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TRULY comparative studies of residential health care systems for mentally retarded are virtually nonexistent. This situation exists despite the fact that all mentally retarded comprise perhaps 5 per cent of the national population, and in the face of the fact that over 200,000 mentally retarded are in public residential facilities, cared for by nearly 100,000 staff members at a cost of over $500,000,000. The research from which this paper is drawn addressed this research lacuna, and was perhaps the first to collect comparative data on a broad range of health care system components in residential centers for mentally retarded and the technological bases influencing them. The present paper presents findings on certain indexes of comprehensiveness of health care in these institutions and their technological influences at five public facilities in widely different locations in this country. It need only be mentioned that care to the youth and adults in these institutions influences the pattern of services for mentally retarded children and youth in the community, and for those who will be admitted to these facilities in the future.

IN 1963 the Federal Congress, taking "a bold now approach," enacted the Community Mental Health Centers Act, which was intended to pave the way for 2,000 new mental health center facilities by 1980. This act was followed in 1965 by Public Law 89-105 which, in turn, provided federal support for staffing such centers, as a stimulant to state investment. The underlying philosophy that justified this vast allocation was to "enable the patient to maintain himself in the community in a normal manner," and to model and modify mental health programs on the basis of research data so that they would develop and perfect both humane and effective services. It was expected that many patients who had previously been sent to remote, overcrowded hospitals could be treated on an outpatient basis directly in the community. It was also expected that many more persons should be able to seek and receive treatment, and that treatment would be sought at an earlier point in life. This paper investigates the extent to which these three objectives-reaching more people, reaching them earlier in life, and treating a larger proportion in the community rather than in the hospital-has been achieved in the course of establishing a community mental health center in an urban disadvantaged community. The data will also be studied for their possible value in anticipating future patterns of service utilization, particularly as these patterns may develop in connection with the imminent decentralization of the mental health centers into functional satellites. In a sense we are contending, then, that if we view our recent experience carefully through the eyes in back of our heads we should be better able to focus our forward vision and plan for more effective future community service. The center under examination is the Temple University Community Mental Health Center, active in North Philadelphia since 1966. This agency, an arm of the Department of Psychiatry of the Temple School of Medicine, first admitted patients during May, 1967. The data to be reviewed here have been collected from the 1960 federal census and from a series of surveys designed by one of the authors of this paper (EAG), including a center-engineered census of the catchment area and a study of mental health utilization patterns by community residents before the center was

All of us in mental health circles are aware that, despite "Action for Mental Health" and the community mental health centers program, we are still far from having efficient and effective mental health care, at any level national, state, or local. One of the elements still missing in our delivery systems is appropriate coordination of services. The term "coordination" has come to have some unpleasant connotations: it conjures up visions of superfluous bureaucrats busily engaged in shuffling papers, drawing up organization charts, trying to fit people and services into boxes on those charts, and generally accomplishing little of value. I should like to suggest, however, that coordination in the true meaning of the word "to bring into a common action, movement, or condition" is essential in our efforts to improve the delivery of mental health services. In today Ts slang phrase, it means "getting it all together" so that comprehensive, continuous care

TEEN-AGE pregnancy is an end result of adolescent sexual behavior. Such behavior is difficult to change but its outcome may be affected by contraception or abortion. The perception of teenage pregnancy as a social problem has led to changes in laws relating to the provision of contraception and legal abortion for minors. In our concern for the social problem, it is important not to lose sight of the personal problems of girls who may be at risk of pregnancy and the social, educational, psychological, and medical sequelae of teen-age pregnancy. The acceptability of legal abortion as a solution to these problems is the focus of this paper. The attitudes of teen-age girls toward abortion are examined here. A girl's attitude toward abortion may influence her contraceptive practice, her response to possible pregnancy, and the ease with which she may accept available solutions.

DEOPLE who do not stop smoking, who rdo not come for early prenatal care, who do not have yearly medical checkups, who do not fasten their seat belts or space their pregnancies, or who do not take other preventive measures recommended in public health programs, are a constant concern to public health professionals. The public health worker's usual reaction to nonconforming behavior on the part of the potential recipient of services is to consider it either (1) essentially irrational, i.e., contradicting what is the person's best interest, on the basis of his own knowledge, or (2) based on ignorance, leading to an incorrect perception of his own best interest. We want to argue in this paper that the recalcitrant consumer is behaving in a way that is consistent with reality and his own best interest; that it is rather the health professional who misperceives the individual situation; and further that, in his zeal to perform his service, the health professional may also encourage misperception on the part of the consumer. The health professional's behavior can be understood in terms of his biasing exposure to special information, as well as in terms of his duty to fight disease and foster healtlh in every possible way in a community of consumers. In analyzing the lack of match between the professional's advice and the individual consumer's behavior, we hope to generate ideas about new ways for health professionals to encourage the adoption of behaviors conducive to good health.

