BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital and a tertiary referral (...) hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

Purpose Children are becoming heavy users of communication and information technologies from an early age. These technologies carry risks to which children may be exposed. In collaboration with the Israel Ministry of Education, the authors launched a week-long safe online awareness program for school children in 257 elementary and middle schools in Israel. Each class independently composed a safe and ethical code of online behavior following two classroom debate sessions. The purpose of this study was to analyze these codes and (...) learn how school children perceive and understand the proper use of the network using thematic analysis. Design/methodology/approach A total of 8,181 students between the ages of 8 and 14 years in 303 classes from 257 schools participated in the program. These classes composed 303 ethical codes, which were decomposed into 2,201 elements. Using mixed-methods research combining quantitative and qualitative methodologies, the elements of the ethical codes were analyzed, interpreted, and classified to identify the dominant themes and discourses used by the students when addressing issues related to safe online use. Findings Findings indicate that Israeli students are aware of the dangers and risks of the internet, and these concerns are reflected in their own ethical codes. The students discouraged online self-exposure and encouraged precautions and wariness towards members of out-groups. The themes included sentences which asked for responsible, appropriate, and lawful use, expressed concern about privacy issues, and stated the need for adult involvement. Most of them reflected an “us against them ” perspective. Originality/value The current study presents an innovative “bottom-up” program based on wisdom of the crowd approach, that can be implemented in schools internationally in order to encourage reflexivity and teach children the necessary skills for safe online experiences. In addition, this study analyses the school children’s own views of the dangers of social media and learn about their perspective and understanding of internet use. (shrink)

There is limited knowledge of the prevalence and nature of risky sexual behavior (RSB) among young adults in Hong Kong. This cross-sectional study explored the psychosocial risk factors of RSB with a sample of 1,171 Hong Kong university students (aged 18–40 years). Grounded in the theoretical propositions of several criminological theories (i.e., the theories of self-control, general strain, social learning, social control, and routine activity), engagement in three types of RSB (i.e., general, penetrative, and non-penetrative) was studied alongside a (...) range of psychosocial risk factors. Relative to female participants, male participants reported significantly higher mean levels of general, penetrative, and non-penetrative RSB. Male participants also reported significantly higher mean levels of negative temperament, use of alcohol and other drugs, and paraphilic interests than female participants, who reported significantly higher mean levels of self-control and social bonds than their male counterparts. The results of multivariate analyses (i.e., OLS regressions) revealed that, to a large extent, the male and female participants shared a similar set of psychosocial risk factors (i.e., use of alcohol and other drugs, and paraphilic interest) for their involvement in general, penetrative, and non-penetrative RSB. Furthermore, a high level of negative temperament was significantly associated with penetrative RSB for both genders, while a high level of perceived neighborhood disorganization was found to be an important factor in the participation of females in general, penetrative, and non-penetrative RSB. The findings of this study may have important implications for practice in regard to reducing, if not entirely preventing, the tendency to engage in RSB. (shrink)

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

Implementing equity principles in resource allocation is challenging. In one approach, some US states implemented race-based prioritisation of COVID-19 vaccines in response to vast racial inequities in COVID-19 outcomes, while others used place-based allocation. In a nationally representative survey of n=2067 US residents, fielded in mid-April 2021, we explored the public acceptability of race-based prioritisation compared with place-based prioritisation, by offering vaccines to harder hit zip codes before residents of other zip codes. We found that in general, a majority of (...) respondents supported the place-based approach, and a substantial proportion supported the race-based plan. Support was higher among Democrats compared with Republicans. All US residents became eligible for vaccines on 19 April 2021 but as of this writing, equitable uptake of vaccines remains urgent not only for first doses for adults but also for boosters and for children. Our findings also provide a benchmark for future pandemic planning that racial and social justice in vaccine allocation are salient considerations for the public. The findings may furthermore be of interest to policy makers designing vaccine allocation frameworks in countries with comparable health disparities across social, ethnic and racial groups, and more broadly, for those exploring ways of promoting equity in resource allocation outside of a pandemic setting. (shrink)

The goal of this article is to present a first list of ethical concerns that may arise from research and personal use of virtual reality (VR) and related technology, and to offer concrete recommendations for minimizing those risks. Many of the recommendations call for focused research initiatives. In the first part of the article, we discuss the relevant evidence from psychology that motivates our concerns. In Section “Plasticity in the Human Mind,” we cover some of the main results suggesting that (...) one’s environment can influence one’s psychological states, as well as recent work on inducing illusions of embodiment. Then, in Section “Illusions of Embodiment and Their Lasting Effect,” we go on to discuss recent evidence indicating that immersion in VR can have psychological effects that last after leaving the virtual environment. In the second part of the article, we turn to the risks and recommendations. We begin, in Section “The Research Ethics of VR,” with the research ethics of VR, covering six main topics: the limits of experimental environments, informed consent, clinical risks, dual-use, online research, and a general point about the limitations of a code of conduct for research. Then, in Section “Risks for Individuals and Society,” we turn to the risks of VR for the general public, covering four main topics: long-term immersion, neglect of the social and physical environment, risky content, and privacy. We offer concrete recommendations for each of these 10 topics, summarized in Table 1. (shrink)

Two separate regulatory regimes govern research with adults who lack capacity to consent in England and Wales: the Mental Capacity Act (MCA) 2005 and the Medicines for Human Use (Clinical Trials) Regulations 2004 (“the Regulations”). A service evaluation was conducted to investigate how research ethics committees (RECs) are interpreting the requirements. With the use of a coding scheme and qualitative software, a sample of REC decision letters where applicants indicated that their project involved adults who lacked mental capacity was analysed. (...) The analysis focuses on 45 letters about projects covered by the MCA and 12 letters about projects covered by the Regulations. The legal requirements for involving incapacitated adults in research were not consistently interpreted correctly. Letters often lacked explicitness and clarity. Neither consent nor assent from third parties is a legally valid concept for purposes of the MCA, yet they were suggested or endorsed in 10 post-MCA letters, and there was evidence of confusion about the consultee processes. The correct terms were also not consistently used in relation to clinical trials. Inappropriate use of terms such as “relative” had the potential to exclude people eligible to be consulted. Unless the correct terms and legal concepts are used in research projects, there is potential for confusion and for exclusion of people who are eligible to be consulted about involvement of adults who lack capacity. Improved clarity, explicitness and accuracy are needed when submitting and reviewing applications for ethical review of research in this area. (shrink)

Older people are an increasingly important consumer group and hence advertising target, yet relatively little research in the UK and in Europe has examined how older adults are portrayed in advertising. In this study, a sample of 221 magazine advertisements depicting older adults were coded for features such as the advertised products, setting, role prominence, rhetorical scheme, tone and type of portrayal. In a departure from previous studies, we devised a set of six descriptive ‘types’ which encapsulate the way older (...) people are portrayed in these advertisements. Also, and as the main focus of this paper, we compared a magazine designed for people over 50 to ten general readership magazines in order to investigate any differences in the portrayal of older adults in age-targeted vs. general readership advertising. Previous research on old age stereotyping, social identity theory and inter-group theory form the basis of our analysis. (shrink)

Adolescence and young adulthood are peak periods for risky sexual behaviors and borderline personality disorder features. RSB is a major public health concern and adolescents with BPD may be particularly vulnerable to RSB, but this is understudied. The aim of this study was to identify distinct RSB profiles in youth and determine whether a specific profile was associated with BPD features. Participants were 220 adolescents and young adults recruited from the community. To identify groups of adolescents and young adults (...) who engage in similar RSB, a latent profile analysis was conducted on sexually active youth. Next ANOVA was used to identify how profiles differed in terms RSB dimensions and BPD features. We identified three distinct RSB profiles: a Low RSB profile that was manifested by the majority of youth; an Unprotected Sex in Relationships profile and; an Impulsive Sex Outside Relationships profile which was manifested by youth with significantly higher BPD features. The findings shed light on the difficulties youth with BPD manifest around integrating sexuality, intimacy, fidelity, and love. This contrasts with the majority of youth who are sexually active in the context of relationships and engage in little or no RSB. The findings have important clinical implications. Adolescent sexuality is frequently in the blind spot of clinicians. To address the elevated risk of RSB in adolescents with BPD, interventions are needed to help adolescents navigate this period and improve their understanding of the reasons for RSB while addressing difficulties in establishing sexual and attachment relationships. (shrink)

This paper engages the philosophical concepts of subjectification and acknowledgment in conversation with Philip Pullman’s young adult novel, Northern Lights. Our particular focus is Lyra Belacqua, Pullman’s central character. Precarious in her vulnerability and in her unknown significance, we read Lyra as usefully negotiating the dangerous transition from childhood to adolescence. In her negotiation of this complex liminality, we argue that Lyra models those difficult-to-define moments encountered by children as they learn to be in and of the world. Situating our (...) reading in a Philosophy of Education discourse, we draw theoretically from the work of Gert Biesta and Stanley Cavell. With Biesta as the primary focus of our paper, we generalize beyond Northern Lights to argue that the reading of fiction constitutes “a weak educational event” in Biesta’s intriguing understanding of that phrase. Partly as a theoretical framing for the Pullman text, we begin with an outline of Biesta’s philosophy. (shrink)

The Human Tissue Act 2004 presents a radical change to the legal regulation of the use of human material in England and Wales. The Act presents a broad regulatory framework but much in the practical operation of the legislation will depend upon regulations to be enacted and a new Code of Practice. This article examines 'appropriate consent' for the use of human tissue for research purposes in the context of the living competent adult. It examines the provision of information as (...) part of the consent process for the use of human materials for research purposes, the question of when consent can be withdrawn, and the controversial exception enabling the use without consent of anonymized material for research purposes where the research has been ethically approved. The paper concludes by highlighting some of the problems which may remain after the legislation comes into force. (shrink)

Are idioms stored in memory in ways that preserve their surface form or language or are they represented amodally? We examined this question using an inci- dental cued recall paradigm in which two word idiomatic expressions were presented to adult bilinguals proficient in Russian and English. Stimuli included phrases with idiomat- ic equivalents in both languages (e.g. “empty words/пycтыe cлoвa”) or in one language only (English—e.g. “empty suit/пycтoй кocтюм” or Russian—e.g. “empty sound/пycтoй звyк”), or in neither language (e.g. “empty rain/пycтoй (...) дoждь”). If idioms are stored in a language-specific format, then phrases with idiomatic equivalents in both languages would have dual representation, and should therefore be more easily recalled than phrases with idiomatic meaning in only one language. This result was obtained. As such, the findings support the dual-coding theory of memory and are also compatible with models of the bilingual lexicon that include language tags or nodes. (shrink)

This article assesses Bernard Stiegler’s critique of infantilization. Contemporary education—and society in general—would no longer develop children into adults, but would keep them in their childish state. Stiegler’s critique is explicitly inspired by Enlightenment ideals, characterized by a positive notion of maturity and a negative notion of childhood and immaturity. Infantilization is for Stiegler therefore immediately a negative development. However, Stiegler’s works also contain a positive understanding of childhood and of the extension of childish characteristics into adulthood. The main thesis (...) of this article is that this results in an unresolved tension in Stiegler’s work. I therefore propose a notion of infantilization not as solely negative, but as fundamentally ambivalent and risky. The continuation of childhood into maturity is necessary for the life of the mind, yet it can also foreclose maturity altogether. I use this new notion of infantilization to correct some of Stiegler’s radically conservative views on education and on the care for the new generations. (shrink)

There is a paucity of experimental data addressing how peers influence adolescent risk-taking. Here, we examined peer effects on risky decision-making in adults and adolescents using a virtual social context that enabled experimental control over the peer “interactions”. 40 adolescents (age 11-18) and 28 adults (age 20-38) completed a risk-taking (Wheel of Fortune) task under 4 conditions: in private; while being observed by (fictitious) peers; and after receiving ‘risky’ or ‘safe’ advice from the peers. For high-risk gambles (but (...) not medium-risk or even gambles), adolescents made more risky decisions under peer observation than adults. Adolescents, but not adults, tended to resist ‘safe’ advice for high-risk gambles. Although both groups tended to follow ‘risky’ advice for high-risk gambles, adults did so more than adolescents. These findings highlight the importance of distinguishing between the effects of peer observation and peer advice on risky decision-making. (shrink)

BackgroundOnline assessment of narrative production and comprehension became an important component of language assessment during the COVID-19 pandemic. This study aimed to establish quantitative measures of narrative macrostructure in the production and comprehension of adult Irish-English bilinguals in an online assessment.MethodsA total of 30 Irish-English bilingual adults participated in an online assessment of oral narrative production and comprehension. Narratives were elicited using LITMUS-MAIN for Irish and English. Story-tell elicitation method was used for all stories. Twenty participants produced Baby Birds and (...) Baby Goats story pairs while 10 participants produced Cat and Dog story pairs. Quantitative measures of story structure, comprehension score, and the overall number of Internal State Terms in production and comprehension were compared across the story pairs, languages, and the output type.ResultsA general linear model indicated no differences in either story structure or story comprehension scores across languages for both sets of stories. Combined analysis for all participants and stories indicated no difference in the story structure scores or comprehension scores across the languages or the story pairs. While the overall number of ISTs was the same across languages, a higher number of ISTs was observed in comprehension relative to production in both languages for Cat and Dog story pair only, but not for Baby birds and Baby goats' stories. The major benefit of using online assessment was the accessibility of participants. The major drawback was the inability to control the environment and the quality of the internet connection.Conclusion and implicationsWhile online assessment increased the availability of participants, which is a significant factor in rural Ireland characterized by low population density and the high percentage of Irish speakers, the availability of stable internet connection limited the applicability of online assessment. Measures of narrative macrostructure were stable across the languages and the story pairs. This is important because of high variability in exposure to Irish, frequent code-switching, and a high number of morphosyntactic errors due to rapid language change that characterizes Irish-English bilinguals. Identifying reliable measures of language performance for Irish-English adult speakers is an important step toward establishing developmental norms for Irish-English bilinguals. (shrink)

Adolescents’ and young adults’ practical moral judgments about two interpersonal moral dilemmas, which differed in their moral complexity, were examined using two philosophical frameworks (deontological and consequentialist principles) as tools for psychological analysis. A sample of 234 participants (ages 14–16, 18–19, and 20–21) reasoned about two moral dilemmas, which had been experienced by a subset of adolescents in a pilot study, in two forms: Participants 1) provided open-ended decisions and justification from the perspective of an imagined moral agent and 2) (...) selected a choice from nine fixed reasoning alternatives (half advocating one course and other half advocating the other course of action, plus a relativistic reasoning). The participants’ open-ended responses served as a foundation of coding systems and were analyzed using log-linear analyses, chi-square tests, and a binominal logistic regression. The combination of qualitative and quantitative methods uncovered unexpected but nuanced young people’s moral thinking. Results indicated that female participants were more likely than males to show a unique decision style: “restructuring” of the moral dilemmas/situations, and moral relativism emerged only when asked to select a choice from nine reasoning alternatives and was primarily evidenced among the younger (aged 18–19) female college students. (shrink)

