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PubMed1981

Best laid plans...pre and postpartum comparison of self and spouse concepts in primiparous Lamaze couples who share delivery and those who do not.

The present study investigated pre and postpartum attitudes toward self, spouse, and ideal of 47 primiparous couples who chose the psychoprophylactic (Lamaze) method of childbirth, 34 who were able to share the delivery as planned (y/y), and 13 who were blocked from doing so due to complications necessitating cesarean sections (y/n). Osgood Semantic Differential ratings revealed that both y/n men and women perceived self and various ideal concepts lower pre and postnatally than did y/y subjects. Both groups of women showed statistically significant increases pre-post in activity for several concepts, with y/n women also showing increases in potency for the ideal woman. The y/n husbands showed no statistically significant pre-post gains, while the y/y husbands widened a statistically significant gain pre-post on the activity dimension for self. Implications for nursing practice and for further research are discussed.

Adult↗

PubMed1992

Cigarette smoking and nicotine gum (0, 2 and 4 mg): effects upon four visual attention tasks.

Sixteen regular smokers, abstinent for 12 h prior to testing, were assessed on a battery of four visual attention tasks: rapid visual information processing (RVIP), letter cancellation, Stroop, and width of attention. Each subject was assessed under four conditions: placebo gum, 2 mg nicotine gum, 4 mg nicotine gum, and cigarette smoking (own brand), with the order of drug administration determined by latin square. Pre-post drug difference scores for letter cancellation response time demonstrated a significant monotonic dose-response function, with significantly faster performance following cigarette than placebo. RVIP response time and target detection were also affected by nicotine. One RVIP task parameter demonstrated a significant monotonic dose-response function, with highest performance under smoking. Other RVIP measures demonstrated curvilinear dose-response functions, with highest performance under nicotine gum, and broadly similar performance after placebo gum and cigarette smoking. Monotonic and inverted-U arousal/performance functions similar to these have been demonstrated in previous research with nicotine. In contrast to the significant changes in sustained attention, neither width of attention nor Stroop task performance (an index of distractability) was affected by nicotine. Resting heart rate and subjective 'need for a cigarette' showed the predicted monotonic dose-response functions following nicotine. There were no significant changes in any Profile of Mood State factor.

Adolescent↗

PubMed1991

Cold exposure during military operations: effects on anaerobic performance.

This study examined the effects of military field operations (MFO) under different environmental conditions on anaerobic performance. US Marines were tested in the field under the following conditions: 1) noncold environment (NC; n = 30, 10-32 degrees C) and 2) cold environment (CO; n = 32, -2 to -22 degrees C). Subjects performed 30-s Wingate tests (WIN) pre- and immediately post-MFO to assess anaerobic performance. The MFO consisted of approximately 4.5 days of combat training maneuvers while carrying field equipment (packs and weapon, approximately 25 kg). WIN measures obtained were absolute and relative mean power (MP), 5-s peak power (PP), and fatigue index (% decline). Significant main effects (P less than 0.01) were observed for time (pre-post MFO). Reductions occurred in absolute MP [651.8 +/- 30.3 to 616.4 +/- 28.5 (SE) W] and PP (897.8 +/- 41.6 to 857.0 +/- 39.1 W); however, no effect on fatigue index was seen. Significant interaction effects (P less than 0.05) were observed in relative measures. Reductions (pre-post) in MP (NC = 8.64 +/- 0.16 to 8.37 +/- 0.14 W/kg; CO = 8.91 +/- 0.26 to 8.04 +/- 0.15 W/kg) and PP (NC = 11.80 +/- 0.24 to 11.61 +/- 0.33 W/kg; CO = 12.23 +/- 0.35 to 11.20 +/- 0.19 W/kg) were greater under CO than NC conditions. These changes were found despite significant (P less than 0.05) but comparable pre-post weight reductions in both CO and NC conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Normal paraspinal tissue compliance: the reliability of a new clinical and experimental instrument.

Test-retest reliability of a hand-held tissue compliance meter was evaluated in 20 normal subjects at four paraspinal locations to determine possible effects of probe response or other sources of variability on measurements taken 10 min later at exactly the same location. If tissue compliance, as measured by this instrument, is to be used in a pre-post context to evaluate treatment effects, caution is urged, since 26% of the sites were significantly (+/- 1.96 SD) different on 10 min retest though subjects remained supine and without intervention. In addition, since 85% of these normal subjects displayed at least one paraspinal compliance asymmetry large enough to qualify as pathological by Fischer's criteria, revision of these criteria may be appropriate, at least for these paraspinal locations.

Chiropractic↗

PubMed1983

Attention and autonomic self-regulation.

To examine how various aspects of attentional functioning are affected by autonomic self-regulation procedures, this study compared the effect of two treatment programs (EMG and thermal biofeedback used in conjunction with various somatic and cognitive relaxation/self-regulation strategies, and Benson's Relaxation Response procedure) and a Waiting List control group for essential hypertensive adults on three, perhaps overlapping, attentional dimensions: the capacity to disembed figure from ground (Embedded Figures Test, Block Design, and Picture Completion WAIS subtests); the capacity to voluntarily deploy attention (Digit Span subtest of the WAIS), and capacity to sustain attention or become absorbed (as measured by the Tellegen Absorption Scale). Thirty essential hypertensive men and women were randomly placed in one of the three groups. Attentional dimensions were assessed before and after the 10-week treatment program (or waiting period) and the relationship between blood pressure and attentional changes were assessed. The only group to evidence significant blood pressure reduction, the "Biofeedback Group," became significantly more Field Independent as measured by the EFT (p less than 0.001) and the Block Design measure (p less than 0.01) and evidenced a strong trend in the same direction on the Picture Completion measure (p less than 0.052, NS). No other significant pre-post attentional changes were found. A Pearson product correlation revealed that changes in diastolic blood pressure were significantly correlated with changes in EFT (r = 0.54, p less than 0.0001) and the Picture Completion measure (r = 0.32, p less than 0.05). The cognitive effect of autonomic self-regulation is discussed. In addition, the possible role of attention in autonomic self-regulation is examined.

Adult↗

PubMed1991

[Relationship between internal lead exposure and psychologic performance after occupational medicine interventions].

In order to investigate the influence of hygienic measures (mobilisation yield of lead in urine by CaEDTA, part-time work) on psychological performance 23 lead exposed workers have been psychodiagnostically investigated twice along with biological monitoring (blood lead level, erythrocyte protoporphyrine). In the pre-post comparison 4 of the 6 performance ranges measured showed distinct performance improvements, which could be shown to be statistically significant for group comparisons and in most individual cases. Parameters sensitive to changes were in the motor-sensory choice reaction, concentration and memory while subjective estimations of well-being exhibited no changes. Also after discussing methodological questions (influence of age, test repetition) the changes are interpreted in the direction of a possible reversibility of neurotoxic effects as a consequence of hygienic interventions.

Adult↗

PubMed2026

Fantastic microbes and where to find them: evaluating learning-by-doing outcomes in a crowdfunded metagenomics workshop.

Metagenomics offers a powerful framework for authentic, interdisciplinary learning, yet it remains underrepresented in undergraduate education due to technical and infrastructural barriers. We hypothesized that a research-based, learning-by-doing metagenomics workshop supported by accessible bioinformatics tools could enhance students' perceived skills, self-efficacy, and conceptual understanding of metagenomic analysis. To test this hypothesis, we designed and evaluated a hybrid hands-on workshop in which undergraduate and postgraduate students analyzed real environmental shotgun metagenomic datasets generated from soil samples collected during a citizen science initiative. Using the graphical workflow platform KBase, participants completed an end-to-end metagenomic analysis, from quality control and assembly to genome reconstruction, taxonomic classification, functional annotation, and scientific presentation of results. Educational outcomes were assessed through validated retrospective pre-post questionnaires, self-efficacy scales, and an open-ended conceptual understanding task. Participants showed significant increases in perceived metagenomic skills and confidence in performing metagenomic analyses, while gains in perceived learning showed a positive trend. Conceptual understanding improved across educational levels, particularly among participants with limited prior experience. Together, these findings demonstrate that authentic, data-driven metagenomics activities can effectively lower barriers to computational biology and foster meaningful learning through hands-on research experiences.

Metagenomics↗

PubMed1990

Inpatient social-cognitive skills training groups with conduct disordered and attention deficit disordered children.

