety-two percent of infants under age 1 and 55% of children age 1 to 3 were traveling in a child safety seat. Public support for the mandatory child restraint law was very high--9 out of 10 believed it should be strictly enforced. Child restraint use was lower than average among motorists who: (1) had low family incomes, (2) were not currently married, (3) were of nonwhite ethnic backgrounds, and (4) were over the age of 40. A shift in social norms appears to have occurred in recent years, such that restraint of young children traveling in cars is now socially expected behavior. Recommendations include: (1) continuing educational efforts to increase knowledge of mandatory child restraint use laws, and (2) increased enforcement of mandatory child restraint use laws.

A Critical Review of Studies of Newborn Discharge Timing

The duration of hospitalization for newborns has declined dramatically, driven by efforts to control health-care costs as well as by efforts to demedicalize childbirth. In order to determine the clinical basis for this practice, the quality of the published literature on discharge timing was analyzed. Thirteen experimental or quasi-experimental studies were retrieved through a computer search. Seven characteristics that influenced the quality of these studies were reviewed: research design; measures of effect; sample descriptions; statistical methods; reliability measures; sample size; and the definition of early discharge, including the use of any related interventions. Although all 13 studies suggest that there are no differences between infants discharged early and their compeers, these studies have three limitations. First, with one exception, these reports are from hospitals where well-defined assessment and follow-up protocols have been established, potentially limiting their wide applicability. Second, these studies lack statistical power to assess the likelihood of rare events such as readmission. Third, few studies report outcomes other than readmission and medical conditions diagnosed within 1 to 6 weeks. Early discharge as the standard of care for well newborns has not been well established by empirical studies. Pediatricians and local public health officials have a responsibility to assure that the health objectives of hospitalization are met whether this occurs in the hospital or through other mechanisms, such as routine home visiting.

Type A Behavior: An Ecological Approach

The recognized association between Type A behavior and coronary heart disease has prompted efforts to alter the behaviors deleterious components in both individuals who have experienced myocardial infarction and those who are at risk for that disease. Utilizing concepts from psychology, sociology, history, and other disciplines and material from scholarly and popular literature, this paper suggests that instead of singularly concentrating on components at the level of the individual, it is important to view Type A behavior from an ecological perspective, with attention directed at the interpersonal, institutional, and cultural environments of individuals. This perspective will enhance understanding of Type A behavior and possibly stimulate interventions at the primary as well as secondary and tertiary prevention levels.

Parent comments and instruction during the first four months of supervised driving: an opportunity missed?

The present study examined the nature of the comments and instruction provided by parents during supervised driving. Unlike previous studies which rely on self-report, the data in this study were obtained through direct observation of parents and teens using in-vehicle cameras with audio recording. The cameras were installed in the vehicles of 50 families for the first four months of the learner license stage. The findings show a great deal of conversation takes place while teens are driving with a supervisor, and that much of this conversation concerns driving. Sixty-one percent (61%) of all recorded clips included driving-related conversation. The most common type of comment by parents was instruction about vehicle handling or operation, observed in 53% of those clips with conversation about driving. This was followed by pointing out something about the driving environment (such as when it was clear to enter traffic; 23%), negative comments about the teens driving (22%), and helping the driver navigate (18%). Other potentially helpful types of instruction, including explanation or insights regarding higher order skills (e.g., hazard anticipation and detection), were noticeably less frequent. Moreover, higher order instruction remained low during the first four months of the learner stage, even as instruction about vehicle handling/operation decreased. These findings suggest parents are not taking full advantage of the opportunity provided by mandatory periods of supervised driving to help their children develop an understanding of important aspects of driving.

EFFECTS OF A MANDATORY SAFETY BELT LAW ON HOSPITAL ADMISSIONS

Although the effectiveness of automobile safety belts in reducing risk of serious injury in traffic crashes is well documented, safety belt use in many U.S. jurisdictions remains low. Michigans mandatory safety belt law for front-seat occupants, implemented in July 1985, is one of 34 similar laws in the United States intended to increase belt use and reduce crash-related injuries. Using time-series intervention analyses of data from 14 hospitals throughout the state, we found a 19% reduction in the rate of admitted patients for all automobile occupant injuries and a 20% reduction in the rate of admitted patients with extremity injuries following implementation of the safety belt law. The utility of hospital data for the evaluation of interventions like the safety belt law reinforce the importance of consistently recording E-codes for all injury patients.

The relationship between the timing of maternal postpartum hospital discharge and breastfeeding.

This study examines the association between discharge timing and breastfeeding, controlling for demographic, economic, and health factors that influence both. Using the 1988 National Maternal and Infant Health database, maximum-likelihood modeling was used to generate 2-equation models to estimate both outcomes simultaneously. The joint estimation of breast-feeding and discharge timing demonstrates that mothers who spent 1 night in the hospital were more likely to breastfeed than mothers who spent 2 or 3 nights in the hospital (OR=1.96, 95% C.I. 1.86-2.03). Furthermore, the model altered the association between breastfeeding and age, breastfeeding advice, and prenatal classes. In 1988, when decisions were a function of clinical judgments about readiness for discharge, early discharge was associated with an increased likelihood of breastfeeding. Instead of basing discharge solely on predetermined rules, derived largely from financial criteria, attention to the decision-making process should be an important part of newborn discharge policies.

Educating Students for Community-Based Partnerships

ABSTRACT Many courses for students in professional schools may expect or require a learning experience “in the community.” Simple placement in a community does not assure, however, that students will develop competencies from a community-based perspective, that is, competencies that enable professionals to: (1) enhance the capacity of community members to serve in partnership endeavors; (2) appreciate the role of participation by under-represented or under-served populations; and (3) develop skills for mobilizing community resources to address community-defined priorities. This article describes six domains-course goals, partners, exposure, product, classroom activities, disciplines-to characterize courses and other learning experiences, in order to assess the extent to which they promote community-based competencies.