Further evidence that the family assessment device should be reorganized: response to Miller and colleagues.

Ridenour, Daley, and Reich's (1999) factor analyses of the Family Assessment Device (FAD) indicated that the FAD be reorganized. Miller and colleagues (2000) contend that the FAD be used in its original format based on the FAD's theoretical foundation; however, this does not preclude the importance of scientific scrutiny of an instrument's construct validity to determine how well an instrument represents its theoretical base. Subscale factor analyses (exploratory and confirmatory), item-level factor analysis, and the clinical and psychometric studies cited by Miller and colleagues suggest a more parsimonious FAD configuration and were consistent with Ridenour and colleagues' factor analyses.

Factor analyses of the family assessment device.

The Family Assessment Device (FAD) operationalizes the McMaster Model of Family Functioning, which has been used in numerous studies, translated into seven languages, and is regarded as one of the most researched family assessment tools available. However, exploratory and confirmatory factor analyses using the 7-by-7 matrix of subscale correlations from the original validity study on the FAD (Epstein, Baldwin, & Bishop, 1983) indicated that the FAD subscales overlap substantially and do not assess unique dimensions of family functioning. Results of our study suggest that the conservatively best use of the FAD is using the General Functioning subscale as a summary score. A model that fits the data marginally better than the General Functioning score and a Measurement Error model, however, consisted of "Collaboration" and "Commitment" latent factors. These results illustrated the need for more extensive validity research on the FAD, because interpretation of the factors and subscales had to rely heavily on face validity.

A world view model of health care utilization: the impact of social and provider context on health care decision-making.

This article provides a conceptual model illustrating the filtering effect that social factors have on a health care event. Individual, family and social network filters translate the symptom for the patient before and after s/he enters the health care delivery system. Simultaneously, managed care and provider filters shape what resource is provided by the health care provider to the patient. Basic premises are that decision-making about health care utilization is a complex social interaction and that better attention to the social context will increase the likelihood of effective health care occurring.

Increased population densities of Amblyomma americanum (Acari: Ixodidae) on Long Island, New York.

Lone star ticks, Amblyomma americanum comprised a significantly greater proportion of total ticks flagged on eastern Long Island and Fire Island, New York, in 1986 and 1990 than in samples reported by other authors from the 1940s (when A. americanum was not collected by flagging or from hosts) and the 1970s. Therefore, population densities of A. americanum apparently have increased in recent years on southeastern Long Island, where this species now is distributed widely.

The effects of a prematurity prevention program on births to adolescents.

This study evaluates the effectiveness of the North Carolina Prematurity Prevention Program in reducing low-birthweight births among adolescents seeking prenatal care at the New Hanover Memorial Hospital obstetric clinic. Modeled on programs developed by Papiernik and Creasy, the program includes three components: staff education, patient identification, and patient education. Thirteen percent of the clinic population is 13-17 years old. The same prematurity prevention protocol is used for both adults and adolescents. Overall, 12% of the 847 women who delivered prior to the program had a low-birthweight infant. Among the 748 women who delivered during the program, the number of low-birthweight infants declined to 9.5%. For mothers 13-17 years old, 14% of the preprogram group had a low-birthweight infant, as did 14% of those in the program. A logistic regression model, controlling for certain risk factors, suggests that the program was not effective in reducing low-birthweight births among these adolescents (OR = 0.9; 95% CI = 0.2, 1.8).

Effects of the North Carolina Prematurity Prevention Program among public patients delivering at New Hanover Memorial Hospital.

Twelve per cent of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per cent of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced.