Risk perceptions,worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer.

This longitudinal study examined predictors of mammography use among women with a family history of breast cancer participating in a risk assessment and surveillance program (N = 213). Assessed were background variables (age, prior mammography utilization), cognitive variables (perceived vulnerability), and affective variables (cancer worry and general distress). Results of logistic regression analyses predicting adherence 1 year after baseline contact, in which variables of prior utilization, feelings of vulnerability, and general distress were controlled for, indicated that cancer worry and age were significant predictors of mammography adherence. Results suggest that moderate levels of cancer worry facilitate, rather than undermine, adherence. The results have implications for the construction of educational messages that should be designed to acknowledge feelings of cancer-specific worry and to provide guidance in health protective behaviors.     

Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women.

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry.     

Angry adolescents who worry about becoming violent

In the present study, 31 of 89 adolescents responded affirmatively to the following statement: "Sometimes I get so angry that I worry I will become violent." These adolescents (the anger group) were compared with the nonanger group, and several differences were found. The anger group (1) reported less intimacy with parents, received less support from them, and was less close to siblings; (2) had more opposite-sex friends, dated more frequently, and more frequently had a boyfriend or girlfriend; (3) had a lower grade point average; (4) were more depressed; and (5) used marijuana more frequently. Results of a regression analysis revealed that depression and dating were the only significant predictors of anger, explaining 17% of the variance.     

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.     

The moderating role of positive beliefs about worry in the relationship between stressful events and worry

Some theorists suggest that worry is elevated by positive beliefs when stressful events occur. Although several cross-sectional studies have revealed an association between positive beliefs and worry, few longitudinal studies have been conducted on this topic. Moreover, the effect of positive beliefs as a moderator on worry when stressful events occur has not been investigated. Against this background, the present study conducted a two-wave longitudinal survey to examine the moderating role of positive beliefs. One hundred and ninety-four college students voluntarily completed questionnaires. Hierarchical regression analysis showed a prospective relationship between the experience of stressful events and the subjective report of worry. Moreover, this relationship was moderated by an interaction with positive beliefs; stressful events were a stronger predictor of the extent of worry for individuals with a high level of positive beliefs than for those with a low level of positive beliefs. The moderating role of positive beliefs suggests that the level of positive beliefs amplifies the threat of worry caused by stressful events.     

Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer

The relationship between worry about cancer and judged cancer risk was examined among 54 expatients who had been cured of breast cancer and 81 women with no history of cancer. Worry required both a perception of substantial risk and the presence of concrete perceptual cues. Worry promoters include visits to a physician and concrete, noncancerlike symptoms (e.g., fever, pain). Supporting analyses indicate that the symptom effects are not due to self-report biases or attributions of symptoms to cancer but are the result of a reminder process whereby vulnerability beliefs are aroused by somatic cues. Judged cancer risk was unrelated to affective cues, suggesting that across-time variation in worry about cancer reflects the onset and offset of symptom episodes rather than a shift in risk appraisals. Expatients were more worried overall than nonpatient controls. The results have implications for controlling disease worry and initiating preventive behaviors.     

Content externalism and phenomenal character: a new worry about privileged access

Some philosophers argue that the thesis of content externalism, according to which the contents of a subject’s thoughts are in part individuated by environmental factors, threatens the standard idea that a subject can know the contents of her thoughts without empirical investigation. It is typically assumed, however, that this thesis does not threaten another common idea about privileged access: that a subject can know the phenomenal character of her experience–its “what it’s like” aspect–without empirical investigation. That is, even if content externalism is true and does imply that a subject cannot know without empirical investigation the contents of some of her thoughts (e.g., her thoughts about water), surely she can know without empirical investigation what it’s like for her to be having whatever experience she is having. I argue that if content externalism threatens privileged access to content (I do not discuss whether it does), then it also threatens privileged access to phenomenal character. My argument does not involve claiming that phenomenal character is itself externally individuated. Rather, it depends on two other claims: (1) that introspective access to phenomenal character is conceptual; and (2) that standard arguments for content externalism suggest that some phenomenal concepts are externally individuated.     

Attributions, beliefs about control, and adjustment to breast cancer

Attributions for cancer and beliefs about control over cancer were examined for their association with adjustment to breast cancer. Although 95% of the respondents made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming another person. In contrast, both the belief that one could now control one's cancer and the belief that others (e.g. the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. The theoretical and practical implications of these results are discussed.     

