The Application of Family Stress Model to Investigating Adolescent Problematic Behaviors: The Moderating Role of Assets.

The Family Stress Model framework proposes that household income can influence child and youth development through caregiver psychological distress. While prior studies have observed stronger associations among households with lower income, the role of assets has been ignored. This is unfortunate, as many existing policies and practices that intend to improve child and family well-being are focused on assets. The purpose of this study is to clarify whether asset poverty moderates the direct and indirect effects of paths linking household income, caregiver psychological distress, and adolescent problematic behaviors. Using the 2017 and 2019 Panel Study of Income Dynamic Main Study and 2019 and 2020 Child Development Supplements, we find that the family stress processes consisting of household income, caregiver psychological distress, and adolescent problematic behaviors are less intensive for families with more assets. These findings not only add our knowledge of FSM by taking account the moderating role of assets but also advance our understanding that assets can benefit child and family well-being through alleviating family stress processes.

Perception biases for problematic behaviors in dogs due to owners' attributes.

The abnormal or undesirable behaviors of owned dogs are not always considered problematic; it depends on the perception bias of their owners. To demonstrate the perception bias in dog owners' attributes, 133 dog owners in Aomori (rural) and Tokyo (urban) were surveyed through questionnaires distributed via seven animal hospitals regarding the frequency of potentially problematic behaviors and their perceived difficulty with them. The interaction effects of the lived location (urban, rural), age (20s-50s, 60s or later), and sex (male, female) of the owners were evaluated through a hierarchical multiple regression model. The analyses of 115 responses demonstrated that the tendency of perception regarding the five major behaviors under consideration varied with these attributes. Our results indicated that owners living in Aomori undervalued destruction behaviors of their dogs both when family members were and were not at home, while they overvalued jumping on people. Senior owners tended to undervalue nuisance barking when family members were at home along with uncontrollable hyperactivity. Male owners also undervalued destructive behavior when family members were not home. The study concludes that perception bias due to dog owners' attributes should be taken into account in epidemiological surveys and during medical interviews by veterinarians or other behavioral specialists. Further exhaustive investigation and exploration of the cultural background of these perception differences should be conducted.

Can Intelligence Affect Alcohol-, Smoking-, and Physical Activity-Related Behaviors? A Mendelian Randomization Study.

People with high levels of intelligence are more aware of risk factors, therefore choosing a healthier lifestyle. This assumption seems reasonable, but is it true? Previous studies appear to agree and disagree. To cope with the uncertainty, we designed a mendelian randomization (MR) study to examine the causal effects of genetically proxied intelligence on alcohol-, smoking-, and physical activity (PA)-related behaviors. We obtained genome-wide association study (GWAS) datasets concerning these variables from separate studies or biobanks and used inverse-variance weighted (IVW) or MR-Egger estimator to evaluate the causal effects according to an MR protocol. The MR-Egger intercept test, MR-PRESSO, and funnel plots were employed for horizontal pleiotropy diagnosis. The Steiger test (with reliability test), Cochran's Q test, MR-PRESSO, and leave-one-out method were employed for sensitivity analysis. We found significant or potential effects of intelligence on alcohol dependence (OR = 0.749, p = 0.003), mental and behavioral disorders due to alcohol (OR = 0.814, p = 0.009), smoking (OR = 0.585, p = 0.005), and smoking cessation (OR = 1.334, p = 0.001). Meanwhile, we found significant or potential effects on walking duration (B = -0.066, p < 0.001), walking frequency (B = -0.055, p = 0.031), moderate PA frequency (B = -0.131, p < 0.001), and vigorous PA frequency (B = -0.070, p = 0.001), but all in a negative direction. In conclusion, our findings reinforce some existing knowledge, indicate the complexity of the health impacts of human intelligence, and underline the value of smoking and alcohol prevention in less intelligent populations. Given the existing limitations in this study, particularly the potential reverse causality in some estimations, re-examinations are warranted in future research.

The Associations between Daytime Physical Activity, While-in-Bed Smartphone Use, Sleep Delay, and Sleep Quality: A 24-h Investigation among Chinese College Students.

Bedtime smartphone use is an emerging issue that threatens the sleep health of children and young adults. Physical activity can have numerous health benefits, including reducing problematic or addictive behavior. However, the role of daily physical activity in reducing bedtime smartphone use is understudied. Hence, we conducted a one-day cross-sectional on the weekend (21-22 May 2021) to investigate the associations between daytime physical activity, bedtime smartphone use, and sleep quality. A total of 828 college students were recruited in two colleges. Their daytime physical activity indices were captured, including self-reported physical activity duration, intensity, volume, and smartphone-monitored walking steps. The participants reported whether they used smartphone while lying in bed (before sleep) and whether they delayed sleep due to smartphone use. Their while-in-bed screen time (duration) and subsequent sleep quality were also measured with self-report and a numeric rating scale, respectively. The results suggested that daytime physical activity duration was associated with lower chances of while-in-bed smartphone use (OR = 0.907, p = 0.019) and smartphone-related sleep delay (OR = 0.932, p = 0.014). However, no significant association was found between physical activity indices and while-in-bed screen time or sleep quality. These findings may contribute to understanding the reciprocal relationship between physical activity and smartphone use and highlighting the potential of controlling problematic bedtime smartphone use through daily physical activity. Future research is warranted to examine the associations with extra objective measures.

Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan.

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5-nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19-1.66, 7 h: aOR 1.10, 95% CI, 0.98-1.23, 8 h: aOR 1.13, 95% CI, 1.02-1.26, irregular: aOR 1.26, 95% CI 1.10-1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

Expectations versus Reality: Long-Term Research on the Dog-Owner Relationship.

In the framework of the early prevention of problems in the owner-dog relationship, it is important to have a broad perspective on the development of this relationship over time, starting before people actually acquire a dog. People who currently (or previously) own(ed) a dog can rely on their experiences when considering a new dog, while this knowledge is unavailable to first time dog-owners. In this study, we explore how self-efficacy, social comparison, perceptions about the (dis)advantages of ownership and commitment to the dog (so-called social cognitive factors), problematic canine behaviors, perceived costs, and satisfaction with the dog change over time. We examine changes from the motivational phase of relationship development (before acquisition of the dog) into the experience phase (six and twelve months after acquisition of the dog). We explore if patterns are different in experienced (previous (n = 73) and current (n = 80)) versus unexperienced (first time (n = 30) dog owners. The respondents filled in three online questionnaires-once before and twice after acquisition of their dog. From T0 (before acquisition of the dog) to T1 (having the dog for six months) participants (especially those with no ownership experience) had to adjust their perceptions about dogs and dog ownership. Experiencing the relationship for an additional year (from T1 to T2) barely changed the social cognitive factors, satisfaction, and perceived costs. A small decline in problematic canine behaviors was present among the experienced dog owners between T1 and T2. To conclude, perceptions about dogs and dog ownership change over time, but after testing these perceptions with reality, they become stable after about six months.

Association between children's sleep patterns and problematic behaviors at age 5.

BACKGROUND: Night-shift lifestyles affect children as well as adults, and are associated with sleep and behavioral problems among children. This study aimed to investigate associations among sleep patterns, individual/environmental factors, and problematic behaviors in children at age 5 years. METHODS: Data for sleep patterns, individual / environmental factors, and problematic behaviors for 8,689 5-year-old children were collected from health-checkup records. Problematic behaviors investigated were anxious behavior (being afraid, difficulty being separated from the mother), developmental behavior (violence, restlessness, rebellious behavior, restrictive diet, stereotypic play), personal habits (thumb-sucking, nail-biting, tic, masturbation), and excretory problems. The relationships between sleep patterns (bedtime, sleep duration) and the presence of these behaviors were analyzed. Individual / environmental factors that affected problematic behaviors were statistically identified using a tree-form model. RESULTS: Late bedtime and short sleep duration showed significant adverse effects on children's problematic behaviors - odds ratio (OR): 1.07, 95% confidence interval (CI): 1.03-1.11 and OR: 0.92, 95% CI: 0.87-0.97, respectively. Long television watching time, abnormality at birth, and lack of father's support also showed significant adverse effects on problematic behaviors (OR: 2.34, 95% CI: 1.87-2.94), and significantly affected late bedtime and short sleep duration. CONCLUSIONS: There were significant associations among sleep patterns, individual / environmental factors, and problematic behaviors in 5-year-old children. Improving children's sleep patterns, reducing the duration of television watching, and improving support from fathers may reduce problematic behaviors.

Exploring the Role of Social Media Use Motives, Psychological Well-Being, Self-Esteem, and Affect in Problematic Social Media Use.

