Lorraine V. Klerman

School Absence—A Health Perspective

Excessive school absence may result in difficulty in completing academic work, being retained in grade, or dropping out of school prior to high school graduation. Frequent or prolonged absence may be an indication that a student has a serious physical or emotional health problem, that he or she is engaged in problem behaviors with potentially serious health and social consequences, that other family members have physical or psychological problems, or that the student is reacting to an unfavorable school environment.

Coping with pregnancy resolution among never-married women.

The Janis-Mann model of decision-making provides the theoretical orientation for empirical analyses of decisions to deliver or abort in matched samples of never-married women. Results focus on four variables: happiness about pregnancy; initial acceptance of delivery or abortion; ease of decision-making; and satisfaction with final choice. Path analyses summarize findings, which are discussed in terms of conflict resolution strategies.

DEMOGRAPHIC AND EDUCATIONAL CHARACTERISTICS OF INNER CITY MIDDLE SCHOOL PROBLEM ABSENCE STUDENTS

Results of a study of characteristics of middle school students revealed highly significant differences between problem absence students and non-problem absence students on all study variables except sex. Characteristics such as increasing grade, being behind appropriate grade, busing and special education status, and the particular school attended were highly correlated with this behavior, as were race and increasing age.

The effect of source of prenatal care on care-seeking behavior and pregnancy outcomes among adolescents

This study measured the extent to which pregnancy outcomes of adolescents are related to the environment of the prenatal clinic where they receive care. The study sample consisted of women aged 18 years and under living in a medium-sized urban city in the Northeast, and who delivered their babies during 1984 or 1985 (N = 466). Hypotheses were tested using multiple regression analysis. Findings support the studys hypotheses: adolescents are likely to obtain more adequate care if the prenatal site is attractive and inviting, and if special efforts are made to register and retain them in care, and adequate care results in better outcomes.

An analysis of statistical methods for comparing obstetric outcomes: Infant health in three samples of school-age pregnancies

Abstract Obstetric data on infants to be used in comparative studies should be reported in terms of the joint distribution of the relevant variables, in order that maximum statistical power may be achieved. A ranking test and a scoring method, both of which depend on the joint distribution of variables, are described and applied to the study data. The ranking test and the scoring method are shown to have greater statistical power to detect differences between programs than examination of individual variables by the chi-square test, and the scoring method has the advantages of simplicity and clarity in comparing the outcomes of several different programs. Infants of teen-age mothers who participated in a comprehensive program of medical, social, and education services (YMP) fared better at birth than infants of teen-age mothers who did not participate in such a program (control group). Infants of mothers who participated in a program of special educational and social services with routine medical services could not be shown to fare better than mothers in the control gruop. When the two special programs were compared directly, a statistically significant difference could not be demonstrated, although the program with the greater emphasis on medical services (YMP) showed a tendency in the direction predicted.

School absence; a problem for the pediatrician

Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence was significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families.

The Interaction between Research Consultants and a Clinical Team: A Case Study in Obstetrics:

Clinical programs in increasing number are coming under the scrutiny of research teams comprised of social scientists, statisticians, and others whose expertise and experience are quite different from those of the medical clinician. When the research group’s desire for precise measurement comes in contact with the clinician’s orientation toward patient care each side must learn to yield a bit if the union is to continue and be productive. Several authors have discussed the problems inherent in interdisciplinary research. Since the mental health field was one of the first to encourage social scientists to help explore some of its inner workings, it is not surprising that one of the most detailed reviews of methods and problems is in the mental health area (Luszki, 1958). The voluntary agencies also have been aware of the issue and have documented their experiences in the proceedings of a conference on “Social Research in the Development of Health and Welfare Agency Programs” (State Charities Aid Association, 1961). Others who have written on the subject include Freeman and Sherwood (1965) on large-scale intervention programs and LaSorte (1968) on research in intensive casework techniques. These materials were written from the point of view of the social scientist. What happens when the research team is under the direction of a health educator? Does his training in group dynamics and communication, liis organizational methods, and his other skills enable him to avoid or deal better with the problems inherent in

CHILDREN-AT-RISK IN AN INNER CITY HOSPITAL

The newborn nursery in an inner-city hosp. provides an opportunity for the detection and treatment of abnormalities in a high risk population. Twelve months of births at Boston City Hospital were reviewed to determine the incidence of conditions requiring follow up. This was the first stage of a project designed to determine the extent and sources of follow up care received. Of the 1700 live births studied, approximately 8% were found to have a major or moderate abnormality on the basis of predetermined criteria. An additional 8% were considered at risk because of a medical condition of the infant such as prematurity, hyperbilirubinemia, or RDS; and 6% because of a medical problem of a parent such as a mother with TB, syphilis, or drug and alcohol abuse. Using hosp. records, an attempt was made to locate abnormal and at risk children to determine current status. Only 10% of the sample could be located. Further attempts were made to increase follow up using Neighborhood Health Centers, Head-start, death certificates, Crippled Children Program and Housing Authority records, and were unsuccessful. Welfare data could not be obtained. The inability to find the sample suggests high geographic mobility, self referral to multiple resources for care, parental unawareness, or a resolution of the condition. If the population cpntinues to be at risk without the benefit of needed medical services, then the hosp. has failed in the important area of parental guidance and support.