Promoting community-based maternal and child health services: a university-health department partnership.

OBJECTIVES: Funded by the Federal Maternal and Child Health Bureau, a partnership between the Johns Hopkins University School of Public Health, Department of Maternal and Child Health (JHU), and the Baltimore City Health Department (BCHD) identifies maternal and child health problems, and develops appropriate interventions. This paper presents the organization and activities of the JHU/BCHD Maternal and Child Community Health Science Consortium as a result of overcoming traditional barriers to collaborative efforts, and discusses what role the Consortium has had in its own collaborative success. METHOD: A review of the literature uncovered a number of barriers to productive interaction. A number of factors contributing to overcoming the barriers was also revealed. The organization and activities of the work of the JHU/BCHD Maternal and Child Community Health Science Consortium has been applied to these barriers and associated factors, and discussed in context of implications for future collaborative efforts. RESULTS: The Consortium has developed a fully integrated administrative structure bridging both the BCHD and JHU. The mission of the Consortium has been translated into four categories of work, each one designed to complement, extend, and augment the other. The infrastructure established in Baltimore, as a direct result of this partnership, has served to overcome traditional barriers to productive academic/agency collaboration, while promoting organizational productivity. This outcome is a result of overcoming the recognized barriers to collaboration. CONCLUSIONS: Health agencies and university public health programs must link resources and collaborate to address public health issues. Commitment to a collaborative approach to the public's health will determine its future.

Politics and practice: introducing Norplant into a school-based health center in Baltimore.

As one element of Baltimore's effort to combat its high rate of teenage pregnancy, the Baltimore City Health Department added the implantable contraceptive Norplant to the array of services offered at one of its school-based health centers in early 1993. The initial findings with the adolescents who received this contraceptive at the school were favorable, particularly regarding condom use, parental involvement, and patient acceptance of the contraceptive. This new policy garnered a significant amount of attention, both nationally and locally. It attempts to address problems that have complicated etiologies as well as diverse clinical, social, and ethical ramifications, all complicated by political realities. The Norplant experience offers useful lessons regarding controversial health initiatives that address problems facing public health practitioners today.

Cancer mortality in Maryland: when being a leader is not best.

Maryland has the second highest statewide cancer mortality rate in the nation. This ranking is primarily due to high death rates for the most prevalent cancers: lung, breast, colon, and prostate. Based on the recent literature and the October 1991 preventive medicine grand rounds at the Johns Hopkins University School of Hygiene and Public Health, this paper summarizes several current viewpoints on cancer mortality in Maryland and the progress that has been made by recently instituted state and community initiatives.

When children have children: the teen pregnancy predicament.

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

PIP: The birthrate among both white and African-American US young women 15-19 years old declined steadily from 89.1 live births per 1000 women (LB/1000) in 1960 to 51.3 LB/1000 in 1985, as a result of the availability of contraception and abortion. The rate has since risen to 62.1 LB/1000 in 1991. In contrast, the birthrate among unmarried young women 15-19 years old increased from 15.3 LB/1000 in 1960 to 42.5 LB/1000 in 1990. The birthrate among white unmarried adolescents more than tripled over the past three decades. The Johns Hopkins University School of Public Health revealed a rise in overall sexual activity from 28% in 1972 to 50% in 1979 in interviews of a national sample of 15-19 year olds. After the Supreme Court decision in Roe v. Wade, 232,440 abortions were performed in 1973 to 15-19 year olds and that number rose to 444,780 by 1980. Title IX of the Civil Rights Act prohibited the exclusion of girls from schools on the basis of pregnancy. In 1977 the Supreme Court struck down a statute that prohibited the sale of nonprescription contraceptives to minors under 16. Reports by the Centers for Disease Control and Prevention identified 1,559,110 legal abortions in 1987, of which 26.1% were to women younger than 20 years old. The adolescent seeking an abortion faces clinical disclosure and parental consent. According to a 1985 poll, 85% of Americans approve of sex education. Nearly 60% of 12-17 year olds surveyed in 1986 said that they had taken a course or had a class on sex education. However, in a 1988 survey of over 4000 public school teachers, only 84% of teachers were in programs that included sexual decision making, abstinence, and birth control methods. Adolescent childbearing may represent normative behavior for those coping with the stress of poverty. Adolescent pregnancy is associated with low birthweight, preterm labor and delivery, poor maternal weight gain, hypertension, anemia, and sexually transmitted diseases.

Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws.

We examined the extent to which psychosocial factors, in addition to the presence of a law, are associated with the use of bicycle helmets. A mailed questionnaire was completed by 3494 children in fourth, seventh, and ninth grades in three Maryland counties: Howard County, which had a law requiring child bicyclists to wear helmets and an educational campaign; Montgomery County, which had an educational campaign but no law; and Baltimore County, which had neither. Overall, 19% of the respondents reported having worn a bicycle helmet on their most recent ride. In a multiple logistic regression, children's use of helmets in all three counties was significantly associated with their beliefs about the social consequences of wearing helmets and the extent to which their friends wear helmets. Significant interactions were also found, suggesting that in the presence of a law, an educational campaign, or both, children's use of helmets was associated more with social concerns than with parental influences or cognitive factors, such as beliefs about the need for helmets or perceptions of risk. To increase helmet use, the issues of stylishness, comfort, and social acceptability of wearing helmets need to be addressed and more widespread adoption of bicycle helmet laws should be encouraged.

Baltimore City Health Department: 200 years of progress and partnership.

The Baltimore City Health Department began its long history of protecting the health of Baltimore citizens in 1793. An outbreak of yellow fever in Fells Point on the northwest branch of the Patapsco River was the impetus for the governor's appointment of the first two health officers. Since that time, the health department has worked closely with the medical community to promote education and preventive measures (e.g., sewer systems, water chlorination, food inspection) in order to stop the spread of communicable diseases. For 200 years, the Baltimore City Health Department has provided "the advocacy and leadership necessary to ensure the protection and promotion of the health of Baltimore's citizens."

Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use.

OBJECTIVES: The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use. METHODS: In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws. RESULTS: Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly. CONCLUSIONS: Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use.