In this exploratory qualitative study, the open-ended responses of 71 Turkish–Muslim university students regarding their religious socialization experiences were coded by NVivo 8. Results indicate that both parents play a major role in their offspring's religious socialization. However, participants perceive their same-sex parents in particular as being more influential. Parents’ methods for transmitting religious values and practices include having religious talks with their children, answering their questions about Islam, sending them to mosques, reinforcing and/or punishing their behaviours. Peers, siblings, and (...) cousins are other important religious socialization agents whom the participants generally perceive as partners in religious activities. Some religious peer groups, same-sex siblings and cousins play a significant role in the participants’ religious learning. In Turkish–Muslim families, the oldest siblings exert a major influence on the religious socialization of their younger brothers and sisters as do grandparents, aunts and uncles. (shrink)

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

This paper examines interaction involving a child with an Autistic Spectrum Disorder, a humanoid robot and a co-present adult. In this paper data from one child (collected as part of the ROBOSKIN project) is analysed in order to evaluate the potential contributions of a conversation analytic perspective to the examination of data relating to socio-emotional reciprocity. The paper argues for the value of treating all interaction as potentially relevant, looking without carefully pre-defined target behaviours and examining behaviour within its specific (...) sequence of interaction. Adopting this approach, the paper suggests, enables noticings and observations that might not be available from perspectives that rely on the coding of pre-specified behaviours in isolation. Treating all interaction as potentially relevant brought into view interactions that might otherwise be dismissed or ignored – because they occurred before, or after, the trial itself. Being informed by the value of unmotivated looking – rather than pre-specified coding schemes – enabled highly relevant behaviour that was not anticipated within the trials to be analysed. Finally, seeing sequence as important meant that behaviours were appreciated in their intricate detail, enabling a more precise understanding than might be available if they were considered separately from that sequential environment. Keywords: autism; assessment; autistic spectrum disorder; experiment; conversation analysis; interaction; humanoid robot; sequences; sequence of interaction; socio-emotional reciprocity. (shrink)

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. (...) Attachment theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

This article examines how ‘trauma’ has been conceptualised in the unresolved state of mind classification in the Adult Attachment Interview, introduced by Main and Hesse in 1990. The unresolved state of mind construct has been influential for three decades of research in developmental psychology. However, not much is known about how this measure of unresolved trauma was developed, and how it relates to other conceptualisations of trauma. We draw on previously unavailable manuscripts from Main and Hesse's personal archive, including various (...) editions of unpublished coding manuals, and on Main–Bowlby correspondence from the John Bowlby Archive at the Wellcome Trust in London. This article traces the emergence of the unresolved state of mind classification, and examines the assumptions about trauma embedded in the construct. These assumptions are situated both in the immediate context of the work of Main and Hesse and in terms of wider discourses about trauma in the period. Our analysis considers how a particular form of trauma discourse entered into attachment research, and in doing so partly lost contact with wider disciplinary study of trauma. (shrink)

I examine critically the application of information‐theoretic ideas to biological communication during embryonic development and in the functioning central nervous system (CNS). I show that intercellular communication relies mostly on simple signals whose role is to effect a selection among predetermined cellular states. Hence, a crucial role is played by cellular memory, which stabilizes such states. Memory in cells is partly located in the nuclear DNA; no less important however is (phenotypic) memory lying in the cell's organelles and compartments. Because (...) of combinatorial effects in gene expression patterns, cell memory is an enormously powerful mechanism, which also underlies plasticity, and thus constitutes the factor unifying genetic determination, plasticity and learning. Communication in the CNS is analyzed in some detail: here, cellular memory is embodied in anatomy (i.e., cell shape) and neurochemistry. These are the major, relatively “static” factors affecting the routing of neural impulses in the adult CNS. In addition, however, faster channeling is also required: action potentials must be directed to their targets along a few of exponentially many paths, and this dynamic routing is crucial for proper operation. I suggest that collective oscillatory modes may play a role in solving this addressing problem, in the same way that the clock signal gates the operation of man‐made computers. BioEssays 25:699–708, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Healthcare professionals may confront ethical issues in practice, particularly when their values conflict with that of their patients or clients. This paper explores an ethical case study in which a dietitian who practices Health at Every Size® has an older adult client who wishes to lose weight. The dietitian believes that losing weight is inappropriate for this client. Using a framework for ethical decision making, this article explores the problem or dilemma, identifies the potential issues involved, discusses the relevant ethical (...) codes, laws, and regulations, and explores possible courses of action and their consequences. By exploring an ethical issue that healthcare professionals may encounter in practice, we can gain a deeper understanding of ethical decision making. (shrink)

We explored the frequency with which typical adults make Theory of Mind attributions, and under what circumstances these attributions occur. We used an experience sampling method to query 30 typical adults about their everyday thoughts. Participants carried a Personal Data Assistant that prompted them to categorize their thoughts as Action, Mental State, or Miscellaneous at approximately 30 pseudo-random times during a continuous 10-h period. Additionally, participants noted the direction of their thought and degree of socializing at the time of inquiry. (...) We were interested in the relative frequency of ToM and how prominent they were in immediate social exchanges. Analyses of multiple choice answers suggest that typical adults: spend more time thinking about actions than mental states and miscellaneous things, exhibit a higher degree of own- versus other-directed thought when alone, and make mental state attributions more frequently when not interacting than while interacting with others . A significant 3-way interaction between thought type, direction of thought, and socializing emerged because action but not mental state thoughts about others occurred more frequently when participants were interacting with people versus when alone; whereas there was an increase in the frequency of both action and mental state attributions about the self when participants were alone as opposed to socializing. A secondary analysis of coded free text responses supports findings 1–3. The results of this study help to create a more naturalistic picture of ToM use in everyday life and the method shows promise for future study of typical and atypical thought processes. (shrink)

