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A comparison of performance by medical and midwifery students in multiprofessional teaching.

AIM: At Dundee University, midwifery and medical students are taught obstetrics together in a 2-week intensive course. We set out to test the hypothesis that staff time and effort could be saved by using shared resources in teaching a multidisciplinary group of students to an acceptable level. METHOD: In order to measure the knowledge gain by two different groups of students, we tested the students before and after a timetabled computer-assisted learning (CAL) session focusing on how to interpret a cardiotocograph (CTG). Also, half of each student group was given extra CTG teaching before the CAL session. RESULTS: The medical students (n=38) increased their median score from 9 to 17 after the CAL (P<0.001) but the midwifery students (n=13) only increased their median score from 12 to 14 after the CAL (n.s.). However, when given a tutorial and CAL, the post-test scores for both medical and midwifery students were similar and significantly higher than pre-test scores (median score increase from 8.5 to 18 for medical students, P<0.001, n=34, and from 9 to 16 for midwifery students, P<0.01 n=11). There was no significant knowledge gain by the medical students who undertook the additional tutorial. CONCLUSION: We conclude that shared resources could be used by medical and midwifery students to reach equivalent levels of skill in CTG interpretation. However, in order to achieve equivalence, staff time and effort was wasted as medical students were given unnecessary tuition.

Cardiotocography↗

Self-esteem and mental health characteristics especially among lean students surveyed by University Personality Inventory.

In recent years, various investigators have indicated an increase in the number of eating disorders. A similar tendency has been observed among university students. The purpose of the present study is to clarify the self-esteem and mental health characteristics of the lean students who suffer from latent eating disorders. We examined 2132 responses to the University Personality Inventory obtained from students who entered Nagoya University in 1995. We analyzed the mental health conditions of the lean students after categorizing the subjects into lean, normal and obese group by body mass index. As a result, the following results were obtained. Lean male students presented with more subjective symptoms than normal and obese students, and extremely lean male students had more subjective symptoms. Lean female students had fewer subjective symptoms than lean male students and no particular differences from normal female students. It is suggested that male and female students had different criteria for self-esteem with regard to body shape. The lean female students were medically ill and formed a latent or borderline latent group with anorexia nervosa. However, they had a similar degree of health awareness as normal students.

Adolescent↗

Peer tutoring in patient-centred interviewing skills: experience of a project for first-year students.

Peer tutoring is a potentially valuable resource in higher education. There are few published accounts of the impact of peer tutoring in medical education. College-wide experience of peer tutoring together with difficulties recruiting medical teachers for a communication programme led to the development of a peer-tutoring project. This paper reports the impact on first-year medical students of peer tutoring in patient-centred interviewing. After attending a preparatory workshop, third-year medical students co-facilitated their first-year colleagues in a session:Interviewing a Simulated Patient. First-year students completed written evaluations immediately after the session and two months later randomly selected students were assessed in patient-centred interviews. The impact of the peer-tutoring experience was evaluated by comparing these outcomes for students in groups co-facilitated by peer tutors with those who worked in groups facilitated by medical teachers. The eight learning objectives were completely met by more than 56% of students. However, there were statistically significant differences for four objectives with more students in groups facilitated by medical teachers completely meeting these objectives. Although the seven educational techniques used in the session were rated favourably by all students, two were rated as more effective in achieving the learning objectives by students in groups facilitated by medical teachers. Free-text comments revealed no differences between groups. Two months after the session, there were no differences between students in terms of interviewing skills as rated by trained observers and simulated patients, whilst simulated patients were more satisfied with interviews from students facilitated by peer tutors (p <0.02). Peer tutors can support the acquisition of basic patient-centred interviewing skills in first-year medical students when contributing to one session of a structured programme. First-year students were receptive and willing to learn from their senior colleagues.

Communication↗

Students' and tutors' perceptions of problems in PBL tutorial groups at a Brazilian medical school.

