A discussion of the increased accessibility to the Internet and how this has lead to a variety of resources being used for learning. Case studies and examples show the benefits of using the Internet as part of resource-based learning.

OBJECTIVE:To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children.DESIGN:Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach.SETTING:South Central and East Los Angeles areas in inner-city Los Angeles.POPULATION:Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age.MAIN OUTCOME VARIABLES:Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral polio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine).METHODS:Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors.RESULTS:Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, 0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90).IMPLICATIONS:Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors' offices or health maintenance organization/managed care plans.

OBJECTIVES:Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services.METHODS:From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading.RESULTS:The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education.CONCLUSIONS:Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.

The reductions in water use achieved by urban households in California during the recent drought are well documented. What is not documented is how those reductions were achieved. In this paper, we report on survey data from the Los Angeles and San Francisco Bay Areas describing the water conservation activities undertaken. We also examine variation in water conservation activities across households and adjust statistically for social desirability biases in the self-reports.

Perspectives on Data Collection in Evaluations - Leigh Burstein and Howard E Freeman PART ONE: DATA SENSITIVITIES Data Collection Strategies in the Minneapolis Domestic Assault Experiment - Richard A Berk and Lawrence W Sherman Observer Studies - Lee Sechrest Data Collection by Remote Control Data Collection Issues in the Evaluation of the Effect of Television Violence on Elementary School Children - Ronald C Kessler et al PART TWO: MOUNTING LARGE-SCALE FIELD STUDIES A Tale of Two Surveys - Ronald M Anderson, Lu Ann Aday, and Gretchen Voorhis Fleming Lessons from the Best and Worst of Times in Program Evaluation Field Sampling Problems in Data Collection for Evaluating Research - Sandra H Berry Measuring Unfiled Claims in the Health Insurance Experiment - William H Rogers and Joseph P Newhouse Issues of Data Collection in Assessing Programs Involving Crime Reduction - Charles Mallar and Irving Piliavin The Job Corps and Supported Work Evaluations Some Failures in Designing Data Collection That Distort Results - Albert J Reiss Jr PART THREE: USE OF RECORD INFORMATION Program Evaluation and the Use of Extant Data - Eleanor Chelimsky Identification of Treatment Conditions Using Standard Record-Keeping Systems - J Ward Keesling Using Longitudinal Earnings Data from Social Security Records to Evaluate Job-Training Programs - Howard S Bloom An Information System for Planning and Evaluating Geriatric Care - George L Maddox The Duke Older Americans Resources and Services Program From Science to Technology - William D Neigher and Daniel B Fishman Reducing Problems in Mental Health Evaluation by Paradigm Shift REPRISE Data Quality Issues in Evaluation Research - Peter H Rossi Summary Comments

*From the Department of Sociology, University of California at Los Angeles, Los Angeles, California †From the Department of Medicine, University of California at Los Angeles, Los Angeles, California

A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all income levels of black Americans. In addition, the study points to significant underuse by blacks of needed medical care. Moreover, blacks compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short.

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.

As the health care system becomes more impersonal, competitive, and cost conscious, there is a potential for increased dissatisfaction with health care providers. This paper describes the use of content analysis to examine aspects of patient dissatisfaction with delivery of health services in a capitated dental plan. All written complaints from three regions of California from June 1984 to June 1986 were collected, and a content analysis was performed on these letters. The rates of grievances differ substantially across regions; however, three regions were similar in their grievance patterns. Access to care was the single largest category of concern, and these grievances were registered because patients had to wait for an appointment (35 percent) or had to wait in the office (32 percent) to receive care. Provider technical competence was the second largest category. Significant variables from a logistic regression that predicts complaint status of an eligible member are (1) years covered, (2) age, and (3) income. The grievance rate and grievance categories described in this study can help define new strategies and policies in the overall mission of a dental capitation organization.

In a discipline in which departments are often characterized by irreconcilable controversies and factional disputes, UCLA’s department stands out as a pluralistic community that fosters interaction, communication, and mutual understanding. At UCLA the micro and macro meet: leading ethnographers and survey researchers work side by side; noted Marxists, functionalists and phenomenologists participate in the same colloquia, and persons with a variety of outlooks share membership on the same student committees. Ambitious students committed to obtaining the Ph.D. experience a stimulating educational career in a department that prides itself on diversity, but whose faculty understands that its program must be structured and coherent.

Data from the Robert Wood Johnson Foundation 1982 survey of access to health care are used to examine the influence of household composition and members' domestic position--e.g. age, sex, marital status, and presence of children, on health status and use of health services. A hierarchical analysis was undertaken to sort groups of individuals and households having different domestic structures. The results of the analyses of use and access for these groups show that, after controlling for age, domestic position and household arrangements are significant explanatory variables. Ways to refine the approach are discussed.

Prologue: Most Americans believe that health care should be available to all those who are sick or injured, regardless of economic or other circumstances. At the same time, most Americans consider the cost of medical care as the most troubling dimension of the provision of this service, and believe that cost constraints should be applied. Where to make such reductions without erasing the gains achieved in access to care over the last several decades, or hurting the least fortunate among us, is the issue. In this lead essay, Howard Freeman and his colleagues report signs of deterioration in access to medical care for the nations poor, minorities, and uninsured. Their study is the third study on access underwritten by The Robert Wood Johnson Foundation. The two previous access studies, ironically, provoked substantially different reactions, stemming more from a change in the political climate than from the findings themselves. At the time of the first survey, 1976, national health insurance (NHI) legislation was a live issue. Its advocates were critical of the survey results because they showed many more people with access to care than NHI rhetoric suggested. In the more constrained climate of 1982, the second survey provoked criticism from conservative quarters because it highlighted the relatively small number of people who lacked access to care. The lead author of this most recent survey is a professor of sociology at the University of California, Los Angeles (UCLA). Robert Blendon, who holds a doctorate in health policy and management from The Johns Hopkins University, is a senior vice-president of the Johnson Foundation. Linda Aiken, a nurse and sociologist, is a vice-president of the Johnson Foundation. Seymour Sudman is a professor of sociology at the University of Illinois. Connie Mullinix, who is working toward a doctorate in health services research at the University of Pennsylvania, is a research associate at the Johnson Foundation. Christopher Corey is a doctoral student in sociology at UCLA.