agement of the program.
The ETV Presentations
The provision of continuing education
for public health workers through ETV
is unique, but there is a tendency to
exaggerate the relative importance of
this part of the educational session. By
some, the whole program may be
regarded as one of "watching tele-
vision." Some undoubtedly expect en-
tertainment since this is the usual
reason for viewing television. The pur-
pose of this program is education. To
be effective ETV must hold attention
but it should not be compared with
programs designed to entertain.
In preparation of an ETV program
on a particular subject, it is necessary
first to identify and obtain the coopera-
tion of persons generally acknowledged
as authorities on the subject. For
example, the aid and guidance of the
Tuberculosis Division of the United
States Public Health Service was sought
and generously provided in preparing
the two sessions on TB control. The
authorities, in conference with project
staff, reached decisions as to content.
Ordinarily a minimum of one full
work day by two project staff members
and usually two or more authorities are
necessary merely for the joint plan-
ning of one educational session. This is
only a start on the detailed preparation.
Always there is the critical question
as to what person or group should
be requested to do the ETV program.
There was virtually no guiding experi-
ence. Public health teachers have had
little to do with television. One could
hardly request a senior professional to
take a "screen test." Not all able
teachers project well on television.
There is the natural tendency of pub-
lic health leaders to prepare a paper to
be read or a lecture to be given as is
so common in public health conferences
or in the classroom.
For television a carefully planned
informal setting with visual aids or a
visual presentation is desired. The
preparation for this is exacting for
both the ETV teachers and the staff.
To one without prior experience, the
complexities in taping a program are a
great surprise. The physical facilities
are impressive— and very costly. A sta-
tion staff of six to ten persons is
required.
To public health personnel without
prior responsibility for a TV teaching
session, exactly timed, the taping is a
trying experience. One must be pre-
pared for a studio rehearsal, the thirty
minute taping and a redoing of it all as
many times as indicated (subject to
time and cost limitations) if there is
reasonable hope of improving the
presentation.
Even if the taping goes well, there ;
can be problems later. In Alabama, one j
Wednesday morning program could
not be broadcast since the TV tower
was struck by lightning Tuesday night.
Even more exasperating, another did
not get on the air as scheduled since
the tape sent ten days earlier had not
reached the studio, and the project staff
was made aware of this when a repeat
program was put on the air.
We have learned that there are oper-
ational problems. Substitute tapes need
to be kept available in the broadcast
station, and each local group needs to
have a plan for a substitute activity in
the event of a broadcast failure.
1
THE HEALTH BULLETIN
June, 1968
The tapes prepared have been evalu-
ated by the public health w/orkers in
Alabama. Only the ones given a medi-
um to high rating will be used in
North Carolina. Those with low ratings
will be replaced and redone if the
subject is retained. Poor reception
detracts seriously. Perhaps this can be
improved by more effective aerials. If
so, it is hoped these will be installed.
Study Manuals
It has been the view of the project
staff that each session has three inter-
related components— the study manual,
ETV and the group discussion. The first
two communicate in differing ways and
possibly on differing aspects of the
subject. The group discussion draws
from these and other sources, and
from local experience, for the learning
together, the planning and motivation
which is its goal.
Hence, it has been the purpose to
provide in the study manual either a
capsule summary of current knowledge
in the subject area or to be one of a
two part presentation, the other being
ETV. Since it is distributed before the
ETV viewing and to counties beyond
the reach of ETV in the three states, the
manual must be complete and under-
standable on its own. It is designed to
be kept and should be available long
after the ETV is a dim memory. It is
hoped that each one who receives a
manual will have a loose leaf notebook
or folder in which the manuals are
retained.
The content of the ETV and the
study manuals are planned together.
The participating authorities and teach-
ers either provide a suggested draft of
content or direct attention to the
sources of information. It has been a
responsibility chiefly of the project
director to prepare the manuscripts.
These are submitted for review and
approval to the ETV teacher or other
authority. Before going to the printer
it must be agreed that the two presen-
tations fit together.
Some participants in Alabama have
felt that the manual and the ETV were
not sufficiently related. In view of
these reactions, in North Carolina dur-
ing the training sessions for discussion
leaders, it was indicated to the partici-
pants that the study manuals were to
supplement the ETV presentation, not
just repeat the same information. This
was not done in Alabama. You will
find also that later manuals include a
"preview" of the total educational ses-
sion which indicates again the inter-
relation of ETV and the study manual.
