Objective. To evaluate the safety, tolerance, and efficacy of 24-hour nicotine patch therapy in adolescent smokers who were trying to stop smoking. Design. Nonrandomized, open-label, 6-month clinical trial. Setting. Five public high schools in the Rochester, MN, area. Subjects. Twenty-two adolescent smokers, aged 13 through 17 years, with current smoking rate of 20 or more cigarettes per day (cpd). Intervention. Daily nicotine patch therapy for 8 weeks (22 mg/d for 6 weeks followed by 11 mg/d for 2 weeks). Weekly individual behavioral counseling and group support continued for 8 weeks with follow up visits at 3 and 6 months and a mailed survey at 1 year. Main Outcome Measures. Self-reported smoking abstinence verified by expired air carbon monoxide of 8 ppm or less, nicotine withdrawal symptoms, adverse experiences, and blood cotinine levels. Results. Subjects had a mean ± SD smoking rate of 23.3 ± 5.0 (range, 20 to 35) cpd at study entry and 2.6 ± 1.6 years of smoking; the mean age was 15.9 ± 1.2 (range 13 through 17) years, and 68% were girls. Of the 22 participants, 19 (86%) completed patch therapy, 3 (14%) had biochemically validated smoking cessation at week 8, and 1 continued to be smoke free at 3 and 6 months after patch initiation. There was a significant decrease from baseline in the mean nicotine withdrawal scores for days 4 and 7 of week 1 and the mean for weeks 2 through 8. Skin reactions were the most common adverse event. As the worst skin reactions, 55% had erythema only, 5% had erythema and edema, and 9% had erythema and vesicles, whereas 32% had no skin reactions. Other reported adverse events were headaches (41%), nausea and vomiting (41%), tiredness (41%), dizziness (27%), and arm pain (23%). None of these were considered serious, life threatening, or led to the discontinuation of patch therapy. In adults with comparable smoking rates, we found that the adolescents had lower blood cotinine levels. Those smoking 20 to 25 cpd had cotinine levels of 146 ± 84 (adolescents) vs 260 ± 98 (adults) ng/ml, and those smoking 26 to 35 cpd had levels of 169 ± 73 vs 276 ± 110 ng/ml, respectively. Conclusion. Nicotine patch therapy seems safe in adolescent smokers. Placebo-controlled trials are needed to establish the efficacy of nicotine patch therapy in adolescents.
In Experiment I, complete presentation of the study list produced better free recall learning than did the usual item-by-item (discrete) presentation. The difference was large and held for items occurring one, two, or three times within a list, whether items were spaced or massed, and for discrete presentation rates of 2, 4, and 6 sec/item. Experiment 2 replicated this superiority of complete over discrete presentation (equating total study time), and Experiment 3 extended the finding to paired associate learning. Experiments 2 and 3 indicated that multiple presentations of a list at fast rates were superior to a single presentation at a more standard rate and only slightly inferior to a single, complete presentation, Practical implications for instruction were pointed out, as were problems that certain of the results pose for theories that emphasize strategic (or at least extended) processing of items for encoding.At some point in the distant past, investigators of learning and memory began to use discrete presentation of the materials to be learned. The items forming a list of words or a list of nonsense syllables were presented one at a time for study, perhaps by having each item on an index card, or perhaps by the use of a memory drum or a slide projector. Each item was presented successively for a few seconds, with 2 sec probably being the modal I time for each item across studies. Most of us never gave the matter a thought; to present materials for learning in an experiment meant discrete presentation.Discrete presentation presumably has some merits, in that the subjects are given the same amount of time to study each item, although few investigators would deny that subjects may rehearse items other than the one being shown at the moment. Whatever, our laws of learning and memory are laws of discrete presentation. Discrete presentation is in contrast to complete presentation, wherein the subjects are given the entire list on a sheet of paper and are allowed a given amount of time to study the items.The question of interest is why anyone would choose to use complete presentation. A variety of answers could be given, some of which will be mentioned here. It could be argued that complete presentation has higher ecological validity than does discrete presentation. Being ecologically more valid, complete presentation allows the subjects greater freedom in using their skills to study the items in a manner they choose. Perhaps a more critical answer to the question revolves around the phenomenon of organization. It is common today to place heavy emphasis on organization as a factor in learning and memory. It would seem that most theorists . would accept the idea that subjects could more readily organize their learning when presentation is complete than when it is discrete. If organization is a pivotal notion, it must follow that complete presentation would be superior to discrete presentation in free recall learning. By like reasoning, it would seem to follow that if the task were one for which organization would...
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