Psychological side effects of breast cancer screening

Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.     

Determinants of Mammography Intentions Among Prior Screenees and Nonscreenees1

This study examined whether the factors influencing a woman's intention to get a mammogram differ between women who have had mammograms in the past (prior screenees) and those who have not (nonscreenees). Responses to a survey were used to predict mammography intentions separately for two groups of women: those with no previous mammograms and those with one. Among the prior nonscreenees, the variables we examined accounted for nearly half the variance in intentions; among the prior screenees, only one-sixth of the variance was accounted for. This suggests that interventions that succeed in increasing mammography utilization among prior nonscreenees may not necessarily be successful among prior screenees.     

The role of causal models in multiple judgments under uncertainty

Two studies examined a novel prediction of the causal Bayes net approach to judgments under uncertainty, namely that causal knowledge affects the interpretation of statistical evidence obtained over multiple observations. Participants estimated the conditional probability of an uncertain event (breast cancer) given information about the base rate, hit rate (probability of a positive mammogram given cancer) and false positive rate (probability of a positive mammogram in the absence of cancer). Conditional probability estimates were made after observing one or two positive mammograms. Participants exhibited a causal stability effect: there was a smaller increase in estimates of the probability of cancer over multiple positive mammograms when a causal explanation of false positives was provided. This was the case when the judgments were made by different participants (Experiment 1) or by the same participants (Experiment 2). These results show that identical patterns of observed events can lead to different estimates of event probability depending on beliefs about the generative causes of the observations.     

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women’s mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women’s mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.     

Mammograms and the management of existential discomfort: Threats associated with the physicality of the body and neuroticism

The current research employs ideas from terror management theory to investigate why mammograms may be psychologically problematic. This perspective suggests that individuals, particularly those high in neuroticism, are threatened by that which reminds them of their physical and mortal nature. In Study 1, a laboratory experiment demonstrated that when concerns about mortality were primed, reminders of one's physical nature (i.e. creatureliness) led women who were high in neuroticism to report reduced willingness to imagine undergoing a mammogram. In Study 2, a field experiment among women receiving a mammogram showed that priming creatureliness increased perceptions of discomfort with the procedure for women high in neuroticism. Theoretical and practical implications are discussed.     

The Impact of Breast Cancer Knowledge and Attitudes on Screening and Early Detection Among an Immigrant Iranian Population in Southern California

Few studies explored factors influencing breast cancer screening and early detection behaviors among immigrant Iranian women residing in the USA. Using a cross-sectional survey, a convenience sample of 319 Iranian American women was selected to investigate the impact of breast cancer knowledge and attitude on screening. A self-administered questionnaire assessed breast cancer screening knowledge, attitude, and mammography use (ever, previous year, and future intention). 79 % of the women in the study reported ever receiving at least one mammogram and 74 % received a mammogram in the past year. Personal attitude had an independent significant effect on: mammography use in the last year, ever use of mammography, and future intention to screen. Knowledge and morality-induced attitude influenced screening behavior but not significantly. Interventions targeting breast cancer screening among immigrant Iranian women in the USA should focus on enhancing personal attitudes in order to influence actual screening behavior.     

Religious Attendance, Health Maintenance Beliefs, and Mammography Utilization: Findings from a Nationwide Survey of Presbyterian Women

Preventive health services, such as mammography, play an increasingly important role in maintaining women's health. Social factors, such as religion, may influence utilization rates by expanding access, offering information, and increasing motivation. The current study examines the relationship between religious involvement, religious beliefs, and mammography usage in a nationally representative sample of Presbyterian women ( N = 1,070). We use multivariate logistic regression models to estimate the influence of religious service attendance and two health-related religious beliefs on self-reported mammography use. The findings show that religious attendance is significantly associated with mammogram use. Women who attend services nearly every week are almost twice as likely to use mammograms compared to women who attend services less frequently or never. Furthermore, the belief that spiritual health is related to physical health is also associated with the use of mammograms.     

Fatigue and Quality of Life Following Radiotherapy for Breast Cancer: A Comparative Study

Clinical reports suggest that fatigue is a common and disruptive long-term side effect of radiotherapy; however, there has been little systematic attention given to this phenomenon. The primary aim of this study was to assess fatigue its impact on quality of life in women who had completed radiotherapy for breast cancer. A key feature of this study was the inclusion of a comparison group of women of similar age with no history of cancer. The results indicated that the fatigue experienced by women after radiotherapy for breast cancer was not significantly different in intensity, duration, or disruptiveness from fatigue experienced by healthy women. In addition, radiotherapy recipients reported a quality of life similar to that of the healthy women. For both groups of women greater fatigue was related to a poorer quality of life. These findings suggest that following radiotherapy for breast cancer, women can expect to experience fatigue which is not worse than what they might normally experience. This information may be a useful part of psychoeducational interventions designed for women scheduled to begin radiotherapy for breast cancer.     

The state of motherhood among professional women

Faculty women at Northwestern University were studied. The focus was on their rate of childlessness and attitude toward having children. The 151 subjects were classified into two age groups: women of childbearing age — under 40 — and women much less likely to have children — 40 and over. Although women ever married in the professional sample had a higher rate of childlessness than women ever married in the general population in all age groups, there seemed to be a trend toward permanent childlessness among younger professional women: Their rate of childlessness (67%) is much higher than that of the older professionals (22%) or the younger women in the general population. Based on additional qualitative and quantitative data, a possible explanation for the younger professional women's behavior seems to be that they are not confident that they can successfully combine motherhood and career. Possible implications of this phenomenon are discussed.     

The effects of message framing and ethnic targeting on mammography use among low-income women.

The authors examined the effects that differently framed and targeted health messages have on persuading low-income women to obtain screening mammograms. The authors recruited 752 women over 40 years of age from community health clinics and public housing developments and assigned the women randomly to view videos that were either gain or loss framed and either targeted specifically to their ethnic groups or multicultural. Loss-framed, multicultural messages were most persuasive. The advantage of loss-framed, multicultural messages was especially apparent for Anglo women and Latinas but not for African American women. These effects were stronger after 6 months than after 12 months.     

Determination from Above

There are many historical concerns about freedom that have come to be deemphasized in the free will literature itself—for instance, worries around the tyranny of government or the alienation of capitalism. It is hard to see how the current free will literature respects these, or indeed how they could even find expression. This paper seeks to show how these and other concerns can be reintegrated into the debate by appealing to a levels ontology. Recently, Christian List and others have considered how the notion of levels could be relevant to the free will debate. Invariably, however, the focus is on the significance of facts at lower levels. The threats come from below, from fundamental physics or neuroscience. Here, I aim to show how we can frame many interesting concerns about free will in terms of threats from above. After arguing that determination from above is no less threatening, I catalogue such concerns that might constitute threats to our freedom. Doing this not only allows us to show how these concerns relate to those standardly discussed, but it pushes us to expand our conception of freedom.     

A study of satisfactions and stresses of single women in midlife

Sixty single women 35 to 65 years old, previously married or never married, were interviewed about the satisfactions and stresses of the single status. Respondents were categorized as having high, medium, or low life satisfaction. Life satisfaction was found to be significantly correlated to such factors as good health, not being lonely, living with a female housemate, having many casual friends, and being invested in work. Half the women mentioned having sexual needs, which were or were not fulfilled. The other half stated that they did not have sexual needs. These two groups did not differ in life satisfaction. Regrets about not having had children occurred in one-quarter of the childless women, without necessarily implying low life satisfaction. Only 15% of the entire sample had low life satisfaction, a percentage similar to that found in the general population.The authors wish to express sincere appreciation to George Loewenstein for his aid with the computer analysis of the data.     

Priming Effects and Free Will

Abstract

I argue that the empirical literature on priming effects does not warrant nor suggest the conclusion, drawn by prominent psychologists such as J. A. Bargh, that we have no free will or less free will than we might think. I focus on a particular experiment by Bargh – the ‘elderly’ stereotype case in which subjects that have been primed with words that remind them of the stereotype of the elderly walk on average slower out of the experiment’s room than control subjects – and I show that we cannot say that subjects cannot help walking slower or that they are not free in doing do. I then illustrate how these cases can be reconciled and normalized within a Davidsonian theory of action to show that, in walking slower, subjects are acting intentionally. My argument applies across various experiments, including those of goal priming. In the final section I argue that the only cases in which priming effects are efficacious are so-called Buridan cases.     

Body on My Mind: The Lingering Effect of State Self-objectification

Objectification theory explicates a model in which women are socialized to view their own bodies as objects to be evaluated. In the current study, we used a 2 (self-objectification condition: swimsuit versus sweater)?×?2 (gender) factorial design to examine whether body-related thoughts continued after women were removed from a self-objectifying situation. Results showed that, compared to participants in the other three groups, women in the self-objectification condition listed more body-related thoughts during a free response task given after they had re-dressed. The amount of shame experienced during self-objectification mediated the relationship between self-objectification condition and lingering body-related thoughts. This study adds to the understanding of how the process of self-objectification works to maintain women’s focus on their appearance.     

Breast Cancer Risk Assessment at the Time of Screening Mammography: Perceptions and Clinical Management Outcomes for Women at High Risk

The purpose of this study was to evaluate the utility of a breast cancer risk assessment (BCRA) at the time of screening mammogram. Women whose BCRA indicated a high risk for cancer received a letter with instructions for breast health care and genetic counseling if appropriate. After 6 months this group received surveys to evaluate their risk perception and their recall of, and compliance with, recommendations. We also explored the impact of other variables such as a recommendation for genetic counseling and physician communication with the women. After the BCRA, the majority of high risk women reported no change in their perceived risk of cancer. A woman’s perceived risk of cancer after a BCRA was significantly associated with her recall of recommendations for breast health care, but not with compliance. A recommendation for genetic counseling was not significantly related to women’s perceived risk of cancer after the BCRA. Ten percent of women who should have obtained genetic counseling actually completed an appointment. Women who discussed their BCRA results with their physicians were more compliant with a six month breast exam with a doctor (53% vs 17%, p = 0.018). Overall, women felt that the BCRA was helpful and did not cause undue stress or anxiety. Although the cohort’s compliance with recommendations was suboptimal, physicians’ interactions with their patients may have a positive influence on their compliance.     

Trust or Distrust Toward Healthcare Services: Breast Screening in the North and South of Italy

This article follows a previous study that has recently been published in Narrare I Gruppi and explored the reasons for the large numeric gap between the regions of the North and South of Italy, referring to the breast cancer screening program adherence rate sponsored by the Italian Healthcare System, that addresses all women living in Italy ranging in age between 48 and 69 years, and proposes a free mammogram every two years. The effectiveness of cancer early detections has been widely demonstrated by medical research; this kind of diagnosis is particularly important in the case of breast cancer. A diagnosis of this form of cancer at its early phases in 97% of cases allows women to survive at least five years after it. However, the different level of trust women feel for healthcare structures is the discriminating element between the North and South of Italy for their access to the screening program. This topic will be thoroughly analyzed by presenting the results of research aimed at evaluating the meaning given to the outcomes of a first exploratory study, this second study also offers the opportunity to share our results within the social context that has generated them. The outcomes of the present research have been presented to a group of “privileged witnesses” living in the South (Naples and its surroundings): 12 women aging from 49 to 65, and 5 healthcare workers (one doctor, 25 two nurses, and two Local Health Authority supervisors); they took part in three Focus Groups for an in-depth look of the theme in question. The analyses of the groups' debates, carried out by means of a software for text analysis (T-LAB), confirmed the results of the previous research: the diffidence and lack of synergy between institutions and healthcare workers are the causes of southern women's lack of participation to the breast cancer screening program. In particular, the comparison between women's and workers' viewpoints shows a different emotional connotation about the possibility to improve participation to the screening: the workers' optimism countervails women's distrust and pessimism.     