INTRODUCTION: There are few published studies that address the problem of dysfunctional tutorial groups. Most studies are restricted to student or faculty opinions separately and to specific aspects affecting the tutorial group function. This study examined teacher and student perceptions of frequency and importance of problems observed in tutorial groups in a new PBL program. METHODS: Tutors (n=30) and students in the second (n=75) and third (n=53) year completed a questionnaire at the beginning of the 1999 academic year. The questionnaire had 33 items grouped as seven "factors" related to tutor performance, feedback, assessment, educational resources, student performance, educational problems and external factors RESULTS: The most important problems identified were related to tutors (mainly in training aspects) and students (mainly in problem discussion). Students and feedback (quality) were the most frequent. There were statistically significant differences between tutors' and students' (higher) and between second and third year (higher) students' perceptions of different factors. CONCLUSIONS: (1) Marilia Medical School (FAMEMA) has problems in the tutorial group function mainly related to contributions of students and tutors. (2) Students' and tutors' opinions, as well as those of second and third year students, differ and therefore all need to be consulted to solve tutorial group problems. (3) It is necessary to develop a better student training program and also to improve the tutors training program. (4) There is a need for continued evaluation of problem-based learning at FAMEMA. We must look at perceptions of students from all years.

Journal Article↗

Reaching and teaching new medical students.

OBJECTIVE: Each year 150 new medical students enter UCLA. During Foundations week they are introduced to the resources and services, which will support their studies, as well as to the problem-based learning (PBL) approach of instruction. The library is responsible for introducing print and digital resources and illustrating how these support the PBL approach. This has been a challenge, given students' belief that they already know about libraries and the limited time frame (roughly 45 minutes) allotted to us. This year we developed a collaborative, student-centered, active learning approach. Students were exposed to a variety of relevant resources and given the opportunity to critique them for appropriateness to their PBL case of the week. DESCRIPTION: Sessions were designed for 50 students at once in the instructional microcomputing facility (IMF), with two or three students sharing each workstation. Since the IMF is equipped with classroom control software, librarians could display resources on each workstation while discussing them. Since we wish to encourage students to begin at our Web page, we wore t-shirts with the logo "Start@Biomed" and our URL. Instruction started with a "Guided Tour of the Biomedical Library Web Page" during which we discussed general services, highlighted special features, including Web-based tutorials and subject guides, and illustrated how to connect to relevant resources such as PubMed, MDConsult, STAT!Ref, and MEDLINEPlus. The student groups then critically reviewed one resource identified by a card next to their workstation by answering the following questions in writing: Would this resource address your specific PBL learning issue? If not, what type of learning issue would it address? Describe an outstanding feature or a barrier to use for this resource? After ten minutes, students were asked to report to the entire group. The use of a hand-held mike, which we passed among the students, added an element of fun to the proceedings and simulated a talk show atmosphere. DISCUSSION: This emphasis on active learning, critical thinking, and problem solving was a successful way to introduce students to the library and its resources, and reinforced the library's role in PBL. The friendly, casual talk-show approach, coupled with our Start@Biomed t-shirts, created a setting in which we became real partners in the learning enterprise. Students reported they enjoyed the experience, and they are returning to us for additional help. Their written feedback, which we collected, summarized, and distributed to the entire class, illustrated a clear understanding of the resources and their usefulness. Both the medical school faculty and the librarians involved feel we have developed a useful, interesting, and appropriate way to reach beginning medical students, who often feel that they already know a great deal about using a library.

California↗

Conventional wisdom is a poor predictor of the relationship between discipline policy, student misbehaviour and teacher stress.

Will an effective discipline policy improve student misbehaviour and result in a reduction of teacher stress? It is commonly believed that student misbehaviour is a major cause of teacher stress, and that the degree of student misbehaviour is reflected in student suspension rates. Moreover, it is believed that student misbehaviour can be reduced by improving a school's discipline policy through the collaborative efforts of whole school communities. As a result of growing concern about student misbehaviour and teacher stress, a Whole School Approach to Discipline and Student Welfare programme was implemented throughout the Australian state of Victoria. This paper reports on the evaluation studies that were conducted to assess the effectiveness of the programme and examine the assumptions which underpinned its implementation. Data were obtained from 4,072 primary and secondary school teachers. Although longitudinal analyses suggested that the programme was effective in reducing teacher stress, there was no mean change in student misbehaviour. Structural equation analyses showed that there was little relationship between a school's discipline policy and the perceived level of student misbehaviour. It was also found that student suspension rates were not related to student misbehaviour, but could be predicted on the basis of a school's discipline policy and the self-esteem of teachers. Two and three wave causal analyses also demonstrated the problems associated with using cross-sectional research to support major policy decisions. Overall, these studies showed that there is little point in trying to reduce teacher stress by reducing student misbehaviour. Rather, it is more appropriate to develop a supportive organisational climate that enables teachers to cope with the student misbehaviour that confronts them.