Effects of counseling Ashkenazi Jewish women about breast cancer risk

The goal of this study was to determine whether genetic counseling or psychosocial group counseling provided to Ashkenazi women can reduce breast cancer worry, cancer risk perception, and interest in having genetic testing. Women (N=211) were randomized to receive individual genetic risk counseling, to receive a group psychosocial group counseling, or to serve as a control group. The authors found that both counseling methods reduced cancer worry, lowered perceptions of breast cancer risk, and decreased interest in having genetic testing. Counseling can help women gain a more accurate perception of their risk, expose them to the benefits and limitations of genetic testing, and reduce their worry about cancer.     

Positive beliefs about worry: A psychometric evaluation of the Why Worry-II

Positive beliefs about worry are theorized to maintain excessive and uncontrollable worry, the hallmark of generalized anxiety disorder (GAD; American Psychiatric Association, 2013). The Why Worry-II (WW-II) is a 25-item revised questionnaire designed to measure five positive beliefs about worry. These five beliefs are that worry: (1) facilitates problem solving; (2) enhances motivation; (3) protects against negative emotions; (4) prevents negative outcomes; and (5) reflects a positive personality trait. The main goal of this study was to assess the WW-II’s psychometric properties, including its factor structure. Undergraduate participants (N = 309) completed the WW-II, and measures of worry, depression, anxiety, and positive and negative beliefs about worry. Overall, the results suggest that the five-factor model is a good fit to the data. The WW-II demonstrated excellent internal consistency, good test–retest reliability at six weeks, and evidence of convergent and divergent validity. The WW-II also uniquely predicted worry severity. Overall, our findings suggest that the WW-II has a five-factor structure congruent with theoretical predictions, sound psychometric properties, and a unique relationship to excessive worry. The theoretical and clinical implications of these findings are discussed.     

Explaining the effects of a decision intervention on mammography intentions: The roles of worry,fear and perceived susceptibility to breast cancer

Objective: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions.

Design: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35–49.

Main Outcome Measures: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions.

Results: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions.

Conclusion: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.     

Beliefs about female and male nonverbal communication

Participants (N= 441) rated from 1 to 10 how frequently or well they believed hypothetical women and men performed each of twenty nonverbal behaviors or skills. Women were believed to use more expressive and involved nonverbal behaviors than men, and to be more skilled at sending and receiving nonverbal messages. Men were believed to be louder and more interruptive, and to display more nervous, dysfluent behaviors. Ratings given to females by females were higher than were ratings in the other gender combinations for over half the variables, which may accurately describe female—female interaction. Perceived gender differences correlated positively with differences reported in observational studies, indicating that beliefs about nonverbal gender differences were generally accurate. The authors wish to thank Tom Leahy for his assistance in data collection.     

Adolescents' communication styles and learning about birth control

Adolescents have different communication styles for acquiring information about birth control from a mass medium--interactant or noninteractant, depending on whether they involve communication with others in the process of media use. Three interactant styles are identified: a home-oriented style, where communication is primarily with immediate members and friends; a peer-oriented style, where communication is primarily with own-age peers and personal friends; and multi-source user, where communication is with more than one cluster of sources and the majority of one's communication is not with any particular source. The noninteractant style identified is a media-oriented style, where the adolescent relies exclusively on the mass media for information acquisition without communicating with anyone about the content or process of learning. Data suggest that the interactant style, especially for the multi-source user, is most beneficial for new learning. Gender and the presence of siblings at home are important moderators of the relationship between communication styles and knowledge of birth control. For example, females with a media-oriented style know more about birth control than females with a home-oriented style. Implications of the findings for the delivery of birth control information to adolescents are discussed.     

Improving comprehension and communication of risks about health

Many patients have severe difficulties grasping several numerical concepts that are related to their health, such as, for instance, the risk of suffering various diseases. Visual aids have been proposed as a promising method for enhancing risk communication and comprehension. In medical practice, however, not all patients benefit from visual aids. In a study conducted on a probabilistic, representative national sample in the United States, we identified a group of patients for whom visual aids are most useful: Those who have low numeracy but high graphical literacy skills. These patients have high scores in three abilities involved in graph comprehension: (1) the ability to read the data, (2) the ability to read the relations between the data, and (3) the ability to read beyond the data. Our results can have important implications for medical practice and for risk communication about health.