ACTIVE: a cognitive intervention trial to promote independence in older adults.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms.

This paper reports an examination of cognitive processes used by 178 women aged 50 years and older in retrieving information about the frequency with which they received Papanicolaou smears, mammograms, and clinical breast examinations. Women were selected from a health maintenance organization in which they had been enrolled for at least 5 1/2 years. The literature suggested that reporting of regular events such as these kinds of tests is likely to be based on schemas, which is an estimation technique in which events are reported in a format with generic content. Thus, if the procedure is believed to occur annually, the respondent will report receiving five tests in 5 years. The study attempted to evaluate whether use of episodic recall, in which respondents are forced to report individual events, would be more accurate than reports based on estimation using a schema format. The results indicated that most of the errors occurred in Papanicolaou smear reporting, which is consistent with the literature, and that the fewest errors occurred with mammograms. Regardless of the questionnaire format, respondents persisted in using schemas based on the date of annual physical examination. Most reporting errors occurred because the interval between examinations was estimated incorrectly.

Design and results of the Women's Health Study.

The Women's Health Study was a methodological experiment carried out in Chicago. More than 1,000 women took part; a comparison sample of 100 men was also included. The sample was selected from two sources. Most of the women and all of the men were selected from an area probability sample that had been screened to identify women in the eligible age range; the rest of the women were selected from rosters at cooperating abortion clinics and were known to have had an abortion. Questionnaires based on the one used in the National Survey of Family Growth were administered to the sample; the questionnaire included items on abortion, sexual behavior, and illicit drug use. The experiment examined five variables: whether the questionnaire began with a series of medical questions or with questions on pregnancy; whether the interview was conducted by a nurse or field interviewer; whether the interview was done at the respondent's home or outside the home; whether the interviewer or respondent administered the questions; and whether the data were collected on paper or via computer. Of the five experimental factors, the one with the most consistent effect was the method of administering the questions. Self-administration significantly increased the reported number of sexual partners, sexually transmitted diseases, and the level of condom use compared to administration by an interviewer. Computer assistance occasionally interacted with the site of the interview to effect reporting. The other two experimental variables-the version of the questionnaire and the data collection staff-had few discernible effects. None of the variables affected reported drug use over the lifetime.

Improving food frequency questionnaires: a qualitative approach using cognitive interviewing.

In an attempt to improve data quality and ease of administration of standard self-administered food frequency questionnaires, various alternative approaches were tried for inquiring about frequency of consumption, portion size, seasonal intake, and food preparation. Evaluation consisted of a cognitive interviewing method in which respondents verbalize their thought process while completing several variations of a questionnaire. Interviewers observed and asked follow-up probe questions to evaluate problems or inconsistencies verbalized by respondents. Consensus and judgment by interviewers and observers suggested several problematic features of food frequency questionnaires: formatting of questions about frequency and portion size; computing average frequencies for aggregated food items or for foods eaten seasonally; comprehension of many items; and ordering of foods. These findings led to cognitive refinement and innovations, which included detailed questions regarding preparation or use of low-fat varieties or other alternatives to help better describe specifics of intake for some foods; questions on seasonal intake for several foods; inclusion of portion size ranges; and additional response categories for frequency of intake. Cognitive interviewing is an important step in pinpointing cognitive problems in dietary questionnaires.

Saliva cotinine and recent smoking--evidence for a nonlinear relationship.

Cotinine concentration in various body fluids is considered to be among the most useful markers of nicotine exposure currently available. Despite the prevailing consensus concerning cotinine's usefulness, cotinine's large intrasubject variability has led some to question the value of a single-point measurement. Several individual differences (for example, age, race, sex, and so forth) may affect cotinine excretion, and a peculiar nonlinearity between the number of cigarettes smoked and cotinine concentration has been reported previously in the literature. The purpose of this investigation was to examine the nature of the association between cotinine and reported number of cigarettes smoked after adjustment for the relationship between cotinine and age, a key individual difference known to affect drug absorption, distribution, metabolism, excretion, and tissue sensitivity. The authors examined the relationship between saliva cotinine and daily cigarette consumption in 116 smokers (mean age = 37.4 years; average number of cigarettes smoked daily = 20.1) who logged each cigarette into a hand-held computer as part of a study on the accuracy of recall. The Pearson correlation between saliva cotinine and the logged number of cigarettes smoked in the previous 17 hours (the time window corresponding to the half-life of cotinine) accounted for significantly more of the variance in cotinine than did the average logged number of cigarettes smoked daily during 5 days. Age was also significantly associated with cotinine levels. Further examination of the relationship between cotinine and amount smoked in the previous 17 hours revealed evidence for a significant nonlinear component. Inclusion of both age and a cubic nonlinear component of daily cigarette consumption resulted in further significant improvement in the amount of variance accounted for in cotinine levels. These results suggest that adjustments forage and the inclusion of a nonlinear component for cigarette consumption will result in more precise use of cotinine as a validation tool for existing differences in smoking levels.