Many services can assist autistic people, such as early intervention, vocational services, or support groups. Scholars and activists debate whether such services should be autism-specific or more general/inclusive/mainstream. This debate rests on not only clinical reasoning, but also ethical and social reasoning about values and practicalities of diversity and inclusion. This paper presents qualitative results from a mixed-methods study. An online survey asked autistic adults and parents of autistic people of any age in Canada, the United States, Italy, France, and (...) Germany what types of services they prefer (autism-specific, mixed-disability, or general/inclusive/mainstream). This paper presents the advantages and disadvantages of different service types, identified through inductive thematic coding and organized into higher-level themes focusing on clinical, structural, societal, interpersonal, and personal aspects of services. Autism-specific services were praised for addressing autism needs, helping clinically, and providing interpersonal benefits of others understanding autism; general services were praised for inclusion, helping clinically, community obligations and awareness, and social skills development. Looking at the interaction of these different aspects in respondent narratives nuances debates about autism-specificity, with a complex interplay between clinical, interpersonal, and societal aspects. Clinical and social perspectives are not necessarily separate and opposed, but intertwined based on different understandings of inclusion. Compared to parents, adults focused more on harm/safety issues, enjoyment, and stereotyping among other themes, attending to personal themes. These findings do not identify one best service type, but suggest that determining the right service in a given context may be informed by definitions of and goals about inclusion. (shrink)

In this exploratory qualitative study, the open-ended responses of 71 Turkish–Muslim university students regarding their religious socialization experiences were coded by NVivo 8. Results indicate that both parents play a major role in their offspring’s religious socialization. However, participants perceive their same-sex parents in particular as being more influential. Parents’ methods for transmitting religious values and practices include having religious talks with their children, answering their questions about Islam, sending them to mosques, reinforcing and/or punishing their behaviours. Peers, siblings, and (...) cousins are other important religious socialization agents whom the participants generally perceive as partners in religious activities. Some religious peer groups, same-sex siblings and cousins play a significant role in the participants’ religious learning. In Turkish–Muslim families, the oldest siblings exert a major influence on the religious socialization of their younger brothers and sisters as do grandparents, aunts and uncles. (shrink)

In this contribution, we draw on findings from a non-formal, community music project to elaborate on the relationship between the concept ofeudaimonia, as defined by Seligman, the interactive dimensions of collective free improvisation, and the concept of collaborative creativity. The project revolves around The Ostend Street Orkestra (TOSO), a music ensemble within which homeless adults and individuals with a psychiatric or alcohol/drug related background engage in collective musical improvisation. Between 2017 and 2019 data was collected through open interviews and video (...) recordings of rehearsals and performances. Participant data was analyzed through inductive analysis based on the principles of grounded theory. One interesting finding was the discrepancy in the participant interviews between social relationships indicative of a negative affect about social group interaction versus strong feelings of group coherence and belonging. Video recordings of performances and rehearsals showed clear enjoyment and pleasure while playing music. Alongside verbal reflection through one-on-one interviews video recordings and analysis of moment-to moment observations should be used, in order to capture the complexity of community music projects with homeless people. The initial open coding was aligned with the five elements of the PERMA model. Overall, we observed more focus on Relationship (sense of belonging), Engagement (flow in rehearsals and performances) and Meaning (belonging to something greater than yourself) and less on Positive Emotion and Accomplishment (goal setting). (shrink)

Individuals with substance use disorders exhibit risk-taking behaviors, potentially leading to negative consequences and difficulty maintaining recovery. Non-invasive brain stimulation techniques such as transcranial direct current stimulation have yielded mixed effects on risk-taking among healthy controls. Given the importance of risk-taking behaviors among substance-using samples, this study aimed to examine the effects of tDCS on risk-taking among a sample of adults using cannabis. Using a double-blind design, 27 cannabis users [M age = 32.48, 41% female] were randomized, receiving one session (...) of active or sham tDCS over the bilateral dorsolateral prefrontal cortex. Stimulation parameters closely followed prior studies with anodal right dlPFC and cathodal left dlPFC stimulation. Risk-taking—assessed via a modified Cambridge Gambling Task—was measured before and during tDCS. Delay and probability discounting tasks were assessed before and after stimulation. No significant effects of stimulation on risk-taking behavior were found. However, participants chose the less risky option ∼86% of the trials before stimulation which potentially contributed to ceiling effects. These results contradict one prior study showing increased risk-taking among cannabis users following tDCS. There was a significant increase in delay discounting of a $1000 delayed reward during stimulation for the sham group only, but no significant effects for probability discounting. The current study adds to conflicting and inconclusive literature on tDCS and cognition among substance-using samples. In conclusion, results suggest the ineffectiveness of single session dlPFC tDCS using an established stimulation protocol on risk-taking, although ceiling effects at baseline may have also prevented behavior change following tDCS. (shrink)

