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The COVID-19 virus brought on a public health emergency that massively disrupted school systems and learning nationwide. During the 2020-2021 school year, many local education agencies (LEAs) in Pennsylvania and other states adopted remote learning to help slow the virus's spread. However, remote learning came with challenges for students, families, and LEAs. These challenges included very practical ones like not having a reliable internet connection or the correct link to log into classes, as well as fatigue from so many remote meetings and feelings of social isolation. This brief examines remote learning in Pennsylvania and its role in shaping education outcomes and COVID-19 case rates in local communities during the 2020-2021 school year. Key findings for the 2020-2021 school year: (1) Vulnerable groups of students were more likely than students overall to attend LEAs where the predominant instructional modes included remote learning; (2) The same groups of students were also more likely to be in LEAs where larger shares of the student population had trouble accessing reliable internet; (3) More remote learning was associated with lower assessment performance in grades 5-8, especially in schools with higher levels of economic disadvantage. It was also associated with lower suspension rates in grades 6-12 and did not appear to harm or help graduation rates; and (4) Remote learning in high school was associated with lower subsequent COVID-19 rates within an LEA's boundary, suggesting it had an important public health benefit. [Contributions from Candy Miller, Rhonda Johnson, and Rosemary Riccardo.]

The National Strategy for the COVID-19 Response and Pandemic Preparedness provides a roadmap to guide America out of the worst public health crisis in a century. It outlines an actionable plan across the federal government to address the COVID-19 pandemic, including twelve initial executive actions issued by President Biden on his first two days in office. The National Strategy is organized around seven goals: (1) Restore trust with the American people; (2) Mount a safe, effective, and comprehensive vaccination campaign; (3) Mitigate spread through expanding masking, testing, data, treatments; health care workforce, and clear public health standards; (4) Immediately expand emergency relief and exercise the Defense Production Act; (5) Safely reopen schools, businesses, and travel while protecting workers; (6) Protect those most at risk and advance equity, including across racial, ethnic and rural/urban lines; and (7) Restore U.S. leadership globally and build better preparedness for future threats. To execute on the National Strategy, the White House will establish a COVID-19 Response Office responsible for coordinating the pandemic response across all federal departments and agencies. Through implementation of the National Strategy, the United States will make immediate progress on the seven goals. To monitor outcomes, the National Strategy includes the creation of publicly accessible performance dashboards, establishing a data-driven, evidence-based approach to evaluating America's progress in the fight against COVID-19. Full implementation of the National Strategy for COVID-19 will require sustained, coordinated, and complementary efforts of the American people, as well as groups across the country, including State, local, territorial, and Tribal governments; health care providers; businesses; manufacturers critical to the supply chain, communities of color, and unions. It will also require a global effort to contain the virus and advance health security. In collaboration with the people of this country, the United States government will lead an effective COVID-19 response that turns this crisis into a crucible, from which the nation will forge a stronger, better, and more equitable future.

The decision about how and when to open schools to in-person instruction has been a key question for policymakers throughout the COVID-19 pandemic. The instructional modality of schools has implications not only for the health and safety of students and staff, but also student learning and the degree to which parents can engage in job activities. We consider the role of instructional modality (in-person, hybrid, or remote instruction) in disease spread among the wider community. Using a variety of regression modeling strategies to address unobserved heterogeneity, we find that simple correlations show in-person modalities are correlated with increased COVID cases, but accounting for both pre-existing cases and a richer set of covariates brings estimates close to zero on average. In Ordinary Least Squares (OLS) specifications, in-person modality options are not associated with increased spread of COVID at low levels of pre-existing COVID cases, but cases do increase at moderate to high pre-existing COVID rates. A bounding exercise suggests that the OLS findings for in-person modality are likely to represent an upper bound on the true relationship. These findings are robust to the inclusion of county and district fixed effects in terms of the insignificance of the findings, but the models with fixed effects are also somewhat imprecisely estimated.