N this paper I shall discuss some political characteristics of pollution control. I consider planning as part of the control process, and I hope that my observations will ring true for those engaged in the difficult art and science of environmental health planning. The five features of the current pollution control scene which seem to me most relevant for understanding pollution politics and the current climate of decision-making are: (1) high visibility; (2) rapid change; (3) pervasive ignorance; (4) conflicting constituencies; and (5) administrative complexity.

This letter was written in criticism of the Correa-Beasly article entitled "Mathematical Models for Decision-Making in Population and Family Planning" published in the January 1971 issue of the Journal. The author believes that while that article claimed to have used linear and quadratic programming in connection with the acceptance of various contraceptives they did not specify an objective function which is the first principle of linear programming. They did not mathematically formulate their stated objective of minimizing the number of pregnancies through the use of direct contraceptive techniques. Another shortcoming of the paper is that its authors failed to recognize the possibility of substitution of one contraceptive for another. The author also finds fault with some mathematical formulations and their application. Finally he claims that he has recent articles in the same area which more clearly approach the problem although in a different way.

One of the current and abiding issues facing family planning educators is the perception of the objectives of family planning among black Americans (as well as other minority groups). There have recently been expressions from many sources suggesting strong feelings that family planning programs (in some or all of their methods) are forms of black genocide. Our purpose in this paper is to provide some preliminary answers to several of the broad and important questions that are generated by the reported expressions: First, to what extent are fears of race genocide held in the black community? Second, to what extent can one attribute the use (or nonuse) of family planning methods to such fears of race genocide? We will attempt to answer these questions, as well as several more specific questions, in two ways: First, by means of a review of historical and anecdotal material; second, by discussing some preliminary findings in a research project attempting to answer these and similar questions.

Using aggregate national data, an attempt was made in 1972 to estimate the numbers of persons who will need each of the fertility-related services (e.g., prenatal and postnatal care for wanted pregnancies, medical care of infant in its first year fertility limitation, and medical treatment of infertility) between then and 1978, and the costs of providing them. The preliminary model was later refined utilizing additional sources of data are needed to help the health care system assist individual members of the community to achieve their family formation goals. The paper includes discussions of the sorts of data that are needed and the reasons for this need, the present sources of data (in terms of providers, households, payers, and carriers), and the types of data gaps (absence, insufficient disaggregation, lack of relatedness, in complete specification). The author contends that attention to the various gaps would increase the potential of our important national surveys to produce data on numbers in need of fertility-related health services, etc. Greater comparability in questions asked and in methods of analyzing and presenting the responses could be achieved at little sacrifice of the basic purposes for which the systems were created. Recommendation is made that a step be taken to convene a small conference of key personnel working on these systems to explore the gaps and incompatibilities, propose means of overcoming them, and identify needed special studies.

The authors are from the Pediatric Genetics Unit, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. Address requests for reprints to: Neil A. Holtzman, MD, Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland 21205. This study was supported by the State of Maryland Department of Health and Mental Hygiene, Preventive Medicine Administration; the Maternal and Child Health Service, Health Services and Mental Health Administration, U.S. Department of Health, Education, and Welfare; and the National Genetics Foundation. Dr. Holtzman is recipient of Public Health Service Research Career Development Award AM 12237 from the National Institute of Arthritis and Metabolic Diseases. Mr. Meek was supported by Traineeship Contract HSM 110 69 297 from the National Center for Health Services Research and Development and by Apprenticeship Grant 5 A07 00204 from the Bureau of Health Manpower, National Institutes of Health. before the 4th day of life and 44 per cent on or before the 3rd day.3 In infants in whom a diagnosis of PKU is subsequently established, the phenylalanine concentration during the first 3 days of life is significantly lower than in those screened later.3'4 The chance of missing the diagnosis is greatest in infants screened at the youngest ages. Of the 23 known phenylketonurics missed by screening (comprising 8 per cent of phenylketonurics screened in the same regions) 15 (65 per cent) were screened on or before 3 days of age.5 It would appear desirable, therefore, to delay screening until at least 4 days of age. However, the incidence of false positives is also higher in infants screened after day 4 than in those screened earlier.3 Therefore, a larger number of infants would require follow-up tests. In order to reduce the number of children who must undergo repeat testing we determined whether certain factors are associated with an initial elevation of phenylalanine but not with true PKU. In this paper we show that a signiflcant proportion of the false positives are found in low birth weight infants, nonwhite infants, and infants who have elevated tyrosines.