Adolescence has been linked to an enhanced tolerance of uncertainty and risky behavior and is possibly connected to an increased response toward rewards. However, previous research has produced inconsistent findings. To investigate whether these findings are due to different reward probabilities used in the experimental design, we extended a monetary incentive delay task by including three different reward probabilities. Using functional magnetic resonance imaging, 25 healthy adolescents and 22 adults were studied during anticipation of rewards in the VS. Differently (...) colored cue stimuli indicated either a monetary or verbal trial and symbolized different reward probabilities, to which the participants were blinded. Results demonstrated faster reaction times for lower reward probabilities in both age groups. Adolescents were slower through all conditions and had less activation on a neural level. Imaging results showed a three-way interaction between age group x condition x reward probability with differences in percent signal change between adolescents and adults for the high reward probabilities while adolescents demonstrated differences for the lowest. Therefore, previous inconsistent findings could be due to different reward probabilities, which makes examining these crucial for a better understanding of adolescent and adult behavior. (shrink)

Analogues of Ramsey’s Theorem for infinite structures such as the rationals or the Rado graph have been known for some time. In this context, one looks for optimal bounds, called degrees, for the number of colors in an isomorphic substructure rather than one color, as that is often impossible. Such theorems for Henson graphs however remained elusive, due to lack of techniques for handling forbidden cliques. Building on the author’s recent result for the triangle-free Henson graph, we prove that for (...) each [Formula: see text], the k-clique-free Henson graph has finite big Ramsey degrees, the appropriate analogue of Ramsey’s Theorem. We develop a method for coding copies of Henson graphs into a new class of trees, called strong coding trees, and prove Ramsey theorems for these trees which are applied to deduce finite big Ramsey degrees. The approach here provides a general methodology opening further study of big Ramsey degrees for ultrahomogeneous structures. The results have bearing on topological dynamics via work of Kechris, Pestov, and Todorcevic and of Zucker. (shrink)

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma drivers (triggers of stigmatisation), facilitators (factors (...) positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction. (shrink)

BackgroundDreams can be affected by recent life events and long-term life experiences. Previous evidence has shown that childhood adverse experiences are associated with sleep quality and dream experiences.ObjectiveThe aim of this study was to explore the relationship between childhood adverse experiences and dream content in adults.Participants and SettingA total of 163 participants without current or past physical or mental disorders aged between 18 and 35 were screened in the hospital. Among them, 120 subjects who completed a dream content record at (...) home and whose anxiety and depression levels and sleep quality were within the normal range were included in the data analysis.MethodsA cross-sectional survey was conducted from June 2017 to December 2019. Dream content for 10 consecutive days was recorded by the participants and coded by the Hall and Van de Castle coding system. Childhood adversity was assessed by the Childhood Trauma Questionnaire. In the end, 719 dreams out of 626 nights for 120 participants were included in the data analysis, gender differences between groups were analyzed using t-tests or U tests, and Spearman’s partial correlation and multiple linear regression were used to investigate the relationship between childhood trauma and dream content.ResultsChildhood adversity was associated with characters, friendly interactions, and objects in dream content. Regression models of childhood adversity predicting characters and objects in dream content were constructed. There were no gender differences in general demographic data, sleep quality, emotional state, childhood adversity, dream recall frequency, or dream content.ConclusionChildhood adversity is associated with adult dream content. (shrink)

As a key constituent of China's approach to fighting COVID-19, Health Code apps (HCAs) not only serve the pandemic control imperatives but also exercise the agency of digital surveillance. As such, HCAs pave a new avenue for ongoing discussions on contact tracing solutions and privacy amid the global pandemic. This article attends to the perceived privacy protection among HCA users via the lens of the contextual integrity theory. Drawing on an online survey of adult HCA users in Wuhan and Hangzhou (...) (N = 1551), we find users’ perceived convenience, attention towards privacy policy, trust in government, and acceptance of government purposes regarding HCA data management are significant contributors to users’ perceived privacy protection in using the apps. By contrast, users’ frequency of mobile privacy protection behaviors has limited influence, and their degrees of perceived protection do not vary by sociodemographic status. These findings shed new light on China's distinctive approach to pandemic control with respect to the state's expansion of big data-driven surveillance capacity. Also, the findings foreground the heuristic value of contextual integrity theory to examine controversial digital surveillance in non-Western contexts. Put tougher, our findings contribute to the thriving scholarly conversations around digital privacy and surveillance in China, as well as contact tracing solutions and privacy amid the global pandemic. (shrink)

There is increasing interest in clarifying how different face emotion expressions are perceived by people from different cultures, of different ages and sex. However, scant availability of well-controlled emotional face stimuli from non-Western populations limit the evaluation of cultural differences in face emotion perception and how this might be modulated by age and sex differences. We present a database of East Asian face expression stimuli, enacted by young and older, male and female, Taiwanese using the Facial Action Coding System (FACS). (...) Combined with a prior database, this present database consists of 90 identities with happy, sad, angry, fearful, disgusted, surprised and neutral expressions amounting to 628 photographs. 20 young and 24 older East Asian raters scored the photographs for intensities of multiple-dimensions of emotions and induced affect. Multivariate analyses characterized the dimensionality of perceived emotions and quantified effects of age and sex. We also applied commercial software to extract computer-based metrics of emotions in photographs. Taiwanese raters perceived happy faces as one category, sad, angry, and disgusted expressions as one category, and fearful and surprised expressions as one category. Younger females were more sensitive to face emotions than younger males. Whereas older males showed reduced face emotion sensitivity, older female sensitivity was similar or accentuated relative to young females. Commercial software dissociated six emotions according to the FACS demonstrating that defining visual features were present. Our findings show that East Asians perceive a different dimensionality of emotions than Western-based definitions in face recognition software, regardless of age and sex. Critically, stimuli with detailed cultural norms are indispensable in interpreting neural and behavioral responses involving human facial expression processing. To this end, we add to the tools, which are available upon request, for conducting such research. (shrink)

