Risky Business: Risk Perception and the Use of Medical Services among Customers of DTC Personal Genetic Testing

Direct-to-consumer genetic testing has generated speculation about how customers will interpret results and how these interpretations will influence healthcare use and behavior; however, few empirical data on these topics exist. We conducted an online survey of DTC customers of 23andMe, deCODEme, and Navigenics to begin to address these questions. Random samples of U.S. DTC customers were invited to participate. Survey topics included demographics, perceptions of two sample DTC results, and health behaviors following DTC testing. Of 3,167 DTC customers invited, 33% (n?=?1,048) completed the survey. Forty-three percent of respondents had sought additional information about a health condition tested; 28% had discussed their results with a healthcare professional; and 9% had followed up with additional lab tests. Sixteen percent of respondents had changed a medication or supplement regimen, and one-third said they were being more careful about their diet. Many of these health-related behaviors were significantly associated with responses to a question that asked how participants would perceive their colon cancer risk (as low, moderate, or high) if they received a test result showing an 11% lifetime risk, as compared to 5% risk in the general population. Respondents who would consider themselves to be at high risk for colon cancer were significantly more likely to have sought information about a disease (p?=?0.03), discussed results with a physician (p?=?0.05), changed their diet (p?=?0.02), and started exercising more (p?=?0.01). Participants’ personal health contexts—including personal and family history of disease and quality of self-perceived health—were also associated with health-related behaviors after testing. Subjective interpretations of genetic risk data and personal context appear to be related to health behaviors among DTC customers. Sharing DTC test results with healthcare professionals may add perceived utility to the tests.     

Fostering Mutual Understanding Among Muslims and Non-Muslims Through Counterstereotypical Information: An Educational versus Metacognitive Approach

Fostering interfaith tolerance may help to reduce religious tensions. The authors examined the attitudes of Christians, Muslims, and people with no religious affiliation toward different religions and explored whether their negative attitudes toward other faiths could be ameliorated. Participants (N = 298) were asked about their attitudes toward Judaism, Christianity, and Islam before they were randomly assigned to either a metacognitive intervention or an educational intervention. Information was conveyed in a simple narrative form in the educational condition. In the metacognitive condition, participants were first asked apparently simple questions that frequently elicited incorrect responses. This was followed by corrective information. Both Christian and Muslim participants appraised their own religion as the most peaceful and tolerant. The educational approach was more effective in reducing stereotypes about Islam among non-Muslims, whereas the metacognitive approach was more successful in lessening prejudice about Christianity among Muslims. Muslims displayed overconfidence in their responses related to religious topics.     

Fragility,uncertainty, and healthcare

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties.     

Ambiguity Aversion,Comparative Ignorance,and Decision Context

People typically find bets less attractive when the probability of receiving a prize is more vague or ambiguous (Ellsberg, 1961). According to Fox and Tversky's (1995) comparative ignorance hypothesis, ambiguity aversion is driven by the comparison with more familiar events or more knowledgeable individuals, and diminishes or disappears in the absence of such a comparison. In this paper we emphasize that “comparative ignorance” refers to the state of mind of the decision maker. We extend the comparative ignorance hypothesis by documenting four new ways in which decision context can affect willingness to act under uncertainty that do not rely on the comparative-noncomparative evaluation paradigm used in previous studies. First, people find uncertain bets more attractive when preceded by questions about less familiar items than when preceded by questions about more familiar items. Second, the preference to bet on more familiar domains is less pronounced for the first domain evaluated on a survey than for later domains. Third, people find bets less attractive when they are provided with diagnostic information that they do not know how to use, compared to when they are provided with no such information. Finally, people are sensitive to the relative competence of their counterpart when playing a simple competitive (matching pennies) game, but not when playing a noncompetitive (coordination) game that has the same mixed strategy Nash equilibrium.     

(Inadvertently) Instructing Missionaries in (Public University) World Religions Courses: Examining a Pedagogical Dilemma,its Dimensions,and a Course Section Solution

In this article, I explore an ethical and pedagogical dilemma that I encounter each semester in my world religions courses: namely, that a great number of students enroll in the courses as part of their missionary training programs, and come to class understanding successful learning to mean gathering enough information about the world's religious “traditions” so as to effectively seduce people out of them. How should we teach world religions – in public university religious studies courses – with this student constituency? What are/ought to be our student learning goals? What can and should we expect to accomplish? How can we maximize student learning, while also maintaining our disciplinary integrity? In response to these questions, I propose a world religions course module, the goal of which is for students to examine – as objects of inquiry – the lenses through which they understand religion(s). With a recognition of their own lenses, I argue, missionary students become more aware of the biases and presumptions about others that they bring to the table, and they learn to see the ways in which these presumptions inform what they see and know about others, and also what they do not so easily see.     

The Doubting Process: A Longitudinal Study of the Precipitants and Consequences of Religious Doubt in Older Adults

Religious doubt arises from a process in which there is a precipitant, the experience of doubt, a coping response, and a health-related outcome. We assess whether social factors precipitate doubt and the coping responses that are invoked to deal with doubt. We evaluate whether these coping responses are, in turn, associated with health. Over time, people who encounter more negative interaction with fellow congregants have more doubts about religion, whereas more spiritual support and greater involvement in prayer groups are associated with less religious doubt. People who encounter more negative interaction are more likely to suppress religious doubts, but people who attend Bible study groups are more likely to seek spiritual growth when faced with doubt. Suppressing religious doubt is associated with less favorable health, whereas seeking spiritual growth has no significant effect.     

Monitoring item and source information: Evidence for a negative generation effect in source memory

Item memory and source memory were assessed in a task that simulated a social conversation. Participants generated answers to questions or read statements presented by one of three sources (faces on a computer screen). Positive generation effects were observed for item memory. That is, participants remembered topics of conversation better if they were asked questions about the topics than if they simply read statements about topics. However, a negative generation effect occurred for source memory. That is, remembering the source of some information was disrupted if participants were required to answer questions pertaining to that information. These findings support the notion that item and source memory are mediated, as least in part, by different processes during encoding.     

Finding Their Place: Women and the Environment for Worship

Abstract

The history of the intersection between women and their worship-spaces is both simple and complex. This article begins to identify ways in which women have responded to restrictions on them in liturgical space and how they have interpreted that space. This task poses serious methodological challenges, identified here, and raises questions about ways in which women have found a place in and around church buildings during a history characterized by their restriction and exclusion. Using a variety of primary and secondary sources, women's action through patronage, fundraising and benefaction, in disobedience and disorder, is explored, together with ways in which women have exercised the natural authority of their religious gifts and experience, when their temporal authority wis limited and indeed have reinterpreted the meaning of the term ‘liturgical space’.     

Examining how people reason about controversial scientific topics

Improving scientific literacy requires examining both what people believe about scientific issues and why they hold those beliefs. We examined how people justified their agreement with statements regarding evolution, climate change, genetically modified foods, and vaccinations. Participants rated their level of agreement with statements reflecting the scientific consensus on these topics, then responded to open-ended questions asking them to justify their position and to generate challenges to their belief. Responses to individual difference measures allowed us to assess the relationship between participants’ positions on these scientific issues and cognitive style, conspiracy ideation, religious service attendance, and political ideology. Qualitative analyses revealed inconsistent and topic-specific patterns of reasoning. Additionally, greater agreement with scientific conclusions was related to a greater predisposition towards analytical thinking and stronger self-reported political liberalism. These findings provide a next step for better understanding why some individuals reject science and for developing more effective means of improving science acceptance.     

The impact of receiving a positive HIV antibody test: Factors associated with the response

In a recent interview study 265 gay men who were HIV postive were asked about their views and experiences of a whole range of health, social and voluntary services. Included in the interview were questions related to the experience of receiving a positive test result and their reaction to being given a diagnosis.The nature of people's reactions to being told they were positive were complex and in spite of making an intellectual adjustment, the reality of hearing the news was often quite different. There appear to be close parallels in the ways people react to hearing news about their HIV status and other disease categories. Satifaction with the way the result was communicated and the sufficiency of information available at different times were associated with the way people responded, as was how long people had to wait for their result once the blood had been taken.The process of HIV antibody testing provides and opportunity to identify possible interventions to promote adaptation to a stressful medical event.     

Exploring religious and/or spiritual identities: part 1 – assessing relationships with health

ABSTRACT

There is considerable debate about the distinction between being religious and being spiritual. It is time to move beyond this issue to an examination of the health-related implications of being religious and/or spiritual. Three health outcomes are used in this study: self-rated health, depressive symptoms, and alcohol use. The data are from a large nationwide random probability survey of adults of all ages who reside in the United States (N?=?2,876–2,883). Four self-identified categories of religiousness/spirituality are examined: religious and spiritual, spiritual only, not religious/not spiritual, and religious only. Tests are performed to see if membership in each category offsets the noxious effects of lifetime trauma on the health-related outcomes. A clear pattern emerges from the data. Lifetime trauma is associated with less favourable health ratings, more symptoms of depression, and greater alcohol consumption. However, these relationships are substantially stronger among people who say they are religious only.     

Online Primary Sources in Religious Studies: Active Learning Exercises for Information Literacy Instruction

Online primary sources are a valuable resource for undergraduate students in religious studies courses. They provide firsthand, factual information about the beliefs and practices of religious traditions, movements, cults, and so on. In addition, they are readily and freely accessible online. Given their value as an information resource, undergraduate students need to be able to identify primary sources and understand how to use them in academic research. The purpose of this article is to describe activities for information literacy instruction that focus on primary sources in religious studies. These activities are intended as a resource for academic librarians who are teaching—or who plan to teach—undergraduate students how to identify and use primary sources.     

