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Purpose: Understanding utilization patterns in school clinics is important in discerning potential health outcomes among adolescents. This study reports on high-middle school and gender differences in ICD-9 diagnostic codes for students using Baltimore school clinics in the academic year 1989-90., Methods: 12,953 visits resulted in 17,241 individual diagnoses. Data were grouped into 17 major diagnostic categories, subcategories for reproductive health and mental health, and 20 sentinel diagnoses., Results: Reproductive health diagnoses were most common for high school clinics (28% of all diagnoses). Mental health (psychosocial) diagnoses were most common for middle school clinics (30%). Adolescent women were much more likely to use clinics for reproductive health care needs than adolescent men. Adolescent men and women used the clinics with equal frequency for mental health, although specific diagnoses varied considerably by gender., Conclusions: This overview of diagnostic patterns among adolescents using Baltimore's school-based clinics provides a unique view of differences in health care needs between younger and older teens and between male and female teens. These data have meaningful implications for clinic staffing and enhanced outreach efforts.

Purpose: Few school-based health centers (SBHC) in the United States dispense contraceptives on-site and little is known about contraceptive continuation in these health centers., Methods: An 11-month contraceptive continuation pilot project offering monthly reproductive health assessment and counseling to students enrolled in Baltimore school clinics was evaluated. One hundred-forty-three women voluntarily enrolled in the study over a seven month period. A monthly contraceptive calendar was developed to collect data on contraceptive use, pregnancy and STD risk, sexual behavior and parental support for contraceptive use. Physical assessment was provided as needed to assess the presence of STD's or pregnancy. Data were analyzed for the month prior to enrollment in the program and eleven months after entry into the program., Results: Both contraceptive (OCP) use and abstinence increased over the course of the program. Condom use remained at approximately 30% with frequent use of OCP's and condoms, condoms or abstinence. Program drop-out was common. Thirteen students became pregnant while enrolled in the program and 35% of the students were diagnosed with one or more sexually transmitted diseases. Partner-switching was common, although two or more partners within any one month was rare., Conclusions: Monthly follow-up provided through SBHCs can improve contraceptive use although dropout rate and contraceptive failure remain high.

The AIDS Prevention for Pediatric Life Enrichment (APPLE) project is a community-based program to prevent perinatal HIV infection by preventing infection in women. One project component tested a primary prevention model developed from principles of cognitive social learning theory which used street outreach and community-targeted small media materials to increase the use of condoms. Formative research was used to explore community perceptions about HIV/AIDS and to design media materials. Program evaluation employed a two-community, time series, quasi-experimental design. Annual street surveys samples individuals in areas where they were likely to encounter outreach workers. Baseline surveys found substantial pre-programmatic behavior change. After two years considerable APPLE name recognition (40%), contact with media materials (63%), and contact with outreach workers (36%) were found and norms reflecting social acceptability of condoms were more positive among women in the intervention community. Condom use at last sexual encounter rose in both communities but was significantly higher in the intervention community. Condom use also was higher among women who reported exposure to either small media or small media plus street outreach. Other self-reported HIV-prevention behaviors did not show change in the initial period.

Over the past 6 years, the city of Baltimore has successfully implemented a school placement policy for human immunodeficiency virus (HIV)-infected children and children with acquired immunodeficiency syndrome (AIDS). Both policy and specific procedures are based on nationally promulgated guidelines. School placement policy is part of an overall AIDS policy that includes education of students and staff and adoption of universal precautions to prevent transmission of communicable diseases in school. Implementation has been marked by excellent collaboration between the departments of health and education. Important policy components include expedited clinical investigation of each case, an interagency review panel, strict protection of confidentiality, a restricted setting for certain children, a school site visit for each placement, and continued monitoring of the school placement by school nurses. Many HIV-infected students need special educational services and/or school health services. The Baltimore City school placement process has avoided the exaggerated publicity endured by some communities, where media reporting has aggravated community fears and invaded the lives of families with HIV-infected children. Baltimore City has succeeded in ensuring access to education, protecting families' confidentiality, and providing special care for HIV-infected students. Local communities should emphasize national guidelines in designing school placement policies for HIV-infected children. School placement policies work best in the context of a comprehensive policy incorporating AIDS education and care.