To educate students while mitigating the spread of COVID-19 during the fall of 2020, schools across the country used different operational approaches, ranging from fully remote instruction to fully in-person instruction with various "hybrid" approaches in between. This report was prepared for the Pennsylvania Department of Education (PDE) to determine whether there is evidence that districts using hybrid approaches (alongside precautions such as mask-wearing and physical distancing) can successfully mitigate in-school virus transmission. Mathematica identified seven school districts across the state to examine whether COVID-19 incidence trends for students and staff in Pennsylvania school districts using hybrid instruction paralleled or exceeded trends in the local community during the fall of 2020.

The novel virus caused by COVID-19 has disrupted life across the country and led to nationwide school closures. In the midst of this disruption and uncertainty, young people, teachers, parents, and other youth-serving professionals are working in new and creative ways to support young people's education. In the interest of understanding how young people are doing in the midst of this crisis, the Center for Promise at America's Promise Alliance conducted a nationally representative survey of youth across the country (N=3,300; 14.4% black, 25.3% Latinx, 49.4% white, 5.7% Asian, 3.8% multi-racial; 50.5% male, 48.5% female, 1% non-binary). This appendix provides a demographic summary of the young people surveyed, each survey question asked, along with how young people responded. [For the main report, see ED606305.]

The public health crisis created by the spread of COVID-19 has disrupted day-to-day rhythms across the United States, including an extended closure of school buildings. Myriad news sources and emerging research are reporting on the deep and disparate effects that are reverberating from these closures. But how do young people themselves perceive the impact so far on their learning and their lives? To answer this question, the Center for Promise at America's Promise Alliance collected data from a nationally representative survey of 3,300 young people, aged 13-19, that was conducted as part of the "How Learning Happens" initiative. Respondents were asked a series of questions about their social, emotional, and academic experiences across both school and out-of-school-time learning settings, including a set of questions related to their specific experiences since being out of school as a result of COVID-19. At the time of the survey administration, a two-week period during late April and early May 2020, two-thirds of respondents had been out of school for more than four weeks. This research brief offers a snapshot of young people's self-reported: (1) Participation in online learning; (2) Connections to peers, adults at school, and their school community; (3) Top-of-mind concerns; and (4) Indicators of health and wellbeing. Findings suggest that students are experiencing a collective trauma, and that they and their families would benefit from immediate and ongoing support for basic needs, physical and mental health, and learning opportunities. Without that support, this moment in time is likely to have lasting negative effects for this cohort of high school students. [This research received additional funding from Sanford Programs at National University System. For the appendix to this report, see ED606306.]

This report evaluates the COVID-19 situation after the release of the report, "A Blueprint for Back to School," which offered a framework for safely reopening schools in the fall. The report reflected the insights from 20 former federal officials, state school chiefs, and superintendents, many drawing on their experiences leading education systems through times of crisis. Schools that have reopened across Europe offer important lessons for schools in the United States, including the need to accommodate parents who feel it is unsafe to send their children back to school. States are releasing their own guidance for reopening schools. Many plans include staggered schedules, social and emotional learning supports, and academic acceleration. Across income levels, racial demographics, and political ideology, parents believe their children are spending less time on schoolwork (40 percent) and are learning less (46 percent) than they normally would in school. [For the report, "A Blueprint for Back to School," see ED606266.]

COVID-19 has profoundly affected educational institutions across the Commonwealth of Pennsylvania, as it has in the rest of the country and around the world. Since March 2020, school buildings statewide have been closed. Although many schools have worked hard to provide instruction remotely, it is likely that schoolchildren all over the state are missing out on a substantial amount of learning, with educational losses and other hardships that are likely to be greater for some of the same populations that are disproportionately harmed by the disease itself, creating a serious equity challenge. As educational institutions plan for re-opening in Fall 2020, the Pennsylvania Department of Education (PDE) needs to provide guidance to assist schools in developing policies and procedures for mitigating the spread of COVID-19 and ensuring the safety of their students and staff. In May, PDE approached their partners at the U.S. Department of Education's Mid-Atlantic Regional Educational Laboratory (REL) to provide analytic support for their guidance. In the face of enormous uncertainty, PDE needs to produce a guidance document that outlines options for fall school openings while addressing infection risk, educational impact, and community concerns, with attention to equity throughout. To inform PDE in developing this guidance, REL Mid-Atlantic researchers undertook three tasks: (1) They conducted a rapid review of existing evidence on public-health and educational issues relevant to reopening schools; (2) They interviewed a cross-section of stakeholders from around PA; and (3) They used an agent-based model (ABM) (Koopman, 2002) to simulate the potential spread of COVID-19 under alternative approaches to reopening schools. This memo describes their findings from each of the three tasks. [For the Pennsylvania Department of Education.]

As COVID-19 wreaks havoc on institutions and the students they serve, ushering in a recession that could have existential implications for all, helping learners earn the credentials they need from the providers best suited to serve them will be a critical issue in determining how well and robustly the nation recovers. The federal government has already provided increased financial support to postsecondary students and institutions. More stimulus funds are likely on the way, offering a rare opportunity to not just shore up existing models, but also to provide a much-needed jolt to the calcified collegiate system, and to rethink how its players interact. Directing additional funds toward interoperability issues could go a long way in alleviating credit transfer challenges. In order to tackle higher education's credit transfer challenge, the Department of Education, along with state departments of higher education, should foster a parallel higher education system in which they support third-party credentialing entities that validate industry-valued skills. Regulators would use additional dollars that are focused on training students for in-demand jobs in this time of rampant unemployment, such as expanded Pell grants, to fund these efforts. This move away from an institution-centered posture to one in which third-party bodies are the assessors of quality and gatekeepers of credentials would skirt the debates about whether learning at one institution is equivalent to that of another. Such a learner-centered approach, focused on the accumulation of knowledge and skills, would facilitate seamless transfer without credit loss, shift significant portions of higher education from seat-time to competency-based learning, and help learners transition expeditiously back into the workforce.

The COVID-19 pandemic has brought unprecedented challenges to the schools, the economy, and the nation's families, exacerbating racial inequities and placing a disproportionate burden on communities of color throughout the country. While physically opening schools at the beginning of the 2020--2021 school year is the goal of most districts, the decision of when to reopen school buildings must be rooted in health and safety and not based on an arbitrary start date or any other priority. However, COVID-19 has also brought an opportunity to reimagine and reengineer the policies and processes that have benefited some students while not prioritizing other students, specifically under-resourced students, Black and Brown students, and students with disabilities. The document, "All Hands On Deck: Initial Guidance Regarding Reopening School Buildings," is a preliminary step toward reimagining the schools as environments that are moving from equity to justice so that students and educators are safe and healthy, and they are able to teach and learn regardless of school, community, race, class, or ability. This guidance is rooted in four basic principles: (1) Health Expertise: Health and safety of all as advised by science is fundamental; (2) Educator Voice: Educators' voices and expertise are front and center as part of decision-making and implementation; (3) Access to Protection: Educators and students need consistently funded access to personal protective equipment (PPE) and the ability to disinfect surfaces regularly; and (4) Leading with Equity: Achieving racial and social justice is imperative and not an expendable aspiration.

Ohio's public schools provide special education services to children with disabilities as early as preschool. Every year, the Ohio Department of Education reports the number of preschool children who received state-funded special education services during the previous year. The 2016-2017 school year had an overall increase of 1,142 (5.9 percent) preschool-age children receiving special education services compared to the prior year. Developmental Delay and Speech or Language Impairment are the most common disability categories among preschool-age children. More than 80 percent (16,197) of children served in preschool special education receive services under one of these two eligibility categories. Autism accounted for 8.9 percent of the total; and the category Multiple Disabilities combined with Other Health Impairment -- Minor made up another 8.3 percent.

By 16 March 2020, most education systems in the EU neighbourhood and Central Asia had closed their schools. In a matter of days, some distance learning was offered in most systems and in the ensuing weeks, most countries steadily broadened the offer and the extent of participation. This short report aims to describe what happened in the countries of the EU neighbourhood and Central Asian during the COVID-19 crisis. It documents the truly impressive achievements, while providing a reality-check for those who see the internet as the means to fulfilling the promise of education for all, whenever and wherever. This report builds on the mapping of the responses of 27 education systems in South Eastern Europe, Turkey, the Southern and Eastern Mediterranean, Eastern Europe and Central Asia. The analysis is based on desk research and interviews conducted with key informants, generally in ministries and national agencies, over a three-week period from 20 April to 13 May. The mapping aimed to find out about the nature and the extent of distance learning in response to the COVID-19 crisis, the methods used, and how it is managed, regulated and implemented. The investigation has focused on the uptake of distance learning across compulsory public education systems, and, where possible, also in vocational and work-based learning contexts. One conclusion of this report is that better monitoring of competence, capability and participation in DDL will help countries make the most of the COVID-19 response and better prepare for and meet learning demands. This mapping nevertheless gives evidence of the capacity of educational systems to change. In particular, it demonstrates that, with the right support and training, many teachers were able to change how they teach in a very short period of time. However, the report also makes plain that countries that did not invest in educational technology and professional development and did not have organisations able to take the lead in the crisis, have been at a disadvantage. It also reveals that Digital Distance Learning is not a panacea: there are considerable challenges with respect to inclusion, pedagogy, connectivity, engagement and quality.

The UK's world-leading universities transform lives, enrich local communities, drive regional and national economic growth, and improve society and social justice. As the UK begins to recover from the disruption of the global coronavirus (Covid-19) pandemic, it is imperative that its universities can emerge from lockdown safely and in line with guidance from governments, public health advice and health and safety legislation. The following principles and areas to consider provide a framework for individual universities to adapt to their own institutional settings and contexts. It is not an exhaustive list but covers a range of priority issues. This publication does not set prescriptive rules for universities but instead identifies key considerations, resources and advice to support them in meeting each individual principle.

This is the third in a series of snapshot reports on COVID-19's impact on practice. American Association of Collegiate Registrars and Admissions Officers (AACRAO) has deployed guidance on a range of topics in support of institutions of higher education. This survey focused on the following: (1) The receipt and delivery of official transcripts and standardized test scores; (2) Transfer credit evaluation; and (3) Fall term calendar and session impacts. This was a bit of a catch-all survey to address questions that have been asked in the last couple of weeks. The survey was open for two business days, and 569 responses were received in that timeframe (95% from U.S. institutions). [For "Impact of COVID-19 on Grading, Transcript and Commencement Practices: Results of the AACRAO COVID-19 Snapshot Impact Survey #1. Amended," see ED606286; "Undergraduate Enrollment Indicators, Impact on Admissions Practice and Fall Course Delivery: Results of the AACRAO COVID-19 Impact Snapshot Survey #2," see ED606287; and "Enrollment Indicators, Fall Course Delivery, Fall Calendar and Social Distancing Measure Plans as of May 20, 2020: Results of the AACRAO COVID-19 Impact Snapshot Survey #4," see ED606289.]

