Age at any birth and breast cancer risk.

In an effort to assess the relative importance of age at first birth, age at subsequent births, and total parity to the occurrence of breast cancer, reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer were analyzed by a multiple logistic regression model. Age at first birth was confirmed to be the most important reproductive risk indicator; it was associated with a 3.5% increase of relative risk for every year of increase in age at first birth (the 95% confidence interval of this estimate was 2.

Where does primary care begin? The health facilitator as a central figure in primary care.

The role of lay advisors (health facilitators) in primary care is described. Health facilitators are people to whom others naturally turn for advice, counsel and support. The majority of illnesses reported by patients are never presented to a doctor.

Maternal age and birth rank of women with breast cancer.

Data from a large international case-control study of breast cancer suggested that women born to young mothers had a 25% lower risk of breast cancer. The association was not secondary to a tendency for these women themselves to have had children at early ages. The data provided no indication of a meaningful association between breast cancer risk and birth rank.

The health interview survey and minority health.

This article emphasizes the advantages and disadvantages of the National Center for Health Statistics Health Interview Surveys (HIS) when applied to the needs of ethnic minorities at the local level. While HIS gives information on health status of minorities and their use of services at the national level, this information is of limited help to providers in local communities. In any national survey, the numbers of minority persons sampled will be very small and heterogeneous populations sharing a common language (for example, Spanish) may be aggregated though their characteristics may differ widely.

Racial differences in medical care expenditures.

Out of pocket medical expenditures made by families for physician services, dental visits, medications, hospitalizations and insurance premiums are examined in a southern rural community using household survey interview data. White families paid an average out of pocket amount for total medical services of $709 as compared with $383 for black families over a 12-month period, 1974-75. Correlates of expenditure differences between blacks and whites are explored with respect to family characteristics (race, education of household head, family income, family size and family composition), illness levels (number of family members with perceived fair or poor health status and number of family members reporting chronic conditions), and use of services (number of doctor visits and type of usual source of care).

Primary care in Durham County: who gives care to whom?

The purpose of this study is to describe quantitatively the primary health care system of a defined population. The ambulatory care services of private practices and institutions in Durham County, North Carolina were sampled four times during 1975-1976 to determine the relative contributions to primary care made by specified types of practice and sources of care. All the institutions and 96 per cent of practicing physicians participated.

Distribution of illnesses and its implications in a rural community.

This study is a continuation of a series of reports on the utilization of health care services in a southern rural community. In this investigation the distribution of the utilization of medical care services is assessed with respect to reported illnesses and related disabilities. It is found that whites report significantly more illnesses, disabilities and physicians visits than blacks.

Primary health care in an academic medical center.

In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care.

Utilization of services for preventable disease: a case study of dental care in a southern rural area of the United States.

The use made of dental services, both preventive and symptomatic, was explored in a small rural southern community in North Carolina as part of a case study illustrative of southern rural patterns of utilization of elective health services. The target population of 1689 persons in 545 households was interviewed in a household survey and in each of four follow-up panel visits over a period of one year--1974--75. Though overall utilization of dental services was low and preventive dental services even lower in both blacks and whites, blacks were at a considerable disadvantage.

Health care decision making in Southern County.

We combine two standard approaches to analyze power and influence in health policy formulation within a moderately large county in the south. Intrinsic methodologic weaknesses are discussed and several conclusions are drawn regarding power in the health care sector of that community. The most significant finding is the shift in power over time, away from the individuals to committees and health care organizations.

Demand for medical care in a rural setting: racial comparisons.

Household data from a southern rural community are used to examine racial differences in the utilization of medical care services, and both monetary and nonmonetary determinants of demand are considered. Regression analysis results indicate that office waiting time (for black households) and travel time to the provider (for both black and white households) have a greater impact on demand than price. Racial differences exist in the effects of health insurance coverage and household income on household medical visit expenditures, and both need and household size are found to be consequential determinants of demand.

Pro Bono Publico--a century later.

From the introduction of Pro Bono Publico smoking tobacco in Durham, NC a century ago, the production of tobacco products has become a vital part of the state's economy. How this may relate to the smoking behavior, and consequently to the health of its residents is assessed from smoking patterns of adult residents of a rural area of Durham County. Male smoking rates are considerably higher than U.

Hospitalizations in a southern rural community: an application of the 'ecology model'.

The purpose of this study is to re-examine the concepts of health services utilization presented by White and his colleagues in 'The Ecology of Medical Care'. We re-test their model in a rural population in the southern United States using longitudinal instead of cross-sectional data and find that the general principles of the 'Ecology' model do, indeed, apply to rural populations like Rougemont/Bahama. Use of this model has implications for modifying and improving the organization of the health care delivery system and for a fundamental change of emphasis in medical education.

Access to health care in a southern rural community.

This case study of utilization of health care services in a rural southern community is the first of a series of reports dealing with access to care in this community. The most striking findings were the low utilization of physician and dental services compared with national standards (particularly by the black population) and the infrequent use of private physicians by blacks. Possible explanations for these findings are the short time interval since integration of services after Medicare and Medicaid legislation, the short supply of primary care physicians, especially black, in this community, and the reluctance of white physicians to accept Medicaid patients.

The role of the health facilitator in community health education.

A community health education program has been established by the Department of Community Health Sciences of Duke University Medical Center in two target areas of Durham County, North Carolina. The program trains unpaid lay people, "health facilitators", to whom others already turn for help, to increase their competency for advising and referring community residents to appropriate community resources. Several methods for identifying potential health facilitators have been developed.