Adolescent↗

Impact of medical student research in the development of physician-scientists.

CONTEXT: A decline in the number of physician-scientists has been identified in the United States for at least two decades. Although many mechanisms have been proposed to reverse this trend, most of these have concentrated on MD/PhD programs, research in sub-specialty fellowships, and other approaches later in physician training. Few have emphasized early medical student research experiences as a contributing solution. OBJECTIVE: To determine the effect of a medical student research experience on career choices and attitudes about biomedical research. DESIGN, SETTING, AND PARTICIPANTS: We jointly report 25 years of experience with National Institutes of Health (NIH)-sponsored Medical Student Research Fellowship programs (MSRFs) at two colleges of medicine, the University of Tennessee Health Science Center and Vanderbilt University. In both programs, students work during the summer of their first or second year of medical school on a research project that is mentored by an established scientist and participate in a structured program (lectures, visiting professor). MAIN OUTCOME MEASURES: We gathered data using pre- and postresearch fellowship questionnaires to assess (a) quality of research experiences; (b) tabulation of productivity, that is, presentations, abstracts, publications, and awards; (c) long-term tracking of former program participants; (d) comparison of residency placements by medical student researchers; and (e) comments from former program participants on the effects of their students' research experiences on career choices. RESULTS: During this time, approximately 1,000 medical students participated in the two programs. Follow-up data (for short-term evaluations, 96-132 respondents with a response rate > 82%; for long-term evaluations, 88-118 respondents with a response rate > 29-33%) strongly suggest (a) interest in an academic career increased, (b) one-third to half of former student respondents considered themselves to be in academic medicine, (c) the vast majority of students conducted additional research after their medical student research experience, and (d) a large number of students were currently doing research or had published or presented their work at scientific meetings. CONCLUSIONS: Over two decades of experience with NIH-sponsored medical student research programs at two medical schools strongly support the ability of these programs to interest medical students in research and academic careers. MSRFs should be included in strategies to reverse the decline in the number of physician-scientists.

Attitude↗

Students with learning disabilities in higher education: academic strategies profile.

This study compared 191 college students with learning disabilities (LD) and 190 students without LD in four main areas: academic difficulties, learning strategies, functioning during examinations, and students' perception of factors that help or impede their academic success. Analysis of the personal data of students with and without LD revealed no significant differences between groups on grade point average, number of courses taken, and family status, but students with LD reported having more difficulties in humanities, social sciences, and foreign language than students without LD. Regarding academic strategies, students with LD devised unusual strategies and preferred additional oral explanations or visual explanations, whereas nondisabled students preferred more written examples. These differences indicated that students without LD used more written techniques than did students with LD. During examinations, the students with LD had difficulty concentrating and were concerned about lack of time. They experienced stress, were nervous, and felt more frustrated, helpless, or uncertain during examinations than students without LD. The implications for college students with LD are discussed.

Adaptation, Psychological↗

A comparative study of food habits and body shape perception of university students in Japan and Korea.