A small portion of Americans account for a disproportionate amount of the incidences of sexually transmitted infection observed over a short period of time. Studies with adults have begun to characterize this population, yet there is very little data on adolescent sexually transmitted infection repeaters (STIR). This study explores characteristics associated with STIR among 102 girls and 93 boys (aged 14-18) court-referred for residential treatment. Background characteristics, substance use disorders, risky and interpersonal behaviors, and history of sexually transmitted infections were collected at intake using valid and reliable instruments. A negative binomial logistic regression was performed to determine the background, risky behaviors, and social patterns associated with adolescent STIR. Approximately two out of three adolescents (62%) did not use contraception the last time they had sex, and 15% had at least one sexually transmitted infection recorded in their medical chart. Sexually transmitted infection repeaters entered treatment with higher rates of cocaine abuse (13%) than youth without multiple infections (3%, p < 0.05). History of sexual abuse, having sex with a person who said no, higher exhibitionism, and social estrangement increased the odds of adolescent STIR. Main effects of exhibitionism and social estrangement on increased odds of STIR were more pronounced for sexually abused adolescents. The findings suggest a need for incorporating HIV education during residential treatment to improve health outcomes and intervention strategies that further connectedness for youth and victims of sexual abuse. [This paper was published in "American Journal of Drug and Alcohol Abuse" v41 n3 p230-236 May 2015.]

The COVID pandemic has led to a prolonged period of educational disruption with few precedents from the recent past to guide recovery. The Institute of Education's project, "Learning Through Disruption," set out to explore the knowledge schools have acquired from working with children and families during the crisis. The authors found that schools adapted what they were doing as they became more aware of local circumstances and found new ways to address the diversity of pupils' and families' needs. In the process they have developed a deep and sophisticated understanding of their communities. This provides the basis for deciding how teaching and learning can best rebuild going forward. This brief report highlights their findings and offers recommendations. [For the main report, "Learning through Disruption: Using Schools' Experiences of COVID to Build a More Resilient Education System," see ED615116.]

By April 15, 20 states had ordered child care centers to close in the wake of COVID-19, with exceptions for programs serving the children of essential workers such as health care professionals. Other states modified regulations, with some reducing class sizes to 10 or fewer. Especially for struggling providers, the emergency presents real financial hardship. Without support, many may never open their doors again. This policy brief touches on key components provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to child care centers as well as emergency child care provided to frontline doctors, nurses, police, and firefighters in some states. This is followed by policy considerations at the state and federal level.

State and local officials who shuttered school buildings to stem the spread of COVID-19 in early 2020 are beginning to plan for the return of students and staff. They will need evidence-based strategies to know how best to create and maintain safe, healthy spaces. To inform their plans, federal health officials have provided guidance on cleaning and disinfection of facilities, appropriate chemicals to use for disinfection, and protocols for countering ongoing virus threats. To help schools clean and disinfect and to assist in counseling and distance learning and associated costs, Congress appropriated $100 million in the Coronavirus Aid, Relief, and Economic Security Act to Project SERV (School Emergency Response to Violence), a program administered by the U.S. Department of Education. These funds are authorized for dissemination through September 30, 2021. Districts and schools will want to prepare their facilities to be safe, healthy places to which students can return. State officials can support districts as they develop plans for closure, cleaning, and reopening of school facilities, both now and in future crises. States should ensure that districts with less capacity to manage operations, less knowledge of strategies to limit infectious disease, or without detailed closure and reopening plans are not disadvantaged at a time when all schools need guidance to ensure the safety of all individuals that come in contact with the school building.

"Spina bifida" is one of the most common birth defects in the United States, affecting some 1,500 babies each year. Spina bifida happens during the first month or so of pregnancy and means that the baby's spine did not close completely. Damage to the nerves and the spinal cord may result. Following a brief story about a child with a Spina bifida, Juan José's Story, this fact sheet presents information on the following: (1) The 3 types of Spina bifida; (2) Incidence; (3) Characteristics and Health Considerations; (4) Help for Babies and Toddlers; (5) Help for School-Aged Children; (6) Educational Implications; and (7) Resources.

This paper examines the effect of fall 2020 school reopenings in Texas on county-level COVID-19 cases and fatalities. Previous evidence suggests that schools can be reopened safely if community spread is low and public health guidelines are followed. However, in Texas, reopenings often occurred alongside high community spread and at near capacity, making it difficult to meet social distancing recommendations. Using event-study models and hand-collected instruction modality and start dates for all school districts, we find robust evidence that reopening Texas schools gradually but substantially accelerated the community spread of COVID-19. Results from our preferred specification imply that school reopenings led to at least 43,000 additional COVID-19 cases and 800 additional fatalities within the first two months. We then use SafeGraph mobility data to provide evidence that spillovers to adults' behaviors contributed to these large effects. Median time spent outside the home on a typical weekday increased substantially in neighborhoods with large numbers of school-age children, suggesting a return to in-person work or increased outside-of-home leisure activities among parents.