Distress, personality, and mammography utilization among women with a family history of breast cancer.

The authors examined the impact of psychological distress and the personality construct of conscientiousness (as measured by the Neuroticism, Extraversion, and Openness-Five Factor Inventory) on mammography utilization among women who were at increased risk for breast cancer. Participants were 200 women who had at least 1 first degree relative with breast cancer. Overall, 80% of the participants had obtained a mammogram in the previous year. Analyses controlling for potential confounders (perceived risk, decisional balance, and physician recommendation for mammography), revealed that distress was negatively associated with mammography utilization among participants who were low in conscientiousness. Distress was not significantly related to mammography utilization among highly conscientious women. The results are discussed in terms of their implications regarding interventions designed to increase mammography utilization in this population.     

Epistemic issues in the free will debate: can we know when we are free?

In this paper, I argue that the views of Robert Kane on the one hand and John Fischer and Mark Ravizza on the other both lead to the following conclusion: we should have very low confidence in our ability to judge that someone is acting freely or in a way for which they can be held responsible. This in turn means, I claim, that these views, in practice, collapse into a sort of hard incompatibilist position, or the position of a free will denier. That would at least be an unintended consequence, and it might be regarded as a virtual reductio. Versions of the objection could likely be made against a number of other accounts of free will, but I will limit my focus to Kane and Fischer. Along the way, by way of response to some possible objections to my argument, I make some comments about epistemic closure principles.     

“Social Separation” Among Women Under 40 Years of Age Diagnosed with Breast Cancer and Carrying a BRCA1 or BRCA2 Mutation

We conducted an exploratory, qualitative study investigating experiences of women who had developed breast cancer under the age of 40 and who were identified as BRCA1 or BRCA2 mutation carriers. These germline mutation carriers face an increased lifetime risk of a second primary breast cancer and an increased risk for a primary ovarian cancer. Thirteen women who fit this criteria participated in three focus groups conducted at a major cancer center in the UK during Spring 2003. We asked broad, open-ended questions that allowed for a wide range of responses about their cancer and genetic testing experiences, physical and psycho-social concerns, family and partner reactions and their need for social support. The women expressed feelings of devastation, loneliness, feeling different and isolation, ambivalence about having to support family members, worries about partner’s anxiety and depression, and anxiety about talking to family members, especially children. These feelings were stronger after the cancer diagnosis and compounded by the genetic test results that occurred at a later time. We also found that, at least temporarily, the women experienced what we call “social separation”—emotional distance from, or dissonance with groups they interact with or are part of, e.g., family and friends, frequently leading to a reduction in communication or a change in previously unstated, but accepted normal interaction. We concentrate on a few characteristics of social separation—feelings of aloneness, isolation and separation, use of silence and verbal discretion, the relationship between estrangement and kinship interaction and norm disruption, and are looking at social patterns of interpersonal relationships that may occur when risk and illness statuses are new and framing and feeling rules have not as yet been clearly developed due to a cultural lag.     

Restaurant Tipping: Free‐Riding,Social Acceptance,and Gender Differences1

The practice of paying gratuities for services is a worldwide custom. Tipping is found only in some professions, which suggests that it serves to increase the efficiency of specific kinds of exchanges. The literature accepts the view that monitoring of employees by customers appears to be the logical rationale for the practice of tipping. This can be seen in that gratuities are paid at the discretion of consumers after they receive the services for which they are paying. However, it does not explain why, given the voluntary aspect of tipping, rational people would not free‐ride on the tipping of others. We found that both men and women free‐ride in their tipping behavior. Yet, we also found that men are more influenced by social acceptance or approval in their tipping behavior than are women.