The impact of group treatment programs on the social skills and peer relations of psychiatrically hospitalized children with disruptive behavior disorders was evaluated. Children assigned to a social-cognitive skills training group (SCST; n = 36) were matched to children who participated in a social activity group (SA; n = 20). The results indicated significantly greater pre-post improvements for the SCST than the SA group in child-reported loneliness, staff sociometric ratings, role-play performances, and in vivo behavioral observations of individual social skills. Child diagnoses did not differentially effect treatment outcomes. The findings are discussed in the context of training, clinical, and methodological issues.

Aggression↗

PubMed1981

Influence of different types of physical fatigue on a visual detection task.

The present study was designed to investigate the effects of different types of physical fatigue-past demand for exertion-on the performance of a visual detection task performed with and without masking. 31 male subjects were first administered a VO2 max test and familiarized with the detection task. They were divided into two groups to control potential effects of masking. They were subjected to three experimental treatment involving the utilization of different sources of energy: (a) a short anaerobic alactic acid effort recruiting phosphocreatine, (b) a supramaximal effort (anaerobic lactic acid) recruiting glycogen without oxygen, and (c) a progressive (partially anaerobic) effort recruiting glycogen and oxygen. All three were performed on a treadmill. Blood samples were collected for the anaerobic lactacid and the partially anaerobic exercises. Once fatigued, all subjects undertook the detection task. A 2 X 3 X 2 X 8 analysis of variance, with repeated measures on the last three factors, was applied to the data (mask/no mask X type of exercise X pre-post performance measures X location of the letter to be detected). No significant difference was found for either the main effects or interactions, except for the location of the letter and the mask/no mask condition. It appears therefore that a physically fit population (mean VO2 max = 62.39 ml X kg(-1) X min(-1)) shows no detectable decrement in a perceptual task performed after fatiguing exercises recruiting various types of energy sources.

Adult↗

PubMed1986

The effects of hydraulic resistance strength training in pre-pubertal males.

In order to examine the effectiveness and safety of hydraulic resistance strength training in young males, 26 pre-pubertal males (mean age = 8.2 +/- 1.3 yr) completed a 14-wk strength training study. Subjects were evaluated before and after the 14-wk experimental period for pubertal state (Tanner's sexual maturity rating, serum testosterone, and serum dihydroepiandrosterone sulfate). Effectiveness of the strength training program was determined by measuring pre-post differences in: isokinetic strength for flexion and extension at the knee and elbow joints at two speeds (30 degrees and 90 degrees X s-1) (KIN COM, Chattecx, Inc., Chattanooga, TN), flexibility, standing long jump, vertical jump, body composition parameters, maximal oxygen consumption, and creatinine phosphokinase. Safety of strength training was assessed by biphasic musculoskeletal scintigraphy before and after the program and by physician evaluation of complaints by subjects. Strength training subjects (N = 16) participated in a 45 min/session, 3 session/wk, 14-wk supervised strength training program with an attendance rate of 91.5%. Participants performed concentric work using hydraulic resistance equipment (Hydra-Fitness Industries, Belton, TX). Eccentric work was not performed. Control subjects (N = 10) did not strength train but did participate in sport activities and activities of daily living. Results indicated that strength training subjects increased isokinetic strength as a result of strength training (average concentric work/repetition increases by 18.5 to 36.6% for the eight motions tested; torque scores over the first 90% of the range of motion increases by 13.1 to 45.1% for the eight motions tested). These changes were significantly greater than changes seen in the control group (P less than 0.05). Strength training subjects also demonstrated significant improvements (as compared to control subjects) in vertical jump (+10.4%), flexibility (+8.4%), and maximal oxygen consumption [+19.4% (l X min-1), +13.8% (ml X kg X min-1)] after the experimental period. Musculoskeletal scintigraphy revealed no evidence of damage to epiphyses, bone, or muscle as a result of strength training. Only one strength training-related injury was reported (left shoulder pain, 3 strength training sessions missed). In contrast, six strength training subjects sustained injuries during activities of daily living, resulting in 47 missed strength training sessions. It was concluded that, in the short term, supervised concentric strength training using hydraulic resistance equipment is safe and effective in pre-pubertal boys.