Given recent advances in technology, connectivity, and the popularity of social media platforms, recent literature has devoted great attention to problematic Facebook use. However, exploring the potential predictors of problematic social media use beyond Facebook use has become paramount given the increasing popularity of multiple alternative platforms. In this study, a sample of 584 social media users (M age = 32.28 years; 67.81% female) was recruited to complete an online survey assessing sociodemographic characteristics, patterns, and preferences of social media use, problematic social media use (PSMU), social media use motives, psychological well-being, self-esteem, and positive and negative affect. Results indicated that 6.68% (n = 39) of all respondents could be potentially classed as problematic users. Moreover, further analysis indicated that intrapersonal motive (ß = 0.38), negative affect (ß = 0.22), daily social media use (ß = 0.18), surveillance motive (ß = 0.12), and positive affect (ß = -0.09) each predicted PSMU. These variables accounted for about 37% of the total variance in PSMU, with intrapersonal motive driving the greatest predictive contribution, over and above the effects of patterns of social media use and sociodemographic variables. These findings contribute to the increasing literature on PSMU. The results of this study are discussed in light of the existing literature on PSMU.

Estudos descritivos e experimentais em contextos aplicados: dados científicos e impacto prático / Descriptive and experimental studies in applied contexts / Estudios descriptivos y experimentales en contextos aplicados

O presente artigo se propôs apresentar, a partir de levantamento bibliográfico em periódicos, livros e capítulos de livro, dados da produção intelectual docente e discente oriundos do Programa Stricto Sensu em Psicologia da PUC Goiás, entre os anos 2003 e 2019. Os dados dos estudos possibilitaram ilustrar características do modo de fazer ciência em análise do comportamento aplicada, com destaque a seus métodos e princípios, e ao comportamento-alvo sob estudo. Também permitiram discutir o impacto prático desses estudos. Os resultados mostraram uma maior concentração de estudos descritivos e/ou experimentais em periódicos que abarcam diferentes aspectos do comportamento emitidos por pessoas diagnosticadas com algum transtorno mental, assim como por pessoas que não apresentam diagnóstico psiquiátrico, os quais estavam sob controle de variáveis ambientais testadas nas condições experimentais.

This article aims at presenting the intellectual research of professors and students from the Psychology University of PUC Goiás between the years of 2003 and 2019. The findings made possible to exemplify the human behavior analysis science, highlighting its methods and principles, as well as the target behavior under study. The findings also allowed a discussion of the practical impact of these studies. The results showed a greater concentration of descriptive and/or experimental studies in journals covering different behavioral aspects from people diagnosed with some mental disorder, as well as people who did not present any psychiatric diagnosis but were under control of environmental variables tested in experimental conditions.

El presente artículo se propuso presentar, a partir de levantamiento bibliográfico en periódicos, libros y capítulos de libro, datos de la producción intelectual docente y discente oriundos del Programa Stricto Sensu en Psicología de la PUC Goiás, entre los años 2003 y 2019. Los datos de los estudios que posibilitaron ilustrar características del modo de hacer ciencia en análisis del comportamiento aplicado, con destaque a sus métodos y principios, y al comportamiento objetivo en estudio. También permitieron discutir el impacto práctico de estos estudios. Los resultados mostraron una mayor concentración de estudios descriptivos y/o experimentales en periódicos que abarcan diferentes aspectos del comportamiento emitidos por personas diagnosticadas con algún trastorno mental, así como por personas que no presentan diagnóstico psiquiátrico, los cuales estaban bajo control de variables ambientales probadas en las condiciones experimentales.

Preference of kittens for scratchers.