BACKGROUND: Abnormal body weight, dietary concerns, and unhealthy weight loss behaviors are increasingly being observed in young females in Japan. Our previous research has shown that the irregular lifestyles of female Japanese and Chinese students are significantly related to their desire to be thinner. In the present study, we compare the food habits and body shape preferences of female university students in South Korea and Japan to explore body shape perceptions in those populations. METHODS: A total of 265 female university students aged 19-25 years participated in this study. University students in Korea (n = 141) and university students in Japan (n = 124) completed a self-reported questionnaire. Data were analyzed using SPSS statistical software. Descriptive statistics were used to identify the demographic characteristics of the students and parametric variables were analyzed using the Student's t-test. Chi-square analyses were conducted for non-parametric variables. RESULTS: Comparison of body mass index (BMI) distributions in Japan and Korea showed the highest value in the normal category (74%) together with a very low obesity rate (1.2%). Significant differences were observed between the two countries in terms of eating patterns, with more Japanese eating breakfast daily and with Japanese students eating meals more regularly than Korean students. A difference was also observed in frequency of meals, where Korean students reported eating meals two times per day (59%) and the majority of Japanese students reported eating meals three times per day (81%). Although most subjects belonged to the normal BMI category, their ideal BMI classification was the underweight category (BMI: 18.4 +/- 3.4). CONCLUSION: Few studies have compared the health related practices of Japanese and Korean university students. The present results suggest the necessity of nutrition and health promotion programs for university students, especially programs emphasizing weight management.

Adult↗

A time and motion study of the effect of ambulatory medical students on the duration of general internal medicine clinics.

BACKGROUND: Teaching medical students in the ambulatory setting may influence the duration or number of patients per clinic. PURPOSE: To directly measure the time required to teach medical students in an outpatient clinic and to determine if there was a difference in activities performed by faculty when a student was present in the clinic. METHODS: In this prospective, nonrandomized study, 83 clinic sessions were analyzed; 50 without a 3rd-year internal medicine clerkship student and 33 with a student. Seven 3rd-year internal medicine clerkship students and 7 general internists participated. The 7 general internists had both clinic sessions with and clinic sessions without a student during our study period. For every clinic session, physicians recorded duration, number of patients, presence of a student, and teaching activities. In a sub-set of 23 clinics (28%), ancillary staff independently recorded clinic duration and number of patients seen. To address time added to a clinic session by a student, we compared clinic sessions with versus clinic sessions without a student for each participating physician. Multiple linear regression was used for analysis. RESULTS: Having a student added 32.3 min to a clinic session (p<.001). Clinic duration recorded by ancillary staff did not differ from duration recorded by physicians (p=.74), and the durations were well correlated (r=.81). Regarding additional activities, physicians were more likely to discuss patients with house staff when students were present, but other nonteaching physician activities did not change. CONCLUSIONS: In this study, teaching a 3rd-year medical student in an internal medicine outpatient clinic required 32.3 extra min per clinic. Clerkship directors and clinic administrators should be aware of the extra time required to teach and be prepared to expect an impact on clinic productivity.

Ambulatory Care↗

Student assessment of clinical experience in general surgery.

Forty-two students kept a log diary of all activities during their general surgical firms at a main university hospital in London. The students saw on average 35 patients per week on whom physical aspects were discussed by the consultant with the student after the consultation in 58%, psychological aspects in 4% and social aspects in 1.6%. Students spent an average of 11.2 hours per week with patients. In outpatients students spent most of their time as passive observers, but there were opportunities for more active involvement on the wards. Here the students spent on average 1.5 hours per week personally examining patients and 1 hour per week taking histories. Each student performed on average two short and one long examination per week and 0.5 short and 2.25 long histories per week. The students received on average 2.9 hours per week of consultant teaching in small groups, junior medical staff teaching at 2.2 hours and non-medical staff teaching of 1.1 hour per week. Students spent almost 4 hours per week attending formal traditional lectures in large groups. Some areas identified for improvement were: the relatively little feedback and supervision students received when personally examining patients and taking histories; the passive involvement of students in most educational settings; the small amount of time devoted to discussing social and psychologically relevant factors in the history; the few practical procedures personally performed by students; the relatively large amount of time students reported as unproductive and the small amount of time spent on self-education.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Relationship between selected discourse strategies and student critical thinking.

This study investigated the relationship between use of selected discourse strategies and level of student critical thinking in nursing clinical post-conferences. Selected discourse strategies included: (a) teacher high-level questions, (b) teacher elaboration of student ideas, (c) teacher probing questions, (d) student participation, and (e) student-to-student participation. The level of student critical thinking was defined as the quartile ranking of students (N = 57) on the Watson-Glaser Critical Thinking Appraisal summative measure. It was hypothesized that greater use of discourse strategies would be associated with high-levels of student critical thinking. All discourse strategies were significantly associated (p < .0001) to student quartile ranking for one taping session (Conference II). Further analysis, however, revealed ambiguous patterns of two-way associations. The more consistent findings suggested a conceptual relationship between less student talk and student-to-student talk and high-levels of student critical thinking.