There have been helpful suggestions
for increasing the interest and improv-
ing the value of the manuals. These are
desired and appreciated. Reactions are
used as a guide for revision and in
future planning.
Group Discussion
In the original project proposal as
approved there was major emphasis on
ETV and a recognition of the need for
study manuals. Group discussion was
not mentioned. Only gradually was the
high importance of this component ful-
ly appreciated. Now it is considered
potentially to be the most important
part of the educational session. The
value of this continuing education pro-
gram depends substantially on local
discussion leaders and your effective
participation.
In planning for the initiation of this
continuing education program in any
state a consideration of high impor-
tance is the selection of those who will
give local leadership to the program.
This was approached differentlly in Ala-
bama and North Carolina. In the for-
mer the one who was acting as the
state coordinator of the program was
able to take time to visit each county
health department, to discuss the pro-
gram and obtain the recommendation of
program coordinators and discussion
June, 1968
THE HEALTH BULLETIN
leaders and to get their agreement ticularly if leading the discussion, can
before they were designated by the infect the group with enthusiasm. The
local health officer. This began to ere- need is for a deep feeling of responsi-
ate the realization that the program was bility by all for the success of group
their program and the degree of its discussion.
success depended on them. Evaluation
in North Carolina decisions were tl x- * . t ^u+,;„ =„
The first concern was to obtain an
made much more quickly under pres- , . ,. . , .1 „ ,«,^t:^„ +^ +u^
, early indication ot the reaction to the
sure of time. State personnel acquaint- ■,■■< 11 +• „ 1 .„^.- ^ ru^ c-,,^
^ I r I J individual educational sessions. The sim-
ed with local workers identified and , 1 .• ,u *.. ^ -.^^ tuic tu^
pie evaluation sheets provide this. 1 he
recommended prospective program ... , auu-,^, u-,«. u^^.^
, , II striking feature in Alabama has been
coordinators and discussion leaders. . . , . .. ^ ., ^„^^. „
the wide range in reactions. No session
This led to a general but erroneous im- , , , . , , . ,. ,
^ , I r I • I was so favorably received that it did
pression that responsibiltiy for this edu- ^ , u x u •* ,. 1^,., -.^
^ , , not have some who felt it was low in
cational program was being assumed .^^^^^^^ ^^^ ^^,^^ ^1^^ ^^^^ ^^^ ^^^^_
in a central office. ^^^ sessions were of very high or high
In marked contrast the attitude .^^^^^^^ ^^ ^^^^^ 1^ ^^^ realized that
desired was that it was a cooperative ^^^ opinions of administrators and
endeavor requiring the participation of ^^^.^^^ ^^^^^ ^^^1^ ^^ ^^^ ^f ,j^g ^j^^
each local health officer and health ^^^ majority reactions. Each week the
department, and of comparable persons ^^^^.^^ ^^ ^^^ evaluation sheets is await-
at state level. Despite this basis for ^^ ^.^^ ^^^^ .^^^^^^^_
some misunderstanding, almost all of ^ , . ,
, . J ix * From the question and answer pro-
the persons suggested, or alternates ^.,, ,
, , , ,,1 i.u ££■grams you will know your questions
selected by the health officers, were ^ ;. , , • j j .u
, / r .!_ . . I are studied and summarized, and those
on hand for one of the ten regiona'
leadership training sessions.
most commonly asked will be used. In
addition your comments are given close
The instruction provided by Dr. Don- ^^^^^^-^^^ particularly the critical ones.
The need for more adequate evalua-
tion is increasingly clear. It is anticipat-
nie Dutton and either Dr. Eugene Wat
son or Dr. Edward Collins was well
received. The expressed regrets were
, â– . , . . ij I u J ed this will be a part of programs
that this training could only be made . , , ,.
., , , , L II i- _x beginning in the tall,
available to such a small proportion of ^ ^
the health workers. A Look to the Future
There is a recognition by some, pos- Programs began with a considera-
sibly many, that it requires practice to tion of interpersonal relations since this
attain a favorable group discussion. subject was given highest priority by
There are those who sit silently or make local health department personnel. In
their whispered comments to their the fall areas of major activity in com-
neighbor. There are leaders who "lee- municable disease control, environmen-
ture." There are many who think that tal health, maternal and child health,
asking questions and getting answers comprehensive health planning, and
is a good discussion. Certainly there others will receive attention,
will be room for improvement in the A means has been found of taking
group discussions in the months ahead. continuing education to every worker
Their value will depend on the attitudes in every health department within
of group members. Even one person reach of ETV. Health leaders in univer-
with obvious indifference may mar a sities, schools of public health, agen-
session. Also one with enthusiasm, par- cies, and health departments have
8 THE HEALTH BULLETIN June, 1968
responded with a readiness to partici-
pate. Can the full potential of this pro-
gram be developed?
Our future largely will be deter-
mined by attitudes. Some may have
had the feeling that this continuing
education program is something being
done to you. It is an activity in which
you were expected to participate. Oth-
ers may have thought of it as a pro-
gram provided for you. If so, you may
be only a passive recipient. Goals can
be attained only by working together.
Think and speak of this as your own
program which, is being done with
cooperative assistance, not to or for
but with.
This sharing calls for greater empha-
sis in at least three activities:
(1) The State Public Health Associa-
ation of each participating state
has a Continuing Education Com-
mittee. Your chairman is Dr. Cor-
rina Sutton. Its major function is
to be the spokesman for all pub-
lic health workers. Future pro-
grams as in the areas mentioned
and in administration, adult
health, mental health and in
other untouched fields must be
planned. What is provided will
be the programs requested by
you if your continuing education
committee is an effective spokes-
man for you.
(2) Cooperating with this committee,
the project staff proposes to seek
your personal recommendations
through a questionnaire which
will be distributed as early as
practiable. The individual recom-
mendations of every public
health worker on many ques-
tions is needed and will guide
future action.
(3) The real value of the program
must be measured. This demands
a relatively precise evaluation.
Let there be the attitude that we
each will gain as much as possi-
ble from the program and will
gladly share in an evaluation
which will show to ourselves
and to others what has been
accomplished.
For Those BeyoncJ the Reach of ETV
It is the purpose to make this program
of continuing education available to all
public health workers in the state.
Where ETV is not yet available the
temporary substitute will be regional
meetings using film reproduction of
selected tapes, individual study of the
manuals and group discussions are rec-
ommended also.
The project staff has been advised
that plans have been developed for
providing statewide ETV coverage in
the months ahead.
Summary
The public health workers of North
Carolina are initiating a program of
continuing education which could have
high significance to the future of public
health. The cooperative participation
of health leaders in universities, agen-
cies and health departments seemed
assured. Despite the inevitable weak-
nesses of a new effort, its rich poten-
tial is evident. Its full value must be
attained. The future depends substan-
tially on the public health workers of
North Carolina and the other pilot
states, and is a heavy responsibility on
the project staff which gladly accepts
this as a challenging opportunity.
Albert V. Hardy, M.D., Dr.P.H.
Project Director
Ronald L. Lester, AA.P.H.
Television Educational
Director
M. Donnie Dutton, Ph.D.
Adult Education Director
Frederick W. Hering, M.S.P.H.
Executive Secretary,
Southern Branch
June, 1968
THE HEALTH BULLETIN
CHARACTERISTICS OF HUSBANDS IN THE UNITED STATES, MARCH 1967
Age of Husband, in Years
14 65
Characteristic and o.er U-U 25-29 30-34 35-14 45-54 55-64 and over
Husbands-number In thousands 45,191 3,081 4,679 4,478 10,318 9,686 7,100 5,849
-percent distribution 100.0 6.8 10.4 9.9 22.8 21.4 15.7 13.0
— percent of all men in
^ age group 67.9 18.4 82.9 85.5 88.9 89.1 85.2 72.5
Age of wif ^-percent* 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
14 24 12.0 92.1 44.0 8.8 1.3 .3 .1 .1
25 29 11.1 6.5 49.1 39.8 6.2 .6 .2 .1
30.34 10.7 .9 5.4 41.5 23.5 2.3 .5 .1
is.A 23.5 .3 1.3 9.2 62.4 33.1 5.2 1.0
Js.n 34.3 .2 .2 .7 6.5 63.4 89.2 39.9
J5 and over :::::::::::::: 8.4 .0 .0 .0 .1 .3 4.8 58.8
Residence-percent in 1966 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Metroplman areas 64.1 62.4 64.5 66.5 66.0 65.6 62.4 9.3
in central cities - 29.2 31.1 30.1 29.0 26.8 29.0 30.6 30.6
Outside central cities 34.9 31.3 34.4 37.5 39.2 36.6 31.8 28.7
Nonmetropolitan areas 35.9 37.6 35.5 33.5 34.0 34.4 37.6 40.7
living arrangement-percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Living with wife 95.7 93.8 96.3 96.3 96.0 96.0 95.0 95 2
Own household 94.0 87.1 94.1 95.0 95.0 95.1 94.0 93.3
Relatives household 1.5 6.3 1.9 1.3 .9 .8 .8 1.8
Nonrelative's household .2 .4 .3 .0 .1 .1 i •'
Not living with wife 4.3 6.2 3.7 3.7 4.0 4.0 5.0 4.8
Own household with relative ^ , , a
present -4 -6 .3 .4 .5 .6 .4 .4
Own household with or without
nonrelatlve present 1.3 .9 1.0 1.0 1.0 1.1 1.9 2.0
Other 2.6 4.7 2.4 2.3 2.5 2.3 2.7 2.4
Numberof own children under 18 ,^^r. ,a«a iaaa innn
years of ag^-pertent in 1966* 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
No'children '^ 42.8 40.5 19.8 9.7 12.3 42.8 .7 96.2
One child 17.3 36.0 24.2 14.0 15.4 24.5 1.9 2.4
Two children 17.6 17.2 31.0 29.2 26.5 16.7 3.7 .7
Three children 11.1 4.8 15.7 22.8 2.3 7.8 .4 .3
Four or more children 11.2 1.5 9.3 24.3 24.5 8.2 1.3 .4
Own children under age 18 per 100
husbands 133 88 171 248 239 115 28 6
labor force^participation-percent in ^^^^ ^^^^ ^^^^ ^^^^ ^^^^ ^^^^ ,^^^ ,^^^
In labor force :::::::::::::: 87.2 96.5 98.4 98.8 98.1 96.6 86.7 29.8
Emnloved 85.1 93.7 95.9 96.6 96.4 94.6 83.9 28.6
E^^Jed ZZZZ.: 2.1 2.8 2.5 2.2 1.7 2.0 2.8 1.
Not in labor force 12.8 3.5 1.6 1.2 1.9 3.4 13.3 70.2
•Excludes husbands with spouse obsent.
Note: Data relate to civillon populotion, and members of the Armed Forces who live off post or with their families on post.
Source of basic data: Reports of the Bureau of the Census and the Deportment of Labor.
10
THE HEALTH BULLETIN
June, 1968
The
American
Husband
The majority of American men marry
and establish their own homes at a
relatively early age, and bear the chief
responsibility for financial support of a
family throughout their working lives.
The latest data on the characteristics of
husbands in the United States are
shown in the accompanying table;
members of the Armed Forces are in-
cluded only if they live off post or
live on post with their families.
A large proportion of our married
men are at the ages when they begin
raising and educating their children. In
1967 over one quarter had not yet
reached age 35 and an additional quar-
ter were 35-44 years old. The married
men aged 65 and over have been in-
creasing in number, and now exceed
5.8 million, or one eighth of all married
men. About 3.3 million of these hus-
bands, many of whom are retired from
active business life, have wives who
are also 65 years of age or older.
Only about 36 percent of our mar-
ried men make their home in small
urban or rural communities. Almost two
thirds live in metropolitan areas (stan-
dard metropolitan statistical areas), with
the suburbs favored over the central
cities.
Virtually all husbands maintain
homes for their families. Only about
6 percent either live apart from their
wives, or live with them in someone
else's household. This latter group is
typified by young newlyweds who
share living quarters with their parents
or other close relative until they are able
to set up a home of their own. Because
fewer and fewer young counles find
this doubling up a financial necessity,
the relative importance of such living
arrangement has declined steadily in
the past two decades, from about 9
percent of all married couples in 1947
to only 1.7 percent in 1967.
Three out of five married couples
have at least one of their own children
under age 18 living with them, but the
proportion declines as the family mat-
ures. When the husband is in his late
twenties, four out of five couples are
responsible for at least one young
child and one in four has three or
more children in their care. The head
of a moderately large family is most
commonly a husband 30-44 years old.
Nearly half of the families of this size
have three or more children living with
them. After the husband's 45th birth-
day, the number of children in the
family decreases sharply: the offspring
go off to school, marry, or leave home
for other reasons. Nevertheless, there
are about 360,000 young children
living in families in which the hus-
band is 65 years or over.
At ages 25-44, when family respon-
sibilities are at a maximum, 98 percent
of all husbands are in the labor force.
