yeloped much more fully than a

private insurers and by fiscal intermediaries of government has been marked by "inventive circumvention" by practitioners. Krizay and Wilson carve out health insurance reform as a policy area, leaving many who are ready for major structural revisions dissatisfied. Their discussion is, however, lively, informed, and individual, and should be of interest to health care professionals and consumer advocates. Charlotte Muller Associate Director Center for Social Research City University of New York

The Teenage Pregnant Girl. Jack Zackler and Wayne Brandstadt. Charles C Thomas, Springfield, IL. 323 pp. 1975. $12.95.

The first two chapters of this book will be of value to everyone interested in teenage illegitimacy. Philip Cutright argues from data of high quality that the rise of teenage illegitimacy in the United States between 1950 and 1971 is due to an increase in fecundity, a decrease in spontaneous fetal loss, and a decrease in first child sterility among nonwhite teenagers. Among white teenagers increased sexual activity is the major cause. Cutright concludes that programs to decrease teenage illegitimacy must include abortion on request. Programs which provide only contraception will not be effective for the young teenager for reasons related to the characteristics of programming and of teenagers. These two chapters and the eighth, which contains an excellent summary of the legal status of family planning services, will be of interest even to obstetricians. The rest contain information and ideas which might be helpful to students in any health profession who want an overview of the subject. However, readers will have to be careful. The book is a collection of essays by different individuals and suffers from an apparent lack of awareness by any one author of what has been written in other chapters. There is much overlap, contradiction, and uneven quality. The fourth chapter, on nutrition and pregnancy in adolescence, is up-to-date and excellent. In contrast, the third chapter, which deals with obstetrical and medical problems of teenage pregnancy, is a disaster area. Because of its potential importance for nonobstetrici'ans, this is a very disappointing chapter. Among the most striking of its deficiencies is a misplaced emphasis, illustrated by the eight detailed pages on the diagnosis

and treatment of vaginal infections caused by Monilia, Trichomonas, and He m op h ilus vaginalis. Physicians would not seek this information in a source such as this book. Others could not use all the detailed information. More important subjects are poorly handled. Table III-VI is presented to show an association between prenatal care and pregnancy outcome. No social class control is entered into the table or its interpretation. Prenatal care is inadequately defined as "at least one visit." A discussion of weight control refers to a chart illustrating the maximum weight gain to be 20 pounds. Weight control and the avoidance of excessive sodium intake are recommended to prevent toxemia. These are dated recommendations. The following statement is particularly jolting, "One-third of fetal deaths occurred before or during labor, and two-thirds were neonatal." This chapter does contain many facts which are correct and could be useful but too much prior information is required in order to sort them out. Chapter 5, dealing with psychological and emotional problems of pregnancy and adolescence, is well done. Chapter 6, "The Community Health Nurse and the Adolescent Family, " overlaps slightly with the previous chapter, but adds some new suggestions concerning the role of the nurse. Chapter 7, entitled "A Social Psychological View of Female Adolescent Contraception," overlaps considerably with the first two chapters and is much less scholarly in approach. It assumes common stereotypes, is largely middle class-oriented, and has little information concerning the meaning of teenage pregnancies within ethnic groups. Chapter 9 gives a historical background of program development. Chapter 10 is entitled, "Comprehensive Service Program for School Age Pregnant Girls," but unfortunately spends much time rehashing again the psychological interpretations relating to teenage pregnancies, so that the reasons for having programs are deyeloped much more fully than a description of the program being presented. Some evaluation data are discussed, but the reader can tell only in a general way what the program described actually did to achieve the results. Chapter 11 concerning the staffing of teenage programs and attitudes of staff once again reviews the problems of teenagers who are pregnant, but does include in addition some concrete and useful suggestions. The final chapter is a good one,

offering some brief, clear suggestions concerning program appraisal. An assumption appears to exist that the reader is about to start a program of his own. If the book has any direction to it, it might be to persuade the reader (over and over again, with stronger and weaker analyses) that there is a problem, to make some suggestions as to what kind of a program would help, and then to suggest how to appraise this program's effectiveness. Unfortunately, there is no final summary to the book, no editorial pulling-together; and the important, tightly reasoned conclusions reached by Cutright in the second chapter do not reappear at the end of the book. NVaomi M. Morris, MD Professor, Maternal and Child Health University of North Carolina

Population. Third Edition. William Petersen. Macmillan Publishing Company, Inc., New York. 784 pp. 1975. $11.95. Many students have been introduced to population studies through earlier versions of Petersen's text. Whereas the second edition was an extensive revision of the first, the third adds information to the format of the second, especially in chapters on Malthusian theory and totalitarian societies. Numerous references to scholarly works have been updated through 1973 but do not encompass the 1974 World Population Conference or post-Bucharest writings. Pithy quotes interjected as summaries of Petersen's presentations move the reader easily through varied topics. For instance, a discussion of the failure of most pronatalist measures is concluded by these words from D. V. Glass: "However urgently governments may have declared their desire to increase the supply of births, they have nevertheless persistently tried to buy babies at bargain prices" (Population Policies and Movements in Europe, p. 371. Clarendon, Oxford, 1940, quoted on p. 550). Petersen acknowledges a "close acquaintance with epidemiology" acquired while teaching preventive medicine. This broadened perspective emerges throughout, and, although primarily limited to studies of causes of death, it makes the text more valuable as an interdisciplinary bridge between sociology and more traditional public health. Carol J. Hogue Assistant Professor Department of Biostatistics University of North Carolina

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