Anthropometry↗

PubMed1995

The efficacy and safety of divalproex sodium in the treatment of acute mania in adolescents and young adults: an open clinical trial.

This open clinical trial investigated the potential short-term efficacy and safety of divalproex sodium in the treatment of adolescents and young adults with bipolar affective disorder in an acute manic phase. Fifteen subjects were treated for 7 weeks with divalproex sodium (mean drug level in blood +/- the standard deviation at trial completion, 642.85 +/- 183.08 mumol/liter) and were assessed weekly with the Modified Mania Rating Scale (MMRS), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment Scale (GAS), and the Clinical Global Impressions Scale (CGI). Of the 15 subjects who entered the study, 8 showed marked improvement on the MMRS (pre-post decrease of > or = 75%), 4 showed moderate improvement (pre-post decrease of 50 to 74%), 1 showed some improvement (pre-post decrease of 25 to 49%), 1 showed no improvement and was withdrawn before the seventh study week because of lack of response, and 1 withdrew because of side effects. The mean MMRS score was significantly changed by 7 weeks of treatment in the 13 subjects who completed the 7-week trial (69.54 +/- 24.21 to 18.08 +/- 8.70; t = 7.72; p < 0.0001), as were the BPRS (36.31 +/- 12.22 to 12.00 +/- 4.22; t = 7.53; p < 0.0001), the GAS (30.23 +/- 9.05 to 54.69 +/- 9.40; t = 7.50; p < 0.0001), and the CGI (5.38 +/- 0.96 to 2.38 +/- 0.87; t = 10.01; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed2026

Reducing state anxiety with alpha-frequency transcranial alternating current stimulation.

BACKGROUND: Anxiety reactivity to acute stress is a transdiagnostic vulnerability factor. We tested whether a single session of alpha-frequency transcranial alternating current stimulation (tACS) targeting the frontoparietal control network reduces stress-evoked state anxiety in healthy adults. METHODS: In a randomized, blinded, sham-controlled study, 42 participants (mean age 58.9 years) completed an acute stress task before and after stimulation. The task was an adapted moving-circles paradigm in which circle collisions triggered a brief aversive event (mild electric shock plus unpleasant noise and a white flash). Active stimulation consisted of 20 min of 10-Hz tACS (2.0 mA/channel; 30-s ramp up/down) delivered via electrodes at F3, P3, Cz, and T7 (0° phase at F3/P3; 180° at Cz/T7). Sham stimulation used the same montage and ramp periods but no sustained current. RESULTS: State anxiety showed a significant Time × Protocol interaction (F(1,35) = 4.22, p = .047): STAI-S decreased after active tACS (Δ = -3.16) but increased slightly after sham (Δ = +1.17). Perceived stress appraisal (SAAS) did not change. Resting-state alpha power at F3/P3 showed no reliable pre-post effects. During the task, left-frontal relative alpha differed by protocol and showed a trend toward larger increases following active tACS. Electrodermal and pupil indices changed across sessions in both groups, with no differential stimulation effects. CONCLUSIONS: A single alpha-tACS session produced a modest, selective reduction in stress-evoked state anxiety, supporting oscillatory neuromodulation as a scalable approach to dampen anxiety reactivity.

Humans↗

PubMed2026

Test-retest reliability of spatiotemporal, kinematic, and kinetic measures in marker-based 3D gait analysis: A systematic review.

BACKGROUND: Marker-based 3D gait analysis (3DGA) is widely used to quantify impairments and evaluate treatment effects. For longitudinal clinical interpretation, clinicians and researchers need reference values for inter-session measurement error. For this purpose, this systematic review synthesized Standard Error of Measurement (SEM) values for spatiotemporal, kinematic, and kinetic (moments) outcomes obtained from marker-based 3DGA studies. METHODS: PubMed and Scopus were searched (final search: 11 December 2025). Studies reporting inter-session test-retest SEM and/or MDC for steady-state overground or treadmill walking using marker-based motion capture were included. Two authors screened records and appraised methodological/reporting quality using a custom tool informed by COSMIN, GRRAS, and biomechanics-specific items. Due to heterogeneity, results were synthesized descriptively using study-level median SEM values, stratified by joint, plane, population (healthy, pathological, single subgroups), and walking condition. Minimal Detectable Change (MDC) values were computed for all available data. RESULTS: Thirty-four studies (762 participants, 44.2% females) were included, with substantially more evidence for overground than treadmill walking. Overground spatiotemporal outcomes showed low errors (walking speed SEM of 0.06 m/s; timing typically ≤0.03 s; spatial parameters generally ≤0.03 m). For joint kinematics during overground walking, median SEMs were 2.4° (sagittal), 1.9° (frontal), and 3.3° (transverse). The corresponding joint-kinetic SEMs were approximately 0.06, 0.04, and 0.03 Nm/kg, respectively. Treadmill data followed similar patterns. SIGNIFICANCE: Marker-based 3DGA allows for accurate assessment of spatiotemporal, kinematic, and kinetic gait features. We provided detailed SEM/MDC lookup tables to support clinical decision-making. Results further offer a benchmark for validating emerging gait assessment technologies (e.g., markerless systems) against realistic limits of marker-based 3DGA.

