Equipoise and the Criteria for Reasonable Action

Critics of clinical equipoise have long argued that it represents an overly permissive, and therefore morally unacceptable, mechanism for resolving the tensions inherent in clinical research. In particular, the equipoise requirement is often attacked on the grounds that it is not sufficiently responsive to the interests of individual patients. In this paper, we outline a view of equipoise that not only withstands a stronger version of this objection, which was recently articulated by Deborah Hellman, but also plays important roles in clarifying the discussion.     

Depression and substance use in two divergent high school cultures: A quantitative and qualitative analysis

Research has generally concluded that adolescent depression and substance use are strongly interrelated, but has rarely considered how this relationship may vary across diverse populations. In this study, we used quantitative and qualitative methods to explore the relationships among depression and cigarette, alcohol, marijuana, and harder drug use across two culturally disparate environments: a suburban and an inner-city high school. Our sample included 164 suburban and 242 inner-city high school students. The students completed Kovacs' Children's Depression Inventory of 1985 and substance use measures derived from various sources. In-depth semistructured interviews were conducted with subjects who scored in the top 10% of the CDI (N=19) from both schools. Our quantitative findings indicated a positive association between depression and cigarette, marijuana, and harder drug use among the suburban students, and no association between depression and the use of any substances for the urban students. There were no significant differences in levels of reported depression across samples. However, with the exception of marijuana use, suburban students reported greater involvement in substance use than urban students. Our qualitative analyses suggest that across-school differences in the relationships among depression and substance use may be related to the varied meanings of depression and substance use that are informed by cultural context.The research was funded by the National Institute of Drug Abuse (NIDA), Grant No. 1 R01 DA-06844, Perry London, principal investigator. The views, opinions, and findings contained in their article are not to be construed as NIDA's position or policy.B.A. from University of California, Berkeley, and Ed.D. from the Graduate School of Education, Harvard University. Research interests include the phenomenology of high-risk behavior and social development among urban adolescents.B.A. from Mount Holyoke College and Ed.M. from the Graduate School of Education, Harvard University. Research interests include the relationships among high-risk behavior, personality variables, and cultural context.B.A. from Michigan State University, M.A. from University of Minnesota-Duluth, and Ed.D. from Harvard Graduate School of Education. Research interests include integrating quantitative and qualitative methods in social science research and the phenomenology of high-risk behavior.Research interests included adolescent high-risk behavior and ethnic and religious identity development. Deceased June 1992.     

Do Debt Policies Make a Difference in Finance Officers' Perceptions of the Importance of Debt Management Factors?

This article explores the importance of various debt policy factors using a national survey of government finance officers. Further, it examines whether the presence of a particular factor in a debt policy influences finance officers' perception of its importance. We find that debt policies tend to be technical in nature and that broad policy issues are most often not included in debt policies. Moreover, we find that the inclusion of debt management factors in debt policies has a powerful influence on their perceived importance by public managers.     

The interaction between single mothers' living arrangements and welfare participation

This article examines the interaction between single mothers' living arrangements and their welfare participation, taking into account the endogeneity embedded in the two decisions. Using data from the 1990 Survey of Income and Program Participation, I estimate a two‐stage instrumental variables model and simulate the effects of partial‐ and full‐family benefit reductions on both the distribution of living arrangements and the rate of welfare participation. Tabulations show that 62 percent of single mothers live independently, 16 percent live in the home of their parents, 12 percent cohabit with an unrelated man, and 11 percent share with others. Reductions in combined AFDC and food stamp benefits increase mothers' probability of living with their parents relative to living independently, cohabiting, or sharing with others. Benefit reductions also decrease the probability of welfare receipt. The resulting drop in the participation rate is even more pronounced once the simultaneous effect on the distribution of living arrangements is taken into account. The implication of these findings is that policies aimed at reducing welfare caseloads may have the unanticipated effect of shifting families' living arrangements, potentially confounding the impacts of policy changes in either positive or negative ways. © 2000 by the Association for Public Policy Analysis and Management.     

Ethical Considerations in the Conduct of Electronic Surveillance Research

The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more cost-effective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights.