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Background: Adolescent health care in family practice at times creates conflicting responsibilities for parents and their teenagers. In the context of a new adolescent preventive health program in a family practice setting, we compared attendance rates using two invitation protocols, the protocols differing in their emphasis on adolescent autonomy vs parental responsibility., Methods: One hundred six teenagers in the seventh and tenth grades were invited for preventive health visits with the family nurse and physician using two protocols. Protocol 1 involved obtaining parental consent before approaching the adolescent. With protocol 2, an invitation letter and parental consent form were mailed to the teenager, while a letter of explanation was sent concurrently to the parents. In each case, the letter of invitation was followed up by a telephone call for those who did not respond. The spontaneous response rate (a positive response after receiving the letter), agreement to attend rate (a positive response after receiving the letter or being telephoned), and the attendance rate were determined according to grade, sex, and protocol., Results: The spontaneous response rate was 21%, the agreement to attend rate was 75%, and the attendance rate was 44%. Attendance rates were higher for the girls compared with the boys (54% vs 35%, P = .08) and for the seventh graders compared with the tenth graders (53% vs 31%, P = .03). The spontaneous response rate was lower among the tenth graders using protocol 2 (8% vs 37.5% with protocol 1, P = .04), while the agreement to attend rate and attendance rate did not differ for the two protocols., Conclusions: Nearly one half of this population of adolescents attended preventive health visits at the family nurse's and physician's initiative. A follow-up telephone call after the initial written invitation resulted in increased participation, while approaching the teenager or parent initially did not make a difference in attendance. This pilot study shows the potential for initiating an adolescent health program in the family practice setting.

Purpose: To study the distribution, prevalence, determinants, and association between the health, social, and environmental concerns and risk behaviors of high school students in Jerusalem in order to provide a better basis for preventive and health promotion services., Methods: 1078 tenth grade high school students, 15-16 years old answered an anonymous questionnaire including, perceived concerns and risk behaviors, (e.g., smoking, alcohol, drugs, and sexual activity). Concerns were grouped into six domains., Results: The most frequently reported concerns related to school, weight, coping with aggression, fatigue, war, enlistment into army, and relationships with peers. Girls had more concerns in the domains of self-image, anxiety, and relationships with peers (p < .05). Adolescents with mothers who had less education had significantly more concerns in the domains of anxiety and relationships with peers and adults (p < .05). Forty-seven percent engaged in at least one risk behavior (boys 63% and girls 34%). The Guttman scalogram indicated the following sequence of risk behaviors: alcohol, cigarettes, sex, and drugs. There were statistically significant associations between concerns and risk behaviors in the domains of anxiety, sex, and relationships with adults and peers., Conclusion: Many adolescent concerns are universal, although the ranking and prevalence may vary based on different regional and population characteristics (e.g., in this population a high rate of concerns relating to aggression and war were identified). The results support the need to develop prevention and health promotion programs relating to the concerns and risk behaviors in the school and community, and individual counseling programs in primary care settings.

The health-promotion and education project, Segev, is an Israeli version of the American Health Foundation's Know Your Body project. The aim of this cohort study was to change knowledge, attitudes, health behavior and risk factors for cardiovascular disease in elementary school children. We present the results of questionnaires about knowledge of, and attitudes to health in 656 Jewish children who started first grade in 1983-4 and completed 4 questionnaires in the first and third grades. The results indicate a statistically significant increase in knowledge and attitude scores in the experimental group after 1 and 3 years of intervention. They indicate that changes in knowledge of, and attitudes to health are possible after even a relatively short school health education program.

A school health education and promotion program, the Israeli version of the American Health Foundation's "Know Your Body" program, was developed by the Department of Public Health of the Municipality of Jerusalem in 1983. Eight experimental and eight control schools participated in this cohort study of Arab and Jewish first-grade children. After the first 2 years of intervention, comparison of experimental and control groups showed a significant increase in serum high density lipoproteins among Jewish children and a decrease in serum total cholesterol and body mass index among both Jewish and Arab children. These results indicate that changes in cardiovascular disease risk factors such as blood total cholesterol, high density lipoproteins, and body mass index are possible after a health education program is introduced to first-grade students for a relatively short period of time.

A community program for promotion of breast-feeding integrated into the Maternal and Child Health (MCH) services is presented and evaluated, using two quasi-experimental designs, comparison groups and time trends. The program, which began in 1981, included guidance from the 7th month of pregnancy to 6 months post-delivery. An increase in the percentage of breast-feeding mothers and the duration of breast-feeding was noted in the post-intervention cohorts (1981-82 and 1985) compared with the preintervention cohorts (1979-81). The comparison of the breast-feeding pattern of the 1985 birth cohort from the MCH service exposed to the program with a similar group receiving routine MCH care indicated that the percentage of mothers breast-feeding fully or partially was consistently higher among the intervention group compared with the control group at 4, 13 and 26 weeks (P = 0.0045), and the mean duration of full breast-feeding was 9.3 weeks compared with 7.0 weeks (P = 0.028). The program had a greater effect on mothers with a lower educational standard, thus closing the gap in the breast-feeding pattern by educational level in the intervention group. The evaluation indicates that a structured breast-feeding promotion program is more effective than the routine guidance received in the MCH service.