We examine the opportunities children have for interacting with others and the extent to which they are the focus of others’ visual attention in five societies where extended family communities are the norm. We compiled six video-recorded datasets collected by a team of anthropologists and psychologists conducting long-term research in each society. The six datasets include video observations of children among the Yasawas, Tanna, Tsimane, Huatasani, and Aka. Each dataset consists of a series of videos of children ranging in age (...) from 2 months to 12 years in their everyday contexts. We coded 998 videos and identified with whom children had opportunities to interact as well as the number of individuals and the proportion of observed time that children spent with these individuals. We also examined the proportion of time children received direct visual gaze. Our results indicate that children less than 5 years old spend the majority of their observed time in the presence of one female adult. This is the case across the five societies. In the three societies from which we have older children, we find a clear shift around 5 years of age, with children spending the majority of their time with other children. We also coded the presence or absence of a primary caregiver and found that caregivers remained within 2 ft of target children until 7 years of age. When they were in the company of a primary caregiver, children older than seven spent the majority of their time more than 2 ft from the caregiver. We found a consistent trend across societies with decreasing focal attention on the child with increasing child age. These findings show remarkable consistency across these societies in children’s interaction opportunities and that a developmental approach is needed to fully understand human development because the social context is dynamic across the lifespan. These data can serve as a springboard for future research examining social development in everyday contexts. (shrink)

Previous research suggests a higher perceived risk associated with a risky behavior predicts a lower likelihood of involvement in that behavior; however, this relationship can vary based on personality characteristics such as impulsivity and behavioral activation. During the COVID-19 pandemic, individuals began to re-evaluate the level of risk associated with everyday behaviors. But what about risks associated with “typical” risk-taking behaviors? In the present study, 248 undergraduate student participants completed measures of impulsivity, behavioral activation and inhibition, propensity to take (...) risks, numeracy, and perceptions of and involvement in both risk-taking behavior and health promoting behavior. Our study revealed that higher behavioral inhibition and greater propensity to take risks predicted greater likelihood of involvement in COVID-19-related risk behaviors, even after accounting for perceived risks and benefits of the behavior. Greater likelihood of involvement in social risk behaviors was predicted by greater numeracy and risk-taking propensity. Identifying as male, a greater propensity to take risks, and greater impulsivity predicted increased health/safety risk behaviors. Younger age, lower risk-taking propensity, and lower impulsivity were associated with a greater likelihood of donating blood. For the likelihood of registering to become an organ donor, increasing risk perception, both before and during the pandemic, was associated with greater likelihood of registering, but greater risk-taking propensity was associated with a decreased likelihood of organ donation registration. For flu vaccination, a greater propensity to take risks was associated with a greater likelihood of flu vaccination during the 2020–2021 flu season. Both cognitive and personality factors can predict involvement in risk-taking and health-promotion behaviors, warranting their continued examination. (shrink)

The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing how therapists should handle (...) unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided. (shrink)

The spread of COVID-19 in Italy resulted in the implementation of a lockdown that obligated the first time the general populace to remain at home for approximately two months. This lockdown interrupted citizens’ professional and educational activities, in addition to closing shops, offices and educational institutions. The resulting changes in people’s daily routines and activities induced unexpected changes in their thoughts, feelings and attitudes, in addition to altering their life perceptions. Consequently, the present study explores how young adults perceived their (...) lives under lockdown during the final week of March 2020, when the reported number of daily coronavirus infections reached its peak in Italy. The research was carried out among 293 university students (234 women and 59 men) with an average age of 20.85 years old (SD = 3.23). The researchers asked participants to describe the emotions, thoughts and experiences that characterized their time under lockdown. The study analyzed specific narratives related to time and space using grounded theory methodology, which was applied using Atlas 8 software, leading to the creation of 68 codes. The study organized these codes into three specific categories: confined in the present, confined in the past, and striving toward one’s goals. Finally, the researchers also created a core-category labeled “continuity of being.” The results showed that the closure of open spaces caused a division in participants’ perceptions of time continuity, with many viewing themselves as feeling fragmented and as living the present in a static and fixed way. Additionally, participants also saw the present as being discontinuous from the past, while, simultaneously, projecting toward the future and the changes it might bring. Finally, this study examined further implications surrounding individual projecting among young people in greater depth. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

It has been argued that people in areas with high pathogen loads will be more likely to avoid outsiders, to be biased in favor of in-groups, and to hold collectivist and conformist values. Cross-national studies have supported these predictions. In this paper we provide new pathogen codes for the 186 cultures of the Standard Cross-Cultural Sample and use them, together with existing pathogen and ethnographic data, to try to replicate these cross-national findings. In support of the theory, we found that (...) cultures in high pathogen areas were more likely to socialize children toward collectivist values (obedience rather than self-reliance). There was some evidence that pathogens were associated with reduced adult dispersal. However, we found no evidence of an association between pathogens and our measures of group bias (in-group loyalty and xenophobia) or intergroup contact. (shrink)

