Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial.

The authors used recursive partitioning methods to identify combinations of baseline characteristics that predict 2-year physical activity success in each of 3 physical activity interventions delivered in the multisite Activity Counseling Trial. The sample consisted of 874 initially sedentary primary care patients, ages 35-75 years, who were at risk for cardiovascular disease. Predictors of 2-year success were specific to each intervention and represented a range of domains, including physiological, demographic, psychosocial, health-related, and environmental variables. The results indicate how specific patient subgroups (e.g., obese, unfit individuals; high-income individuals in stable health) may respond differently to varying levels and amounts of professional assistance and support. The methods used provide a practical first step toward identifying clinically meaningful patient subgroups for further systematic investigation.     

On Making and Keeping Promises

Do the conditions under which promises are made determine whether they ought to be kept? Philosophers have placed a number of conditions on promising which, they hold, must be met in order to make promise-keeping obligatory. In so doing, they have distinguished valid promises from invalid promises and justified promises from promises that are not justified. Considering such conditions, one by one, we argue that they are mistaken. In the first place, the conditions they lay down are not necessary for either valid or justified promise-making. In the second place, promises need not meet such conditions in order to create moral obligations. In general, such analyses of promising fail because they suffer from a confusion between promise-making and promise-keeping. Philosophers have wrongly supposed that obligations to keep promises are dependent upon, or derivable from, the quality of the promises themselves, at the time they are made, instead of focusing on conditions that must be satisfied at the time when promises are supposed to be kept. It is not the quality of a promise that determines an obligation to keep it but the rightness or wrongness of performing the promised act.     

Evidence for clinical smoking cessation for adolescents.

OBJECTIVE: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. DESIGN: Qualitative literature review. RESULTS: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. CONCLUSION: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track.     

Echoic memory processes in good and poor readers

Four experiments were conducted to determine whether echoic memory plays a role in differences between good and poor readers. The first two experiments used a suffix procedure in which the subject is read a list of digits with either a tone control or the word go appended to the list. For lists that exceeded the length of the subjects memory span by one digit (i.e., that avoided ceiling effects), the poor readers showed a larger decrement in the suffix condition than did the good readers. The third experiment was directed at the question of whether the duration of echoic memory is different for good and poor readers. Children shadowed words presented to one ear at a rate determined to give 75-85% shadowing accuracy. The items presented to the nonattended ear were words and an occasional digit. At various intervals after the presentation of the digit, a light signaled that the subject was to cease shadowing and attempt to recall any digit that had occurred in the nonattended ear recently. Whereas good and poor readers recalled the digit equally if tested immediately after presentation, the poor readers showed a faster decline in recall of the digit as retention interval increased. A fourth experiment was conducted to determine whether the differences in echoic memory were specific to speech stimuli or occurred at a more basic level of aural persistence. Bursts of white noise were separated by 9-400 ms of silence and the subject was to say whether there were one or two sounds presented. There were no differences in detectability functions for good and poor readers.