OBJECTIVES: The objective of this study was to determine kitten preferences towards different scratchers and the effects of catnip and cat odor on kitten scratching behaviors. METHODS: Two-choice preference tests were conducted to compare scratchers and preferred scratchers with or without additives (ie, catnip, catnip oil, cat hair) in six studies. Kittens (n = 40, <8 weeks old) had access to two scratchers on the floor of a simulated living room for 20 mins and interactions were video-recorded. The time each kitten spent scratching each scratcher was compared. RESULTS: In study 1, the S-shaped cardboard was preferred over a hemp post with a toy on top, and no difference was observed in the other pairs of scratchers compared. In study 2, the S-shaped cardboard was preferred by kittens compared with a raised scratcher covered with window screen or with carpet, and no differences were observed between the latter two scratchers. In study 3, the scratcher covered with window screen set upright was preferred over the same scratcher laid horizontally on the floor. The S-shaped cardboard was preferred over the scratcher covered with bubble wrap. In study 4, kittens preferred the S-shaped cardboard over the scratchers covered with window screen or short-fiber carpet but not over the scratcher covered with long-fiber carpet. In study 5, the S-shaped cardboard was strongly preferred over the long cardboard and rectangular cardboard but not over the boat-shaped cardboard. In study 6, dried catnip plant, catnip oil spray or the hair from other cats did not alter the scratching behavior exhibited by the kittens vs the control S-shaped cardboard alone. CONCLUSIONS AND RELEVANCE: The S-shaped cardboard scratcher was a preferred scratcher for kittens. Catnip or odor of other cats did not alter this behavior in kittens. S-shaped cardboard may be a preferred scratching device for kittens.

Predictive Effects of Sex, Age, Depression, and Problematic Behaviors on the Incidence and Remission of Internet Addiction in College Students: A Prospective Study.

The aim of the study was to determine the predictive effects of sex, age, depression, and problematic behaviors on the incidence and remission of internet addiction (IA) in college students over a one-year follow-up. A total of 500 college students (262 women and 238 men) were recruited. The predictive effects of sex, age, severity of depression, self-harm/suicidal behaviors, eating problems, risk-taking behaviors, substance use, aggression, and uncontrollable sexual encounters on the incidence and remission of IA over a one-year follow-up were examined. The one-year incidence and remission rates for IA were 7.5% and 46.4%, respectively. Severity of depression, self-harm and suicidal behaviors, and uncontrollable sexual encounters at the initial investigation predicted the incidence of IA in a univariate analysis, whereas only severity of depression predicted the incidence of IA in a multivariable logistic regression (p = 0.015, odds ratio = 1.105, 95% confidence intervals: 1.021⁻1.196). A relatively young age predicted the remission of IA. Depression and young age predicted the incidence and remission, respectively, of IA in college students in the one-year follow-up.

Risk Factors for Problematic Behaviors among Forensic Outpatients under the Medical Treatment and Supervision Act in Japan.

The Medical Treatment and Supervision Act (MTSA) was enacted in 2005 in Japan to promote the reintegration of clinical offenders with mental disorders into society. Under the MTSA, individuals who committed serious crimes in a state of insanity or diminished responsibility are diverted from the criminal justice system to the mental health system. Based on court decisions about MTSA-based treatment, clinical offenders have an obligation to engage in rehabilitation within their local community under the guidance of mental health professionals. However, patients under MTSA-based clinical treatments have faced various problems in the course of treatment, because of psychiatric as well as other static or dynamic factors, and sometimes have committed problematic behaviors, such as violence and medical non-compliance. Hence, this study aimed to clarify factors related to patients' inclusion in MTSA-based outpatient treatment and additionally, their commitment of problematic behaviors, based on confidential data acquired during a four-year government survey period (National Center of Neurology and Psychiatry) from MTSA enactment (July 15, 2005) to December 31, 2009. In total, we recruited 441 clinical offenders receiving MTSA-based outpatient treatment from 158 nationwide facilities. To evaluate related factors, we collected demographic, psychiatric, forensic, clinical treatment, and social service information. Statistical analyses demonstrated that predominant profiles of patients included male gender, younger age, low school history, psychiatric diagnoses (F1, F2, and F3), and no correctional or outpatient history before MTSA-based treatment. F1 or substance use diagnosis, in particular, was increasingly correlated with other factors, such as male gender, older age, and correctional history before MTSA treatment. Among the 441 patients, 189 (43%) committed problematic behaviors in the course of the MTSA-based outpatient treatment. Risk factors for patients' commitment of problematic behaviors comprised F1 diagnosis and inpatient history before MTSA-based treatment inclusion. In summary, reduction of overall problematic behaviors under the MTSA outpatient likely makes progress by focal attention to patients with psychiatric disorders caused by substance use and/or a past inpatient history for more severe psychiatric symptoms. This work is of ongoing and future importance in the domain of forensic community treatment, to connect risk-enhancing factors with risk management.

Anxiety-like behavior in Rett syndrome: characteristics and assessment by anxiety scales.