The rule I call ‘Civilian Immunity’ – the rule that prohibits targeting civilians in war – is the heart of the accepted jus in bello code. It prohibits targeting civilians in a wide variety of war circumstances. Seth Lazar's brilliant book, Sparing Civilians, attempts to defend Civilian Immunity. In this essay I show, first, that his ‘Risky-Killing based argument’ fails to provide civilians with the robust protection Sparing Civilians promises. I argue, secondly, that the moral framework that Sparing Civilians (...) employs, a moral framework that centralizes the Deontological Clause, leaves the immunity of civilians against Leaders unexplained. (shrink)

We discuss the effectiveness of mediated communication (internet communication via a computer tablet) and tacit engagement in a Project on mental health. The project is aimed at improving the wellbeing of adult women living with chronic mental disorders in long-term psychiatric internment. The computer tablets act as "portals" to provide access and conatct with the outside world for patients who have poor (if any) external social support. This support includes a patient-centred psycho-social care, and accompanying clinical and pharmaceutical treatment. Both (...) patients and their relatives accepted the benefits of internet mediation, for very different reasons. For the patient, this is a flash of contact with humanity, and for the relatives the internet communication this proved to be an alternative to the need for physical proximity. As some patients had no relatives or friends to communicate (even remotely) with the outside world, and because there is a school next door to the clinic, we visualized that the communication between these two communities could provide both a therapeutic and poetic act of learning and compassion. The electronic portal could serve as a virtual bridge between two forbidden domains. Although awareness of students of the nearby school was raised about mental health, the use of internet mediation devoid of physical proximity made the students suspicious of the goal of the mediation. From the patient's side, however, each contact was an instance of joy. Several issues were raised from this exercise. (shrink)

It is hypothesized that human faces judged to be attractive by people possess two features—averageness and symmetry—that promoted adaptive mate selection in human evolutionary history by way of production of offspring with parasite resistance. Facial composites made by combining individual faces are judged to be attractive, and more attractive than the majority of individual faces. The composites possess both symmetry and averageness of features. Facial averageness may reflect high individual protein heterozygosity and thus an array of proteins to which parasites (...) must adapt. Heterozygosity may be an important defense of long-lived hosts against parasites when it occurs in portions of the genome that do not code for the essential features of complex adaptations. In this case heterozygosity can create a hostile microenvironment for parasites without disrupting adaptation. Facial bilateral symmetry is hypothesized to affect positive beauty judgments because symmetry is a certification of overall phenotypic quality and developmental health, which may be importantly influenced by parasites. Certain secondary sexual traits are influenced by testosterone, a hormone that reduces immunocompetence. Symmetry and size of the secondary sexual traits of the face (e.g., cheek bones) are expected to correlate positively and advertise immunocompetence honestly and therefore to affect positive beauty judgments. Facial attractiveness is predicted to correlate with attractive, nonfacial secondary sexual traits; other predictions from the view that parasite-driven selection led to the evolution of psychological adaptations of human beauty perception are discussed. The view that human physical attractiveness and judgments about human physical attractiveness evolved in the context of parasite-driven selection leads to the hypothesis that both adults and children have a species-typical adaptation to the problem of identifying and favoring healthy individuals and avoiding parasite-susceptible individuals. It is proposed that this adaptation guides human decisions about nepotism and reciprocity in relation to physical attractiveness. (shrink)

This nation’s obesity epidemic is hardly a laughing matter. Approximately 300,000 Americans die from obesity-related causes each year, and without corrective measures, obesity may soon be responsible for as many deaths as cigarette smoking. Sixty-one percent of adults are overweight or obese, and the cost of obesity for the year 2000 was estimated to be 117 billion dollars.In Pelman v. McDmalds, a case decided in September 2003, a federal judge dismissed an amended complaint that attempted to hold McDonalds liable for (...) its customers’ obesity-related illnesses. While many argue that such litigation is frivolous and that the plaintiffs did not deserve direct compensation for their injuries, the debate has largely overlooked the important question raised by these cases - who should pay for the enormous financial strain that obesity places on America’s health care system? Although the courtroom may not be the appropriate forum to deal with this issue, the litigation has undoubtedly brought a great deal of much-needed attention to a vexatious social problem. (shrink)

The evidence linking tobacco product advertising to adolescent smoking initiation and resulting long-term addiction, premature death, and disability is well established. Each link in the causal chain has been substantiated: children and adolescents are especially vulnerable to advertising; point-of-sale advertising comprises 92.1% of cigarette advertising and marketing expenditures by manufacturers and 71.3% of smokeless tobacco advertising; tobacco companies have targeted youth through advertising; advertising exposure causes adolescents to start and to continue smoking; among adults who become daily smokers, nearly all (...) first use of cigarettes occurs by 18 years of age; adolescents who smoke are at high risk for long-term addiction because their brains are still developing; and long-term addiction results in the tremendous personal, social and financial costs of tobacco-related illnesses. (shrink)