Effects of dexamethasone and high terrestrial altitude on cognitive performance and affect.

This study examined the effects of dexamethasone and exposure to high terrestrial altitude on cognitive performance, affect, and personality. Cognitive performance was evaluated by five cognitive tasks, affect was evaluated by the Clyde Mood Scale and the Multiple Affect Adjective Check List, and personality was examined using the Minnesota Multiphasic Personality Inventory. Sixteen healthy young men received either dexamethasone (4 mg every 6 h) (n = 7) or placebo (n = 9) for 34 h prior to and 52 h after ascent to 4,300 m. Subjects treated with dexamethasone correctly performed more computer interaction and addition problems than did placebo-treated subjects. They also were less sleepy, dizzy, depressed, and anxious than placebo-treated subjects at altitude. No adverse effects on cognitive performance, affect, or personality were noted after dexamethasone was discontinued on the third day at altitude. Results indicate that dexamethasone at the present dose positively influences cognitive performance and mood states at altitude, but has no residual effect on personality.

Question-induced cognitive biases in reports of dietary intake by college men and women.

In two experiments, investigated how variations in questionnaire structure influence respondents' reports of two aspects of dietary intake--the frequency with which various food items are eaten and the sizes of the portions that are eaten. In Experiment 1, approximately 400 subjects, prior to making a frequency judgment, were asked to think either about a specific occasion or about all the occasions on which they had eaten a particular food. The thoughts that preceded the frequency judgment influenced that judgment: Thinking of the range of occasions on which a food is consumed resulted in higher frequency estimates than thinking only of the most recent occasion. In Experiment 2, the same subjects made judgments about their typical portion sizes of several foods relative to described standards. For only one of eight foods were estimates properly and significantly affected by differences among the described standards. These results suggest that respondents are not particularly sensitive to portion-size definitions. We consider the implications of these phenomena for the development of a general theory of the cognitive processes that subserve health-survey responding.

Cognitive laboratory approach to designing questionnaires for surveys of the elderly.

Data from surveys of the elderly are used by policy analysts to design health services programs. Consequently, the quality of survey data on elderly respondents has important implications for this growing segment of society: improving the quality of data should result in more cost effective programs for the elderly. However, studies suggest that the quality of responses from the elderly may be less than that for other respondents. Moreover, the increasing needs of policy analysts and health researchers for data have resulted in more complex survey questions that place a high cognitive burden on respondents. New methods for improving the design of these questionnaires are needed. This project investigated whether new techniques of questionnaire design, adapted from the theories and methods of cognitive psychology, could be effectively used in interviewing older respondents. The techniques used in this study, concurrent think-aloud interviews with followup probe questions, have been shown recently to be effective with younger respondents. Problems that elderly respondents have in comprehending survey questions, retrieving relevant information from memory, and using decision processes to estimate and provide answers were investigated. Questions on functional ability and social support were taken from the 1984 Supplement on Aging to the National Health Interview Survey. Analysis of respondents' think-aloud protocols and responses to probes suggest that the cognitive interview procedures were effective in identifying problems with the survey questions that would result in data of poorer quality and in suggesting the wording of questions that would be likely to result in answers of greater validity and reliability. Implications of these results for survey design and validation studies are discussed.

Recall strategies and memory for health-care visits.

Complex questions in health surveys place heavy cognitive demands on respondents, prompting researchers to appraise how specific cognitive interventions may improve the accuracy of people's answers. Investigators in one experiment asked participants to recall visits to medical providers in forward, backward, or no particular order, and matched results with providers' records. "Free" recall proved marginally superior to forward or backward ordering, although overall respondents underreported the number of visits by 20 percent; participants' gender and self-reported health status, among other factors, also affected quality of recall. The experiment lends support to contentions that the methods of cognitive science applied to survey research better the accuracy of population survey data.

Induced vasodilation in the treatment of posttraumatic digital cold intolerance.