BACKGROUND: Rett syndrome (RTT) is a severe neurodevelopmental disorder characterized by regression of language and motor skills, cognitive impairment, and frequent seizures. Although the diagnostic criteria focus on communication, motor impairments, and hand stereotypies, behavioral abnormalities are a prevalent and disabling component of the RTT phenotype. Among these problematic behaviors, anxiety is a prominent symptom. While the introduction of the Rett Syndrome Behavioral Questionnaire (RSBQ) represented a major advancement in the field, no systematic characterization of anxious behavior using the RSBQ or other standardized measures has been reported. METHODS: This study examined the profiles of anxious behavior in a sample of 74 girls with RTT, with a focus on identifying the instrument with the best psychometric properties in this population. The parent-rated RSBQ, Anxiety, Depression, and Mood Scale (ADAMS), and Aberrant Behavior Checklist-Community (ABC-C), two instruments previously employed in children with neurodevelopmental disorders, were analyzed in terms of score profiles, relationship with age and clinical severity, reliability, concurrent validity, and functional implications. The latter were determined by regression analyses with the Vineland Adaptive Behavior Scales-Second Edition (Vineland-II) and the Child Health Questionnaire (CHQ), a quality of life measure validated in RTT. RESULTS: We found that scores on anxiety subscales were intermediate in range with respect to other behavioral constructs measured by the RSBQ, ADAMS, and ABC-C. Age did not affect scores, and severity of general anxiety was inversely correlated with clinical severity. We demonstrated that the internal consistency of the anxiety-related subscales were among the highest. Test-retest and intra-rater reliability was superior for the ADAMS subscales. Convergent and discriminant validity were measured by inter-scale correlations, which showed the best profile for the social anxiety subscales. Of these, only the ADAMS Social Avoidance showed correlation with quality of life. CONCLUSIONS: We conclude that anxiety-like behavior is a prominent component of RTT's behavioral phenotype, which affects predominantly children with less severe neurologic impairment and has functional consequences. Based on available data on standardized instruments, the ADAMS and in particular its Social Avoidance subscale has the best psychometric properties and functional correlates that make it suitable for clinical and research applications.

Tendencias del uso de drogas en la Ciudad de México: Encuesta de estudiantes, octubre 2012 / Drug use trends in Mexico City: 2012 students survey

Introducción Los estudios epidemiológicos en nuestro país muestran un incremento en el consumo de drogas ilegales y de alcohol. La edad de inicio también ha disminuido, especialmente en el consumo de alcohol. Por su parte, el consumo de inhalables se ha incrementado en forma importante, especialmente entre las mujeres jóvenes. Son diversos los factores asociados al consumo de drogas, pero de manera importante destacan el desarrollo de estrategias de resistencia, junto con sus habilidades sociales subyacentes, así como los estilos parentales de crianza. Método La presente es una encuesta probabilística en población escolar de secundarias y bachilleratos de la Ciudad de México que se levantó en noviembre del 2012, con representación a nivel de cada Delegación. La muestra fue de 26 503 alumnos. La información se obtuvo mediante un cuestionario estandarizado y validado en encuestas anteriores. Resultados El consumo de tabaco disminuyó significativamente (de 44.3% a 41.0%), el 32.9% de los adolescentes comenzó a utilizar tabaco antes de los 13 años. El 68.2% consumió alcohol alguna vez; en tanto que la edad de inicio promedio de consumo de esta sustancia se mantuvo en los 12.6 años. La prevalencia de consumo de drogas alguna vez aumentó de 21.5% a 24.4%. La mariguana es la droga de preferencia en la población estudiantil (15.9%). También se encontraron incrementos en la presencia de abuso sexual, mientras que el intento suicida disminuyó. Discusión Los resultados muestran el continuo crecimiento que tiene esta problemática, aunque los inhalables se mantuvieron constantes y el tabaco disminuyó de manera importante. Dado estos resultados, es una tarea preponderante dedicar más esfuerzos a la prevención con estudios e intervenciones evaluadas para preescolar y primaria, así como para los padres de familia y los maestros.

