A block rotation in community health and child advocacy: improved competency of pediatric residency graduates.

CONTEXT: Despite increasing recognition of the importance of community health and child advocacy activities by pediatricians, residency programs have had little experience providing this education. There are no known reports examining the effects of such training on residency graduates. OBJECTIVE: To determine whether a program for educating residents in community health and child advocacy, Pediatric Links With the Community (PLC), improved attitudes and competencies of residency graduates. DESIGN: Survey of all graduates of the Rochester Pediatric Residency Program from 1991-2001. Graduates before institution of PLC (pre-PLC) were compared with graduates after institution of PLC (post-PLC). PARTICIPANTS: A total of 137 (81%) of 169 graduates participated; 78 (85%) of 92 were in the pre-PLC group and 59 (77%) of 77 were in the post-PLC group. INTERVENTION: PLC provides all pediatric residents with a 2-week rotation working with multiple community-based organizations. OUTCOME MEASURES: Differences between pre-PLC and post-PLC graduates in self-reported attitudes and competencies in multiple community health and child advocacy activities on 4-point Likert scales. RESULTS: The pre-PLC and post-PLC groups' attitudes toward community health activities were equally positive (3.4 vs 3.5, P =.08). The post-PLC group rated its competency higher in 8 of 12 activities (P <.05); its overall rating of competency was also higher (2.8 vs 2.3, P <.001). CONCLUSIONS: Although all pediatricians surveyed had positive attitudes toward community health and child advocacy activities, those who participated in PLC had higher self-perceived competency in most activities. Residency training programs can increase graduates' competence in community health skills.

Keeping middle school students abstinent: outcomes of a primary prevention intervention.

PURPOSE: (a) To test the longer-term (6-12 month) effect of a school-based intervention designed to delay the onset of sexual intercourse on continuation of abstinence, (b) to compare the effect of the intervention when delivered by different providers, and (c) to describe the factors that influence students' transition from abstinence to sexual activity. METHODS: This study was a nonrandomized control trial with one control and three intervention groups. The setting was health education classes in urban, predominantly ethnic minority schools. The participants were middle school students (N = 1352; mean age, 13.1 years) in five schools. Of participants, 50% were African American, 20% white, 16% Hispanic, and 14% other. Youth were assigned to one of four groups. The control group consisted of the regular school health curriculum and teacher. All three intervention groups received the Rochester AIDS Prevention Project curriculum, but implemented by different types of instructors, including ethnically diverse male-female pairs of adult professional educators; male-female pairs of extensively trained high school peer educators; and school district health teachers. A confidential questionnaire administered preintervention and at long-term follow-up (mean, 44 weeks) measured demographics, risk behaviors, and sexual intercourse history. RESULTS: At preintervention, 27% of girls and 62% of boys reported sexual intercourse experience. At follow-up, 19% and 32%, respectively, of the previously abstinent girls and boys had "transitioned" to sexual activity. Increasing age (p <.01, females; p <.001, males), lower socioeconomic status (p <.0001), and higher general risk behaviors (p <.0001) best predicted the transition. Logistic regression indicated that the intervention was effective for peer-taught males (p =.02) and regular teacher-taught males (p =.001) and females (p =.05). CONCLUSIONS: Successful abstinence maintenance was only possible among those subjects who were not already sexually experienced at study enrollment. Baseline scores regarding intercourse and general life risks already evident by seventh grade suggest that urban, school-based primary prevention interventions must occur before adolescence. Early adolescence interventions need to include both abstinence and safer sex messages.