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This paper reports results from a prospective study of the relationship between mothers' health attitudes and beliefs and their utilization of pediatric clinic services for their children. Attitudinal data were obtained in interviews with a random sample of mothers attending the Children and Youth clinic of a large teaching hospital; data about children's clinic visits during a period of 3 1/2 years subsequent to the interview were abstracted from their medical records. Four aspects of clinic utilization were examined: visits for well-child care; acute-illness visits; accident-related visits; and appointment keeping. Health attitudes were found to be associated with both preventive and illness/accident visits, but in opposite directions. Mothers with an active, interventionist orientation towards health care and mothers who attributed good health and low illness-susceptibility to their children were high users of preventive services and generated few illness/accident visits. Conversely, more passive mothers, and mothers who perceived their children to be in poor health and susceptible to illness, were responsible for fewer well-child and more illness/accident visits. Mothers' agreement with the physician's diagnosis at the index visit was an additional strong predictor of use of well-child services, while disagreement was associated with more visits for illness and accidents. The convenience of appointment times and general satisfaction with the clinic were the best predictors of appointment keeping.

Preventive health behavior is broadly defined to encompass a spectrum of actions that range from voluntary exposure to the risk of disease, injury, or death to active efforts at prevention or detection of disease. Data are presented to show that men, in our culture engage in more risk-taking behavior and take preventive measures less frequently than women, while women avoid risks and take preventive action, particularly when this action requires medical intervention. The literature reviewed supports the hypothesis that these differences in behavior arise out of the socialization and adult role patterns that our society defines as appropriate for each sex. Women, in particular, are encouraged to define their problems in medical terms and to seek help for them within the medical care system.

In studies of the effectiveness of health care organizations, the job satisfaction level of professional staff is often viewed as an “outcome,” since providing a climate that satisfies participants' needs is one aspect of organizational effectiveness. Staff satisfaction, however, has not been linked with outcomes associated with clients. In this article, the authors examine the relationship between the aggregate job satisfaction level of nursing staff in 77 family planning clinics and two client outcomes 1) the aggregate satisfaction level of teenage clients with contraceptive services obtained in the clinic, and 2) the subsequent rate of client compliance with contraceptive prescriptions. Among the variables studied in testing an organizational-level model, it is found that the job satisfaction level of nursing staff is the strongest determinant of the aggregate satisfaction level of clients; client satisfaction level, in turn, predicts the rate of clients' subsequent contraceptive compliance. Staff satisfaction has a noteworthy indirect effect on compliance through client satisfaction. Compliance, however, appears to be more susceptible to variations in clinic structure than to variations in staff satisfaction levels. Implications of these findings for studies of effectiveness of health services and for management of health care organizations are discussed.

This article reports an analysis of individual and neighborhood level effects on the residential mobility of new town residents. The data on which this analysis is based were obtained in a random sample survey of 1,000 households residing in Columbia, Maryland. The results of this survey demonstrate marked differences in the mobility behavior of owner and renter families.Personal considerations based on life cycle stage and dwelling unit satisfaction appear to play the major role in moving decisions of renters, although the data suggest that low-income and black renters may be limited in their decision making by a lack of suburban housing alternatives. Homeowner's moving plans are more strongly affected by neighborhood characteristics.

Data are reported from a random sample survey of residents in an average income inner-city black neighborhood. Respondents' moving preferences and moving plans were equally associated with housing and neighborhood dissatisfaction, and weakly related to family composition or demographic characteristics. The physical condition of the neighborhood and respondents' social ties to the area were most important in their moving preferences and plans. It is suggested that both movers and stayers are limited in their ability to materially change their living conditions through mobility, and some proposals for stabilizing this neighborhood are advanced.

This paper advances the hypothesis that the future of sex mortality differentials in industrialized countries may depend on the future mortality rates of blue collar men. Data are presented to support the argument that mortality rates from ischemic heart disease for this population subgroup play a significant role in current differentials and, furthermore, that sexsocial class-mortality differentials correspond to social structural differences in protection against and/or exposure to health risks. Research and policy implications of this argument are addressed briefly.

The relationship between the increasing participation of women in the labor force, female mortality, and the male-female mortality differential is examined in this work. The mortality experience of women and men 16 to 64 years of age in the Wisconsin civilian labor force is examined for the period 1974 to 1978 through comparisons of central death rates and sex mortality ratios. In general, this study suggests that, at this time, female mortality is not negatively affected by female labor force participation. Furthermore, there is little evidence to suggest that the entrance of women into the labor force will narrow the sex mortality differential in the general population. However, among certain occupation groups, males and females of similar marital status experience mortality rates that are quite similar. Possible interpretations of these unusual findings are presented.

Adoption of the most effective methods of contraception requires individual decision-making and negotiation with contraceptive providers. In order to take account of both behavioral elements, a two-dimensional framework for understanding contraceptive adoption and continuation by unmarried young is proposed, incorporating a "social-psychological model" of individual decision-making and an "interpersonal model" of factors affecting provider-client interaction. The social-psychological model is based on an earlier value-expectancy theory of behavior motivation as applied to health-related behaviors. The interpersonal model is derived from conflict-bargaining perspectives on professional-client interaction; it is suggested that expectations for this interaction are based on a limited number of internalized "models": the "professional"; the "bureaucratic"; the "commercial"; and the "parental." Insofar as client and professional "models" disagree, communication may break down and client understanding and/or acceptance of provider advice cannot be assured. The components of the social-psychological and interpersonal models are described in detail, and a combined framework is proposed.

Previous work has suggested a number of relationships between structural characteristics of medical care units and the quality of medical performance. Detailed chart audits were carried out in five comprehensive child care clinics and measures of clinic structure and staff attitudes were also obtained, making it possible to examine some of the proposed relationships. No association was found between chart quality and hospital goals, levels of clinic bureaucracy, or physicians' training and qualifications. Quality of charts was lower in clinics with predominantly patient care rather than teaching and researchoriented physicians, and higher in clinics where nurses were assigned a major role. The hypothesis is advanced that quality of medical records will be higher under conditions most favorable to sharing of information within the medical team, particularly between doctors and nurses.

Data on sex differences in morbidity are summarized: explanations are sought in the methods of data collection. It is shown that sex differences in morbidity are affected by data collection processes. It is suggested that these effects are a function of variation in the social norms that govern the behaviour of men and women when confronted with physical discomfort, health interviews and medical practitioners.