Humans↗

PubMed1991

Quality of life of community mental health program clients: validating a measure.

A quality of life theory is proposed as a framework for conceptualizing and evaluating mental health services. Quality of life consists of fulfilling needs, meeting social expectations, and accessing opportunities by using abilities. Abilities are impaired by mental illness. Mental health services moderate social demands, supplement opportunities, and restore abilities. A 263 item questionnaire was developed to assess the impact of mental health services on clients' quality of life. A 24 site study including 1,154 pre-tests, 758 post-tests, and 190 interviews with randomly selected community residents was conducted. Evidence for the reliability and validity of the questionnaire are presented. The instrument discriminates among four known client groups, client and community samples, communities with known quality of life differences, and pre- versus post-treatment samples of clients. The convergence between client's retrospective impressions of improvement and measured pre-post improvement is discussed.

Adolescent↗

PubMed1995

The significance of belief and expectancy within the spiritual healing encounter.

Historically, traditional cultures recognized the importance of belief and expectancy within the healing encounter and created complex rituals and ceremonies designed to elicit or foster the expectancy and participation of both the healer and patient, as well as the community as a whole. This holistic approach to health care was a fundamental component in the spiritual healing rituals of virtually all traditional native cultures. The focus of the current study was to assess the impact of healer and patient expectations on mental and physical health parameters following a spiritual healing session. A pre-post methodological design which incorporated extensive psychophysiological health outcome measures along with independent medical diagnoses was utilized. The study was conducted in a northern California suburb of Marin County utilizing an American-born spiritual healer trained in the Philippines. The results indicated that there was a statistically significant difference between the pre-treatment and post-treatment scores for all fourteen dependent variables examined. The data also demonstrated a significant difference between the high versus low expectancy subjects for both patient and healer groups, as well as a significant relationship between high expectancy in patients and healer and the effectiveness of the spiritual healing encounter. The results of the study therefore suggest that high healer and patient expectancy may be important elements which can serve as both predictors as well as facilitators of the healing process. The degree of bonding or communication between the healer and patient was postulated as an important factor in this regard. Due to the fact that a majority of the conditions reported (75%) were organic disorders that would not commonly disappear within the 3 week time frame of the study, the significant results obtained suggest that spiritual healing in combination with traditional allopathic medicine may have the potential to be an effective treatment protocol for severe or long-term disorders. An important contributing feature of this study was that an independent means of assessing the patients' self-reports, i.e. an allopathic medical examination, was included in the experiment. There was a significant correlation between the patient's expectation level and their assessment of improvement, as well as a significant relationship between the patient's assessment of their condition and the objective evaluations provided by independent medical examinations.

Adult↗

PubMed1994

Cardiopulmonary resuscitation in elderly patients hospitalized in the 1990s: a favorable outcome.