This report, the fifth in the National Center for Early Development & Learning's (NCEDL) "Spotlight" series, is based on excerpts from a paper presented during the "Research into Practice in Infant/Toddler Care" synthesis conference in fall 1997. The report addresses preventing respiratory infections in child care centers. Findings on the subject include: (1) children under the age of 3 who attend child care have more respiratory infections than children of the same age who are cared for at home; the severity of these infections in young children is also greater; (2) children who are routinely in contact with only 3 children daily rather than 30 children have less of a chance of coming into contact with an infectious agent; and (3) children attending child care will be infected with viral respiratory infections earlier than children living at home with no siblings in school. The report notes that, curiously, a synthesis of research reveals no evidence that excluding sick children from a child care center reduces the incidence of acute respiratory disease, and that a hygienic intervention conducted in child care centers resulted in no significant differences in the rates of illness. The report concludes with suggestions for future research. (EV)

Preventing the spread of Acquired Immune Deficiency Syndrome (AIDS) among women is a national priority. In the United States, AIDS is the sixth leading cause of death among young adult women, and their rate of infection is four times higher than men. This article was developed to help stimulate interest in the power dynamics of relationships and how these might influence adolescent women's risk for acquiring the virus (HIV) that causes AIDS. It explores how high-risk adolescents view their personal power, the degree to which they see themselves as powerful in their ability to influence their steady partner and their relationship, and if these perceptions of power improve their ability to engage in safer sex behaviors. Preliminary analysis lends some support to previous theory and qualitative studies that suggested adolescent women's power and empowerment should be consideration for HIV prevention among high-risk adolescents. Also, an understanding of power dynamics in relationships is complex and must be contextualized in respect to gender and race. The pattern of results supports previous research that has found racial and gender differences in viewing power, relationships, and condom use. Preventing the spread of HIV and AIDS requires a clear understanding of the ways in which gender, culture, and developmental issues interact in contributing to safer sex behaviors. (Contains 85 references and 3 tables.) (JDM)

Women are a rapidly growing group of people with AIDS in the United States, and Hispanic/Latina and African American women are disproportionately represented. This paper reviews the literature on the epidemiology of AIDS/HIV infection among Latina women, children, and adolescents and discusses the needs of Latinas regarding AIDS prevention education. Approximately a half million U.S. cases of AIDS had been reported through October 1995, of which women accounted for 11 percent. Hispanics and African Americans represented 21 and 53 percent, respectively, of cases among women. Intravenous drug use by self or partner was a major risk factor, particularly in the Northeast. Children under age 13 were usually infected via maternal transmission, and Hispanic children accounted for a third of pediatric cases. Inner-city adolescents were also at increased risk for HIV infection related to high-risk sexual behaviors and drug abuse. Other risk factors for Latinas are poverty, lack of access to health care, inadequate prenatal care, culturally prescribed gender roles and attitudes, and socioeconomic and political disempowerment. Educational interventions must address the needs of Latinas within cultural context. Cultural norms may dictate that a woman appear sexually naive, making it difficult for her to negotiate safe sex practices. Development of peer support groups may be the best approach. Recommendations are offered for working with the Hispanic community. (Contains 27 references.) (SV)

