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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 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 seat-belts 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 successful model of a strategy to increase children's helmet use. (Am J Public Health. 1993;83:667-674), Combining education with legislation is the most effective means of encouraging bicycle safety helmet use among children. Residents of three contiguous counties in Maryland were surveyed on bicycle helmet use. Howard County was the only one with a mandatory helmet law for children under 16. Implementation of the law was combined with an educational safety program to encourage helmet use. In an adjacent county, Montgomery, there was no legislation, but there was a comprehensive bicycle safety education program incorporated into the school curriculum and involving local media. The third county, Baltimore, had no helmet legislation and no safety education program. Children in grades four, seven and nine were mailed questionnaires that were to be filled out anonymously. Children's helmet use rose from 11% to 37% after the implementation of the law and bicycle safety campaign in Howard County. Nonetheless, only a small percentage of the respondents indicated that they regularly wore safety helmets.

Pediatricians will often visit a mother and newborn in the hospital within the first one to two days after childbirth to promote a supportive relation between the pediatrician and family, decrease anxiety of parents and improve parental self-confidence, provide information about infant care, and detect and treat diseases of the infant. Pediatricians may also maintain daily telephone contact with the parents shortly after childbirth. This practice of early contact between the pediatrician and mother is more common in private practice than in hospital-based clinics. Studies have shown that early contact between health care workers and mothers of newborns caused the mothers to be more receptive to advice offered by health care workers concerning infant care. The effects of visits by the pediatrician to mothers with newborns, in combination with telephone access shortly after childbirth, were assessed. It was anticipated that early contact between the mother and pediatrician would improve the use of health care services, the mother's recognition of the pediatrician as a source of information on infant care, and her knowledge of infant care, and would reduce anxiety and depression in the mother following childbirth. The study involved 251 mother-and-newborn pairs, including 122 pairs who were not exposed to early contact with a pediatrician and 129 pairs who were provided with early physician contact. The frequency of clinic visits within the first month following childbirth, the likelihood of seeking care at a clinic, and use of phone access to the physician were greater among mothers provided with the intervention of early physician contact and telephone access. However, this intervention had no effect on use of emergency services, rate of immunizations within the first month and a half of the newborn's life, knowledge about infant care, or upon anxiety and depression of the mother. These findings suggest that early communication with the pediatrician and telephone access to the pediatrician improve use of health care services and the relation between the mother and physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Descriptive case information evaluated by 68 medical personnel included a fall from a highchair as the explanation of an injury, with or without injury pattern data obtained for such falls from the U.S. Consumer Product Safety Commission (CPSC). Respondents given the CPSC data appropriately had less confidence in the explanation. (Author/JW)

In 1990, the first regulation requiring the use of helmets for bicyclists younger than 16 years of age was passed in Howard County, Maryland. This unexpected injury control measure resulted from the convergence of multiple factors and efforts: the bicycle-related deaths of two children from the same middle school, creative students and teachers motivated by these deaths, a responsive legislator to introduce the legislation, available surveillance and research statistics supporting the need and efficacy for helmet use, increased national awareness of the importance of helmet use to prevent bicycle-related head injuries, and organized national and local public health groups to support the legislation. This case study of activism in injury control illustrates the importance of supporting research, of well-organized public health coalitions and groups, and of creative community activists motivated by local circumstances.

Objective: Despite clinical advances, sickle cell disease (SCD) remains a difficult, chronic medical condition for many children and youth. Additional treatment strategies, including complementary and alternative medicine (CAM) therapies, would be welcome to enhance the clinical care of SCD patients. This study's objective was to identify CAM therapies that are currently used by families for children with SCD, and to investigate SCD families' interest in CAM. Patients and methods: Fifty-seven (57) parents of pediatric SCD patients participated in this cross-sectional telephone survey in early 2000. A SCD Severity Scale was developed by combining the general health assessment and four measures of SCD severity (Cronbach's α = 0.81). Results: Fifty-four percent (54%) of the sample used CAM therapies for the SCD children. Forty-two percent (42%) used bioenergetic therapies (prayer, spiritual and energy healing), 28% used lifestyle/mind–body CAM (relaxation techniques, exercise, imagery, and diet), 12% used biochemical therapies (herbal medicines, megavitamins, and folk remedies), and 5% used biomechanical therapy (massage). CAM use for the SCD children was positively associated with the child's age, SCD Severity Scale score, respondent education, and respondent CAM use. The use of relaxation techniques was associated with greater SCD severity. Most respondents (83%) felt that CAM can be helpful. Conclusions: The use of CAM therapies is common for children with SCD. Prayer, relaxation techniques, and spiritual healing were the most commonly reported CAM therapies. Because clinical studies have shown the benefit of spiritual and relaxation practices for SCD and this study shows that these CAM therapies are being used commonly by SCD families, future research should focus on spiritual and relaxation practices for children with SCD. [ABSTRACT FROM AUTHOR]

Background: Access to firearms among delinquent youths poses significant risks to community safety. The purpose of the study was to describe how a group of criminally involved youths obtained guns., Methods: Youths were randomly selected from a juvenile justice facility to participate in a semistructured, anonymous interview. Transcripts were coded and analyzed with the aid of textual analysis software., Results: Of the 45 participants, 30 had acquired at least 1 gun prior to their most recent incarceration, and 22 had acquired multiple guns. About half of the first gun acquisitions were gifts or finds. The first guns youths acquired were usually obtained from friends or family. The most recent acquisitions were often new, high-caliber guns, and they came from acquaintances or drug addicts. New guns often came from high-volume traffickers. Gun acquisitions from strangers or through "straw purchases" were rare. Though few obtained guns directly through theft, some youths believed their supplier had stolen guns. Youths rarely left their community to obtain a gun., Conclusions: Guns were readily available to this sample of criminally involved youths through their social networks. Efforts to curtail high-volume, illegal gun traffickers and to recover discarded guns from areas in which illicit drug sales take place could potentially reduce gun availability to high-risk youth.