The proportion declines with advance
in age, but still is almost 87 percent at
ages 55-64 years. Thereafter, it drops
sharply as increasing numbers retire,
become disabled, or find it impossible
to obtain employment. Though in most
families the husband is the principal
bread-winner, an increasing number of
wives are supplementng their families'
income either by working part time or
temporarily, or by resuming a career
interrupted while the children were of
tender years. At present, in one out of
three families both the husband and
wife are in the labor force.
—From Statistical Bulletin, Metropoli-
tan Life Insurance Co.
June, 1968
THE HEALTH BULLETIN
11
Are
Radio Inf-erview
Human
Tumours
Caused By
Viruses?
Benign human tumours— warts and
molluscum contagiosum— are certainly
caused by viruses. It is even possible
that these or related viruses occasion-
ally give rise to malignant growth.
(Wart viruses from American cottontail
rabbits and cattle, which are structural-
ly very similiar to human wart viruses,
are known to induce malignant tumours
in domestic rabbitis and hamsters, re-
spectively.) But for the rest the sup-
position that at least some human
tumours are virus-induced is based on
analogies with what happens in lower
animals. Although these analogies can
be highly suggestive, they are not by
themselves convincing; and this is why
so much time and effort has gone into
attempts to establish that certain hu-
man tumours are caused by viruses.
This effort has also a practical side, be-
cause, if an oncogenic human virus
were to be isolated, vaccination might
be feasible. Under appropriate condi-
tions vaccination can reduce the incid-
ence of virus-induced tumours in lab-
ratory animals, although such proced-
ures may well be difficult to apply in
man . . . There is no shortage of ani-
mal models; all we need is convincing
evidence that even one human malig-
nant tumour is induced by a virus.
Reference: The Lancet, May 1968,
Page 1142.
With Dr. Neely
On PKU
Our guest today is Dr. E. Robert
Neely, Pediatric Consultant with the
Maternal and Child Health Section of the
North Carolina State Board of Health.
In 1965 the General Assembly of
North Carolina enacted a law establish-
ing at the State Board of Health a
volunteer metabolic screening program
for newborn infants in which the first
abnormality tested for was PKU.
Q. Dr. Neely, what is PKU?
A. PKU or phenylketonuria is an in-
herited disease in which an infant
cannot use phenylalanine which is an
amino-acid or normal substance of pro-
tein that we eat. This food substance
gets very high in the blood stream of
the PKU infant and is deposited in
several parts of the body, especially
the brain. Early the child with PKU
seems normal but after four months or
so, he may develop marked irritability,
severe vomiting, convulsions (or fits),
dry scaly rash, and a musty odor with
an increasing appearance of mental
retardation or slowness.
Q. How are PKU patients detected?
A. Presently the best way to detect
this disease is by mass testing of new-
borns in public health screening pro-
grams and we feel that actual measure-
ment of the blood phenylalanine level
is more reliable. There are a few other,
less reliable tests including one that
doctors can do on the baby's urine in
his office or clinic.
Q. How often does PKU occur?
A. As I said before, PKU is inherited
which means he gets the disease passed
12
THE HEALTH BULLETIN
June, 1968
on from his parents who may have the
disease but are probably only carriers
of the disease. A carrier is a normal
person who if he marries someone who
is also a carrier of PKU, they have one
chance in four of having a child with
PKU. One of every 70 people is a car-
rier and the instance of PKU varies from
1 in 7,000 births in Utah to 1 in 20,000
births in the Southeastern United States.
The incidence in this state thus far is
approximately 1 in 20,000 births.
Q. How many PKU children have you
found in North Carolina?
A. By screening we have found 8
since our full program started in Jan-
uary 1966.
Q. How many newborns have been
tested?
A. In 1966 we tested approximately
69,000 newborn infants or 73% of our
births and in 1967 we tested 83,000
or 89% of our births. Since we have a
voluntary program in North Carolina,
methods other than our state program
may be used for screening, and two of
our larger hospitals do their own
screening in their hospital laboratory.
If we add those to our tests, 93% of
all our newborns were tested.
Q. What happens after a high PKU
test is found?
A. All test results falling above our
screening level are returned to phy-
sicians and hospitals, sending it in
asking for a repeat test. After the re-
peat test is completed, and if we feel
the results are compatable with PKU,
we request that the child be admitted
to one of our University Medical Cent-
ers for further diagnostic evaluation. I
might say here that frequently there
are several repeats before we send the
patient to a center and most of our
PKU infants have had extremely high
blood levels of phenylalanine.
In the Medical Center a team ap-