Preventing Halloween arson in an urban setting: a model for multisectoral planning and community participation.

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a city wide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.

Establishing LA VIDA: a community-based partnership to prevent intimate violence against Latina women.

LA VIDA--the Southwest Detroit Partnership to Prevent Intimate Violence Against Latina Women--evolved in response to community concern about the problem of intimate partner violence (IPV) and the lack of culturally competent preventive and support services for Latino women and men in southwest Detroit. Since 1997, diverse organizations have mobilized as a community-academic partnership to ensure the availability, accessibility, and utilization of IPV services. This article describes and analyzes the evolution of LA VIDA within a community-based participatory research framework using a case study approach that draws on multiple data sources including group and individual interviews and field notes. The challenges and lessons learned in addressing a complex multifaceted problem such as IPV in an ethnic minority community are highlighted in an examination of the process of mobilizing diverse organizations, conducting community diagnosis and needs assessment activities, establishing goals and objectives within a social ecological framework, and integrating evaluation during the development phase.

Management of diarrhoea at the household level: a population-based survey in Suleja, Nigeria.

Home management of diarrhoea was studied in 1,638 children under 5 years of age whose 1,160 mothers we randomly selected in Suleja local government area (LGA) in November 1991. The sampling method used was a cluster scheme based on "probability proportionate to size", with 40 clusters randomly selected. Prevalence of diarrhoea during the two preceding weeks was 20.8%; 73.8% of the cases were in children under two years of age; 32% of the children had received no treatment, and 56% of the mothers had used health facilities (Government and private). The estimated annual incidence rate of diarrhoea disease was 4.6 episodes per child. During episodes of diarrhoea, almost all mothers continued breast-feeding and giving other available home fluids, but 42.2% stopped solid food. Forty-four percent of mothers gave sugar-salt-solution (SSS) at home for diarrhoea; nearly half (45.3%) of them could not prepare the solution correctly. Mothers treated at home with SSS, herbs and fluids significantly more often when the diarrhoea was perceived as severe. Mothers sought help outside the home (at a health facility or traditional healer) significantly more often for severe cases. The survey provides important information about what happens at home - the place where diarrhoeal disease control programmes succeed or fail. The findings highlight the communication messages that need to be devised for mothers. Since government health facilities remains the commonest (87%) source of information on diarrhoea, health workers need to be equipped with the skills for advising mothers on management of diarrhoea in the home.

Growth patterns by age and sex in children with sickle cell disease.

We examined growth patterns by age and sex in 133 children and adolescents with sickle cell disease. These patients are estimated to be representative of the total population aged 1 to 18 years with sickle cell disease in a large metropolitan area. Median height and weight curves constructed from serial growth data available for all 133 children demonstrated impairment in height and weight at all ages and in both sexes. Analysis of growth trends by age reveals a pattern of increasing deficit with increasing age; boys are more severely affected than girls. Growth velocity curves constructed for a series of 13 adolescents with sickle cell disease illustrate the marked delay in the onset of the normal pubertal growth spurt in these patients.

Zinc status of children with sickle cell disease: relationship to poor growth.

We examined the zinc status of 80 children with sickle cell disease (SCD) and 44 disease-free sibling controls aged 3 to 18 years. For both patients and controls, variations in serum zinc by age, type of hemoglobinopathy, and growth status were measured. The mean serum zinc concentration of patients was significantly lower than for controls (77.8 +/- 9.9 vs. 82.2 +/- 9.8 micrograms/dl, mean +/- 1SD, P less than .05). Serum levels of alkaline phosphatase (AP) and retinol-binding protein (RBP), two zinc-dependent proteins, were also lower among patients (AP: 171 +/- 66 vs. 243 +/- 97 IU/L, P less than .001; RBP: 1.92 +/- .9 vs. 2.77 +/- .9 mg/dl, P less than .001). Patients greater than or equal to 12 years of age (n = 34) had significantly lower zinc levels than those less than 12 years (74.5 +/- 8.4 vs. 80.3 +/- 10.3 micrograms/dl, P less than .01), and children with homozygous SCD (Hb SS, n = 55) had a more pronounced deficiency than those with a variant hemoglobinopathy (76.3 +/- 8.9 vs. 81.5 +/- 11.5, micrograms/dl, P less than .05). Patients classified as having "poor" growth (height-for-age less than 5th percentile, n = 24) had a lower serum zinc level than those with "normal" growth (72.8 +/- 8.0 vs. 79.8 +/- 10.0 micrograms/dl, P less than .01). Dietary intake data, body mass index, and serum total protein and albumin levels were similar for patients and controls, suggesting that zinc deficiency in SCD does not relate to inadequate dietary intake. The origin of low serum zinc levels in children with SCD is more likely to relate to factors such as increased urinary zinc excretion, chronic intravascular hemolysis, and/or zinc malabsorption.

Pregnancy and birth rates among sexually experienced US teenagers--1974, 1980, and 1983.

We examined pregnancy rates and birth rates among United States teenagers aged 15 to 19 years in 1974, 1980, and 1983. Pregnancy rate refers to live births plus induced abortions per 1000 women; birth rate refers to live births per 1000 women. We present these rates for all teens aged 15 to 19 years and for teens aged 15 to 19 years who were sexually experienced. Data sources included National Center for Health Statistics birth records, Centers for Disease Control abortion surveillance reports, and Bureau of the Census population estimates. Sexual experience estimates came from national surveys of adolescent sexual behavior. Between 1974 and 1980, the pregnancy rate among all teens increased; the pregnancy rate among sexually experienced teens declined. From 1980 to 1983, the pregnancy rate declined among all teens and among sexually experienced teens. Birth rates among US teenagers (all teens and sexually experienced teens) declined between 1974 and 1983. Whereas the decline in the birth rate from 1974 to 1980 was primarily due to increased use of abortion, the decline from 1980 to 1983 related to the decrease in teenage pregnancies.

Conducting a participatory community-based survey for a community health intervention on Detroit's east side.

This article describes a participatory action research process that brought together community members, representatives from community-based organizations and service providers, and academic researchers to collect, interpret, and apply community information to address issues related to the health of women and children in a geographically defined urban area. It describes the development and administration of a community-based survey designed to inform an intervention research project; discusses the establishment of a community/research partnership and issues that the partnership confronted in the process of developing and administering the survey; and examines the contributions of participants, and implications for research and collective action.