In a recent study of the Bureau of Labor Statisticsoperated national industrial safety statistics program conducted by the authors,1 it was found that current data collected underestimates the extent of industrial accidents nationally and provides no reliable insight into the incidence rates below the federal level. Various alternative methods for estimating work injuries deserve consideration. This paper will focus attention on the use of accident rate tables for derivation of state level estimates of work injuries and fatalities. In addition, some attention will be directed towards assessing the value of work injury rate tables in developing measures of work injury incidence and relative improvement over the working lifetime of individuals. The concept of accident rate tables is not a new development. It has been used extensively in the insurance industry as a basis of developing work injury experience rates of different industries and occupations. Further, some researchers in the field of Workmen's Compensation and statistical program evaluation, notably Jaffe and Pearce,2'3 have conducted experiments in the generation and application of work injury rate tables to estimates and actual counts of the labor force by age, sex and industry to develop synthetic work injury measures. However, in both instances, the experiments were tied to the necessity of having available information on the age, sex, industry and occupational affiliation of the labor force. Information of this fine degree of demographic detail is generally unavailable at any time except for decennial Censuses. Annual estimates of the labor force by age and sex at both the national and state levels have, until recently, been virtually lacking. Data on the age and sex of both industrial fatalities and disabilities can be obtained from tallies of individual reports of accidents filed with State Accident or Workmen's Compensation systems. Therefore, the further refinement of the estimating technique has been stymied by both the lack of good demographic detail of national and state labor forces on an annual basis and untabulated data on the demographic characteristics of accident data in most states. A notable exception is the State of California, Work Injury Reporting System. For over a decade, the State of California Department of Industrial Relations, Division of Research and Statistics, has compiled and published tabulations of the age, sex distributions of both fatalities and disabling injuries. The Division has also developed, to a lesser-known extent, estimates and projections of the State Labor Force by Age and Sex. The information is generally available on a five-year bench-mark basis.4 Thus, in light of this data availability, it was decided to conduct several tests with the combined data sources in California as an' experiment in the refined application of the accident rate table concept of work injury estimation.

THE goal of the present paper is to invite new thoughts about the effects of fear-arousing communications on persuasion. As a consequence, it is unashamedly theoretical and may seem to run counter to the insistent cries for the practical and relevant. But it is my thought that the theories and assumptions we make about other people are an important determinant of what we say when we try to influence or educate them. To do a better job in this role, we must be sure that we are using the most adequate theory in developing our persuasive and educational appeals. The best way to increase the quality of our theories is to develop and compare different ways of thinking about the same problem. Thus, to convince you that nothing is so practical as a good theory, I shall review two sets of ideas that can be used to understand the persuasive effects of fear-arousing health messages, discuss how well these ideas fit empirical data, and then leave you to decide which provides the most creative suggestions for practical action. The health professional's unique knowledge gives him the special responsibility to inform others of the imminence of health dangers. Because he wants his audience to believe and to act upon his recommendations, he is very likely to wonder about the most effective way of presenting his information. At this point the practitioner has to consider his options. Should he "hit them hard" and arouse strong fear with graphic descriptions of death and danger, or should he use a mild, unfrightening approach and avoid any mention of the serious hazards that may occur if one fails to execute a protective action? Which technique is most effective? If he has read the early study by Janis and Feshbach (1953) he would find support for a mild approach. This study suggests that increasing the vividness of the threat information on dental disease and thereby raising the level of fear decreases the proportion of subjects who follow a program of dental care. If he reads further, he is likely to notice that nearly all subsequent studies show that communications which stimulate higher levels of fear [on issues such as tetanus (Leventhal, Singer and Jones, 1965; Dabbs and Leventhal, 1966), smoking and lung cancer (Janis and Mann, 1965; Leventhal, Watts and Pagano, 1967)] lead to more acceptance of the communicator's recommendations.2 Indeed, he may notice that the number of studies with positive effects, high-fear messages producing more attitude and behavior change than low-fear messages

THE United States is a drug-using culture. On any given day an American adult is likely to ingest four or five identifiable chemical compounds that are pharmaceutical in nature. Consider the individual who arises in the morning, brushes his teeth with toothpaste containing fluoride, downs a Bromo-Seltzer, has two cups of coffee containing caffeine, takes a dexedrine to help him with his weight problem, lights his postcoffee cigarette containing nicotine, and then heads for a round of events in the business or professional world which may include cocktails and wine with meals, followed by brandy and a good cigarthis individual is more likely to be typical than unusual. While for the most part individual adults do not get into trouble through their use of drugs, some unfortunates do experience complications -social and medical. The natural history or the epidemiology of how individuals use drugs and in what ways undesirable and frequently unexpected consequences arise is the basis for this paper-the epidemiology of drug use and abuse.