Adult↗

[Sexual autonomy in college students].

PURPOSE: This study was to add to the understanding of sexual autonomy in college students in Korea. A descriptive survey design was used. METHOD: The participants in this study were 1,865 college students from 13 colleges, The questionnaire consisted of 15 items on general characteristics and 13 items measuring sexual autonomy. The SPSS 10.0 program was used for data analysis. RESULT: The global score for sexual autonomy was relatively high at 55.24 with a possible range of 13-65. The item on sexual autonomy with the highest score were, 'I can prevent repeated STD infections' and the item with the lowest sexual autonomy score was 'I can speak clearly about having intercourse'. Factors related to sexual autonomy were identified as gender, parents' attitude, year in university, experience with STD prevention and experience with pregnancy prevention. The score for sexual autonomy was lower in male college students (p=.000), students whose parents' attitudes to sex were vague, first year students (p=.000), students who had little experience with prevention of STDs (p=.002), students who had little experience with prevention of pregnancy (p=.001). CONCLUSION: The results showed that in setting priorities for sex education the following groups of students should be given first priority, male students, students whose parents' attitudes to sex were vague, first year students, students who have not had experience with prevention of STDs, and students who have not had experience with prevention of pregnancy.

English Abstract↗

Pedagogic Strategies Perceived to Enhance Student Learning in Athletic Training Education.

OBJECTIVE: To investigate students' and instructors' educational experiences in Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training education programs and specifically to determine to what extent pedagogic strategies were reflected in students' perceptions of their learning experiences, instructors' perceptions of their teaching, and athletic training course syllabi. DESIGN AND SETTING: Students and instructors currently enrolled in or teaching in 5 university athletic training programs accredited by CAAHEP provided in-depth interviews pertaining to students' educational experiences. Students' educational experiences in CAAHEP-accredited athletic training programs were also examined through current athletic training education course syllabi. SUBJECTS: Twenty-one students (9 males, 12 females) and 12 instructors (7 males, 5 females) were interviewed to examine their perceptions of teaching and learning experiences within their program. MEASUREMENTS: Students' and instructors' perceptions of their educational experiences in CAAHEP-accredited athletic training education programs were analyzed qualitatively using the data-analysis software program NUD*IST. Data from all 3 sources (students' interviews, instructors' interviews, course syllabi) were coded into categories within the NUD*IST program and then triangulated to ensure the authenticity of the findings. RESULTS: Based on the analysis of students' and instructors' interviews and course syllabi, 3 pedagogic strategies were identified that appeared to facilitate athletic training education in CAAHEP-accredited programs: use of scenarios and case studies, authentic experiences, and a positive educational environment. CONCLUSIONS: Students and instructors in CAAHEP-accredited athletic training education programs recognize and value specific pedagogic theories of teaching and learning and achievement motivation in students' educational experiences. Specific educational themes identified across athletic training instructors, students, and programs are outlined. All athletic training educators should take an interest in understanding what students and instructors in CAAHEP-accredited athletic training programs view as helpful pedagogic practices within their educational experiences.

Journal Article↗

Student athletic trainer perceptions of clinical supervisor behaviors: a critical incident study.