This report discusses the role that school health centers can play in providing comprehensive health care and health education services to adolescents and reviews the effectiveness of such health centers in three Chicago high schools. School-based health centers need to stress: (1) high-quality care; (2) parental, school, and community involvement; (3) consistent care from trusted adults; (4) convenience, affordability, confidentiality, and respect; (5) support and education; (6) flexibility and openness; and (7) comprehensiveness. Three such centers were opened by the Ounce of Prevention Fund in three Chicago high schools in economically-depressed areas in the mid-1980s with financial support from state and private organizations. The centers were found to contribute to adolescent health by greatly increasing the number of students who visited school health centers, reducing the number of low birthweight babies born to student mothers, and providing various health maintenance and education services to students. The report argues that school-based centers need adequate financial support to provide high-quality, comprehensive services, and that such support should be mandated in any future health care reform initiatives. (Contains 18 references.) (MDM)

Hudson Valley Migrant Health (HVMH) (a Public Health Service program) collaborated with the Center for Disease Control (CDC) and the New York State Department of Health (NYSDOH) on a study of the incidence of sexually transmitted diseases and tuberculosis among migrant farmworkers in the mid-Hudson region of New York. CDC research personnel screened 115 migrant workers from August 31 to September 12, 1992, distributed results, and initiated treatment. HVMH assumed primary responsibility for follow-up. Other agencies offered support during both phases of the study. Screening results indicated a 36 percent tuberculosis positivity, 6 percent HIV positivity, and 32 percent syphilis positivity. In addition, 32 percent lacked immunity to the Hepatitis B virus. Barriers to providing screening and health care include: (1) limited hours of access both by farmworkers to health care, and by providers to farmworkers because of work schedules; (2) underdeveloped linkages with county departments of health; (3) travel distances and lack of transportation for follow-up; (4) inefficient transfer of medical information upstream and downstream; and (5) limited staff and financial resources of HVMH for the extensive follow-up required. Nine recommendations are offered; they include adopting more positive attitudes toward farmworkers; improving collaboration and coordination among agencies; coordinating interstate Medicaid coverage; establishing outreach, health education, translation, and transportation services; and increasing the role of the Public Health Service. (KS)

Previous research has shown that, unlike novice physicians' performance, diagnostic quality of expert physicians improves when contextual information (the "Enabling Conditions") about a patient is available. The present study was designed to explore these findings further by systematically varying the typicality of enabling conditions and consequences (signs, symptoms, and complaints) of a case, and determining the effect of this manipulation on subjective disease probability estimations. Subjects were 25 sixth-year (resident) students and 30 experienced family physicians in the Netherlands. A significant interaction was found between expertise level and typicality of enabling conditions in cases with prototypical consequences, but not in cases with atypical consequences. The implications of these results are discussed in terms of the illness-script theory. Two figures and one table present study data. (Contains 20 references.) (Author/SLD)

Among Latinas, the number of cases of Acquired Immune Deficiency Syndrome (AIDS) is increasing relentlessly. From August 1989 to August 1990, there was a 53 percent increase nationally in cumulative AIDS cases among Latinas. In New York City, AIDS is the leading cause of death among Latinas aged 25-34. The conditions and circumstances that place Latinas at greater risk for Human Immunodeficiency Virus (HIV) infection are poverty, substance abuse, lack of access to primary health care, late or no prenatal care, increase in sexually transmitted diseases, high rates of adolescent pregnancy, and culturally prescribed gender roles and sexual attitudes. Poverty in the Latino community reduces access to quality health care and is conducive to the transmission of HIV. Victims of poverty have already compromised immune systems, they receive disease prevention information too late, they forego treatment of sexually transmitted diseases, and they do not receive adequate treatment for substance abuse. Intravenous drug use is the primary mode of transmission of HIV among Latinas. In addition, Latinos have low rates of condom use due to traditional male attitudes and the reluctance of women to promote condom use. An underlying danger in HIV/AIDS prevention programs targeted to women of reproductive age is the potential for abuses of reproductive rights. Health care providers may overtly, or covertly, promote reproductive decisions (contraception, sterilization, and abortion) that conflict with a woman's religious beliefs and deeply valued procreative needs. Prevention strategies must be comprehensive and address the impacts of class, gender, and political disempowerment; limited access to health care; and high risk of infection. (KS)