Induced vasodilation was used in 10 patients with posttraumatic cold intolerance. Eight of 10 patients improved. Before the treatment program and cold exposure, the injured digits were an average of 1.5 degrees C cooler than the control digits. After cold exposure, the mean temperature difference was 3.2 degrees C. At the conclusion of the study, the temperature differences between the injured and control digits were an average of 0.1 degree C before cold stress and 1.0 degree C after. Associated with this measured improvement was an improvement in cold tolerance. This was maintained 1 year later by 67% of the patients. One year after the completion of this study, nine patients were treated at home on a less controlled program with improvement in 67% of patients.

Comparison of behavioral treatments for Raynaud's disease.

Induced vasodilation by classical conditioning was compared to biofeedback therapy as treatment for idiopathic Raynaud's disease. Classical conditioning therapy consisted of 54 10-min immersions of both hands in water (43 degrees C) simultaneously with whole-body exposure to cold air (0 degrees C), given three times per day, 3 days per week, for 6 weeks. Biofeedback therapy consisted of eight sessions of electromyograph feedback (frontalis) while listening to relaxation tapes, followed by 10 sessions of digital thermal feedback while listening to relaxation tapes. Both groups received 10-min cold stress tests of whole-body exposure to 0 degrees C before and after treatments. Results indicated that both therapies significantly increased the digital temperature response to cold. Although no differences between classical conditioning and biofeedback were found at the end of training, a 1-year follow-up indicated that classical conditioning was more effective.

Induced vasodilation as a home treatment for Raynaud's disease.

Ten patients with Raynaud's disease treated themselves at home using induced vasodilation 3 times/day, every other day, for 18 treatment days. The patients, dressed in indoor clothing, immersed both hands in warm tap water (43-45 degrees C) for 8-10 min while exposed to naturally occurring ambient cold. Results of pre- and posttreatment cold exposures showed a significant mean increase in digital temperature of 3.4 degrees C (p less than .001). Conditioning therapy appears to be an effective, feasible alternative to drug or surgical therapy.

Comparison of the hunting reaction in normals and individuals with Raynaud's disease.

Cold-induced vasodilation (CIVD or hunting reaction) was studied in eight subjects with Raynaud's disease, an idiopathic vasospastic disorder of the peripheral vasculature, and in nine normal subjects using 5, 10, 15 +/- 1 degree C water bath immersions of the right middle finger. Differences between Raynaud's and normal subjects were only marginal at 5 degrees C; at 10 degrees C, Raynaud's subjects showed a longer time to the first rise of skin temperature, had lower mean digital skin temperature, and a lower amplitude of their digital skin temperature during CIVD; at 15 degrees C, Raynaud's subjects had a longer time to first rise, lower number of CIVD cycles, and a lower recovery temperature.

Risk taking as motivation for volunteering for a hazardous experiment.

Army male enlisted personnel were tested in two experiments to assess the psychological correlates of volunteering for a hazardous combat simulation, (Experiment 1) and a riskless, psychological experiment (Experiment 2). Subjects were given a biographical and personal habit questionnaire, the IPAT Anxiety Scale, Rotter's Locus of Control Scale, and Torrance and Ziller's life experience inventory. Results from Experiment 1 indicated that volunteers were significantly less anxious, and more willing to take risks than were nonvolunteers. Noncommissioned officers, smokers, laterborn children, and children of lower socioeconomic class parents were significantly overrepresented among the volunteers for this hazardous experiment. In Experiment 2, which solicited volunteers for a routine, nonhazardous experiment, the only variable to discriminate the volunteers from the nonvolunteers was mothers' education level. Results are in agreement with findings, using college students, that volunteer samples differ significantly from nonvolunteer samples, and that the characteristics that discriminate these two groups vary as a function of situational factors.

Induced vasodilation as treatment for Raynaud's disease.

We examined the efficacy of induced vasodilation as a treatment of idiopathic Raynaud's disease. Eight persons with Raynaud's disease and seven normal persons each received 27 simultaneous pairings of hand immersion in warm water (43 degrees C) for 10 minutes with exposure of the whole body to cold (0 degrees C). A second group of seven normal persons and nine persons with Raynaud's disease received no treatments. All subjects had cold test exposures (0 degrees C) at the start and end of the study. Subjects with Raynaud's disease who received treatments showed significant increases in digital temperatures (2.2 degrees C) during the cold test compared with the values of untreated subjects with Raynaud's disease (p less than 0.05); normal subjects who had received treatments showed no difference from those who had not. Digital temperatures of subjects with Raynaud's disease after treatment increased to levels approaching those of normal subjects, although they showed lower digital temperatures during initial exposure to cold (p less than 0.01). This therapy offers a practical alternative to traditional treatments.