OBJECTIVE: To compare the clinical characteristics and survival of elderly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990's and to assess predictors of survival. DESIGN: Retrospective survey of cardiac arrest database and hospital charts, plus telephone follow-up. SETTING: 450-bed acute care teaching hospital. STUDY POPULATION: Seventy-eight hospitalized patients 70 years or older and 73 hospitalized patients under 70 years of age. MEASUREMENTS: Survey of cardiac arrest data base, hospital charts, and telephonic follow-up to allow (1) comparison of clinical characteristics, survival, and long-term follow-up between two age groups and (2) univariate and multivariate analysis of predictors of mortality. MAIN RESULTS: Pre-arrest clinical characteristics were not significantly different between the age groups. Prior to arrest the majority of patients were functionally active, and over one-third were hospitalized for acute coronary artery syndromes. In approximately 85% of the patients, the arrest was witnessed, and 70% of the patients had their cardiac rhythm monitored at onset of the arrest. Survival was not significantly different between the age groups; 26% of the total 151 patients were discharged. No significant difference was noted in pre-post arrest functional status of survivors. Survival at 1, 2, and 3 years in elderly and younger survivors was 86% versus 80%, 76% versus 67%, and 71% versus 61%, respectively. Multivariate analysis identified the presence of coronary artery disease, admission systolic blood pressure, and functional level to be independent pre-arrest predictors of mortality. At the time of the arrest, the initial cardiac rhythm and duration of CPR were found to be independent predictors of mortality. CONCLUSIONS: Elderly patients hospitalized in the 1990's who receive CPR have outcomes similar to younger patients who receive CPR. The favorable outcome in the elderly patients may reflect patient selection: the majority of our patients were functionally active prior to hospitalization, without multiple serious illnesses; many were hospitalized for acute coronary artery syndromes; and, in most cases, the arrest was witnessed with the patient's cardiac rhythm monitored at onset of the arrest.

Adult↗

PubMed1989

Influence of body hair removal on physiological responses during breaststroke swimming.

Nine male collegiate swimmers (EXP) were studied 8 d before (PRE) and 1 d after (POST) shaving the hair from their arms, legs, and exposed trunk. A control group (CON, N = 4) of their teammates was also tested at these times but did not remove body hair. In PRE and POST, distance per stroke (SL), VO2, heart rate (HR), and post-swim blood lactate concentration (BL) were measured during a 365.8 m breaststroke swim at approximately 90% effort. Subjects also performed a tethered breaststroke swim with retarding forces of 6.27, 7.75, and 9.26 kg. The EXP group experienced a significant (P less than 0.05) reduction in BL (mean +/- SE: 8.48 +/- 0.78 to 6.74 +/- 0.74 mmol.l-1), a decreased VO2 (3.60 +/- 0.15 to 3.27 +/- 0.14 l.min-1), an increase in SL (2.07 +/- 0.08 to 2.31 +/- 0.10 m.stroke-1), and an insignificant (P = 0.08) decline in HR (174 +/- 5 to 168 +/- 4 beats.min-1) during the free swim. The CON group showed no changes in BL, SL, or HR. During the tethered swim, there were no significant PRE-POST differences in VO2, HR, or BL for either group. In a separate group of swimmers (nine who shaved body hair and nine controls), removing body hair significantly reduced the rate of velocity decay during a prone glide after a maximal underwater leg push-off. It is concluded that removing body hair reduces active drag, thereby decreasing the physiological cost of swimming.

Adult↗

PubMedDate not supplied

Sustained effects of educating retailers to reduce cigarette sales to minors.

Despite state laws prohibiting the purchase of tobacco by minors, the ease with which underage youth can purchase cigarettes has been documented nationwide. The public health community as well as policy makers have called for a combination of retailer education and enforcement of laws prohibiting tobacco sales to minors. Enforcement activity may not be feasible in many communities, however, and an educational intervention may be the only option. This paper reports results of a 6-month followup assessment following a face-to-face education intervention with retailers to reduce cigarettes sales to minors in San Diego County, CA. A control-experimental group, pre-post design was employed to study the sustained effects of the program on the illegal sale of cigarettes to minors. A total of 236 stores were visited by minors, ages 14-17 years, with the intent of purchasing cigarettes. Information was collected three times: pre-test, immediately following the intervention, and 6 months after the intervention ended. The groups included a no-treatment control group of 108 stores and an intervention group of 128 that received three educational visits from project staff over a 1-year period. Community education via media and informational presentations was also conducted. As previously reported, a 68-percent pretest sales rate was found for stores overall. Immediately following the intervention, 32 percent of the intervention group and 59 percent of the control group sold cigarettes to minors. These results were maintained 6 months following the conclusion of the intervention. Results are discussed in terms of education versus use of enforcement.

Adolescent↗