Introduction Epidemiological studies in our country show increases in the consumption of illegal drugs and alcohol. The age of onset has decreased, especially regarding alcohol use. Meanwhile, consumption of inhalants has increased significantly, especially among young women. There are several factors associated with drug use, but the development of resistance strategies, along with its underlying social skills and parenting styles, stand out in a significant way. Method Data comes from a probabilistic survey carried out in November 2012, with students from 7th to 12th school grades, in Mexico City, which was representative for each of its districts. The sample was 26 503 students. Information was obtained through a questionnaire standardized and validated in previous surveys. Results Tobacco consumption decreased significantly (44.3% to 41.0%); 32.9% of the adolescents began its use before age 13. Lifetime consumption of alcohol was 68.2%, while the average age of onset of cannabis use remained at 12.6 years. Lifetime prevalence of any drug use increased from 21.5% to 24.4%. Marijuana was the first drug of choice among students (15.9%). Increases were also found in sexual abuse rate, while suicide attempt decreased. Discussion Although inhalants use remained stable and tobacco use decreased significantly, results show the continued growth of drug use. Given this context, concentrating more efforts in prevention with studies and evaluated interventions for pre-school and elementary school students, as well as for parents and teachers, is a preponderant task.

Comparison of problematic behavior according to the ryouiku techou standard.

[Purpose] We compared problematic behaviors of children according to the severity of their mental retardation (MR) of intellect as categorized by the Ryouiku Techou in this study, to investigate the influence of MR of intellect on children's problematic behaviors. [Subjects] The subjects were 86 mentally retarded children undergoing physical therapy at hospitals and other facilities. [Methods] The examiners were 13 physical therapists and 8 occupational therapists who worked at the hospital and knew the children well. The examiners individually assessed the subjects using the Japanese version of the Aberrant Behavior Checklist. The subjects were divided into two groups (A and non-A) according to the Ryouiku Techou standard. [Results] No significant differences were observed between the groups except in the items of stereotypy and lethargy. [Conclusion] Problematic behaviors other than stereotypy and lethargy were not influenced by the Ryouiku Techou standard.

Evolution of a remedial CME course in professionalism: addressing learner needs, developing content, and evaluating outcomes.

INTRODUCTION: Scant information is available about the nature of the professional violations resulting in referral of physicians for remedial continuing medical education (CME). The CME program at Case Western Reserve University (CWRU) School of Medicine has developed the Intensive Course in Medical Ethics, Boundaries, and Professionalism (medical ethics course) for physician referrals due to ethical breaches. In this report, the authors present 7 years of data regarding the type of behavior that resulted in course referral as well as information regarding course and outcome evaluation development and participant demographics. METHODS: The medical ethics course has been designed in consultation with licensure agencies to address the learning needs of physicians with problems in the areas of boundary maintenance and ethics. Teaching methods and outcome evaluations include lectures, case discussions, multiple-choice question tests, skill practice sessions, and writing a reflective essay based on the participants' ethical lapse. Information is also gathered regarding participant demographics, training, and practice characteristics. RESULTS: Between September 2005 and February 2012, 358 learners participated in the course. The average age was 52 years and 73% were board certified. Of the 269 physicians who wrote a reflective essay, the reasons for referral included prescribing of controlled drugs, sexual boundary issues, providing services to family or friends, not maintaining proper medical records, and billing issues. DISCUSSION: This report outlines the strategies used by CWRU to develop remedial CME courses using the medical ethics course as an example for course and outcome evaluation development. This is the first report characterizing the type and frequency of the medical ethics violations that result in mandatory participation in remedial CME.

Adolescent Preventive Health and Teams-Games-Tournaments.

The problematic behaviors of teenagers and the subsequent negative consequences are extensive and well documented: unwanted pregnancy, substance abuse, violent behavior, depression, and social and psychological consequences of unemployment. In this article the authors review an approach that uses a cooperative learning, empirically-based intervention that employs peers as teachers. This intervention of choice is Teams-Games-Tournaments (TGT), a paradigm backed by four decades of empirical support. The application of TGT in preventive health programs incorporates elements in common with other prevention programs that are based on a public health orientation and comprise the essential components of health education, that is skills training and practice in applying skills. The Teams-Games-Tournaments intervention supports the idea that children and adolescents from various socioeconomic classes, between the ages of 8 to 18, in classrooms or groups ranging in size from 4 to 17 members, can work together effectively in cooperative instructional situations where group members serve as teachers for one another. Teams-Games-Tournaments has been applied successfully in such diverse areas as adolescent development, sexuality education, psychoactive substance use, anger control, coping with depression and suicide, nutrition, comprehensive employment preparation, and family intervention. This article reviews the extensive research on TGT using examples of successful projects in substance abuse and nutrition. Issues are raised that relate to the implementation of preventive health strategies for adolescents, including cognitive aspects, social and family networks, and intervention components.