OBJECTIVE: To identify and describe critical helpful and hindering clinical teaching behaviors of supervising athletic trainers, as perceived by student athletic trainers, and to provide a better understanding of the student athletic training experience. DESIGN AND SETTING: The critical incident technique was used to identify critical behaviors of supervising athletic trainers as perceived by student athletic trainers. SUBJECTS: Sixty-four student athletic trainers from 4 undergraduate NATA-approved or CAAHEP-accredited programs volunteered to participate. MEASUREMENTS: The data from the critical incident forms were reviewed for acceptability, inductively analyzed, and categorized. Results are reported in raw numbers and percentages. Examples are provided to illustrate each category. RESULTS: Helpful and hindering supervisor behaviors were identified in 4 major categories and 24 subcategories. Students reported more helpful than hindering behaviors. Students reported mentoring behaviors most often, followed by accep- tance, nurturing, and modeling behaviors. Student athletic trainers wanted to be respected as professionals regarding ability and knowledge. They also desired mentoring through explanation, demonstration, and constructive feedback and nurturing through confidence building and other supportive supervisor behaviors. Students most often identified incidents of humiliating behaviors and lack of availability by the supervisors as hindering the clinical experience. CONCLUSIONS: Supervising athletic trainer behaviors had a profound effect on the professional development of student athletic trainers. Interaction between supervisors and students positively or negatively affected student athletic trainers' growth and development. Selection of supervising athletic trainers, matching of supervisors with students, and training for supervising athletic trainers are important issues that need further investigation. Student athletic trainers can provide insightful information that can be used to better understand and enhance the clinical experience.

Journal Article↗

The effect of incorporating women's health into a PBL curriculum on students' tendencies to identify learning issues in an ambulatory care setting.

PURPOSE: To investigate whether the incorporation of women's health into problem-based learning (PBL) cases affects students' tendency to identify learning issues related to women's health as they encounter patients in an ambulatory care setting. METHOD: Students in the PBL curriculum at the Allegheny University of the Health Sciences, MCP-Hahnemann School of Medicine, participate in a nine-week primary care practicum at the end of their first year, during which they spend three half-days per week in an ambulatory setting examining patients and completing patient logs that include any learning issues identified. Patient logs from 23 first-year PBL students who had not been exposed to a new women's health education program prior to their practicum in 1993 and from 22 first-year PBL students who had been exposed to the program prior to their practicum in 1994 were reviewed. For each women's health learning issue identified, the sex of the student and the sex, specialty, and practice setting of the student's preceptor were recorded. Data were analyzed with several statistical methods. RESULTS: There was no statistically significant difference in the numbers of men and women students or preceptors between the two years. In 1993 an average of 59% of the patients seen per student were women; in 1994 the average was 61%. The mean numbers of total learning issues identified (including women's health learning issues) were similar in the two years, but the mean percentage of clinical women's health learning issues identified increased significantly between 1993 and 1994, as did the mean percentage of community/preventive health women's health learning issues identified. There was a significant student-sex-by-preceptor-sex interaction for the total number of women's health learning issues identified (p = .024): for both years, the students paired with a preceptor of the same sex identified a higher number of women's health learning issues than did the students paired with a preceptor of the opposite sex. CONCLUSION: The results suggest that PBL is an effective way to increase students' awareness of women's health issues in a primary care clinical setting. More studies are needed to define the effect of PBL on the kind of reading and learning students will do when they get to the clinical setting.

Adult↗

Assessment of knowledge of primary care activities in a sample of medical and chiropractic students.

OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.

Chiropractic↗

Peer-Led Alcohol Education program: a pharmacy student-led program for seventh-graders.

OBJECTIVE: To delay or discourage the use of alcohol by seventh-grade students through peer-led education. Peer-Led Alcohol Education (PLAE) program objectives were to: (1) educate students about alcohol use and (2) assess the differences between pharmacy student presenters and high school student (peer) presenters. SETTING: Middle schools in rural Nebraska. DESIGN: PLAE focuses on normative beliefs, personal values, and pledging. Pharmacy students and high school students were trained to deliver alcohol education presentations to seventh-grade students. Evaluation results were compared among groups of seventh-grade students who received PLAE presentations from peer presenters and from pharmacy student presenters. RESULTS: PLAE presentations were made to 342 seventh-grade students at 11 schools. Evaluation results suggest that pharmacy students projected more confidence in their presentations, used more creative prop selections, and were more effective communicators. High-school presenters had a greater ability to "relate" to the seventh-graders and thus were deemed more on-target with the information. CONCLUSION: Evaluation findings suggest that rural seventh-grade students in Nebraska perceived that the PLAE program provides useful information to aid them in their decisions regarding alcohol use.

Alcohol Drinking↗