How internet users find, evaluate, and use online health information: a cross-cultural review.

The Internet has become a favored source to find health information. Worldwide, about 4.5% of all Internet searches are for health-related information. However, research has found that the quality of online health information is mixed, which raises serious concerns about the impact of this information. This paper reviews relevant research to understand how health information on the Internet is retrieved, evaluated, and used. Most users of online health information are looking for information about specific health conditions because they or someone they know was diagnosed with a medical condition. They typically use general search engines to find online health information and enter short phrases, often misspelled. They seldom go beyond the first page of a search. Both their search and evaluation skills are limited although they are concerned about the quality of online health information. They avoid sites with overt commercialism, but often do not pay attention to indicators of credibility. Online health information is used to fill an information void which can enhance coping and self efficacy, affects health-related decisions and behavior of users and their friends and family, and is often discussed with health care providers. There are cross-cultural differences in the types of sites used as well as how online information is used. Based on the research reviewed in this paper, three major recommendations are suggested. Professionals should recommend sites. Professionals should promote more effective search and evaluation techniques. Professionals should be involved in developing and promoting uniform standards for health and mental health sites.     

Anonymous Pastoral Care for Problems Pertaining to Sexuality

Anonymous pastoral care is one of the options for help in problems pertaining to sexuality. This paper explores the topics they seek help for, the religious aspects involved, and the relation between the normativity of their church tradition on the one hand and sexual and spiritual health criteria on the other. We analyzed helpseeking questions of two protestant Christian organizations in the Netherlands providing anonymous pastoral care: Refoweb and EO-Nazorg. Sexual themes were addressed in 19 and 2.3 % of the submitted questions, respectively. Of the helpseekers, 56 % is female, 15 % male, and 29 % unknown. Questions and problems for which people seek anonymous pastoral care focus primarily on premarital abstinence, gender roles, contraception, sexual orientation and masturbation. The authority of the Bible seems to be important for questioners, especially when dealing with ethical questions. Different relations between the normativity of the church tradition and sexual and spiritual health are discussed.     

Overcoming the “Holy Hush”: A Qualitative Examination of Protestant Christian Leaders’ Responses to Intimate Partner Violence

Described as a “holy hush,” past research has noted a general silence about and reluctance to address intimate partner violence (IPV) in religious congregations. To explore this, we interviewed 20 Protestant Christian religious leaders about how they understood and responded to IPV. Based on a thematic content analysis, our study revealed some of the challenges, tensions, and complexities that may be barriers to leaders speaking about and responding to IPV, and also the ways religious leaders in our sample attempted to overcome these challenges. For example, results revealed religious leaders understood violence on a gradation from less to more severe, and linked a need for and type of response to the level of violence. Throughout, religious leaders expressed a tension between their leadership role and responding to IPV. Furthermore, religious leaders acknowledged their need for greater training and connections to service providers, however, they reported not currently being connected to other IPV resources or organizations in the community. We discuss how the findings illuminate challenges and tensions for religious leaders in responding to IPV and how some leaders in this study were navigating these tensions to respond. We also discuss how findings may inform future research and the development of trainings and protocols for religious leaders and congregations on responding to IPV, promoting survivor safety, and fostering a greater understanding of IPV. Implications for collaboration with other community‐based IPV organizations are also discussed.     

Being Religious: Working at Self-Maintenance and Self-Transformation

We see religion in the things people treat as crucial to what they are and to what they aspire to become, things that make the biggest difference in how people feel about themselves. They may be social aspects or personal (behavioral or characterological) aspects of the self. The things people are militant about, the practices in regard to which they are most scrupulous, and the things about themselves that distress them are indicators of where their religious concerns lie, whatever the subject matter. People work to maintain themselves as they want to see themselves and as they want others to see them; they seek ways to repair damage to their selves. They seek also to transform themselves so as to escape present unhappy definitions of self and to achieve ideal states of being. What needs to be changed may be perceived as aspects of personal self, as attitudes other people have toward otherwise unchangeable aspects of self, or as the entire socio-political system in which people feel trapped. The process by which people manage successfully to transform themselves includes social cooperation, including the formation of groups to provide mutual reinforcement.     

Religion and Decisions About Marriage,Residence, Occupation,and Children

Using data from the first wave of the Portraits of American Life Study (PALS), we consider the extent to which people report that religious factors influence their decisions about career choice, marriage, residency, and number of children. We find significant positive relationships between the importance of religion or religious faith and the perceived influence of religious factors on one's choice of occupation, decision about whether or whom to marry, decision about where to live, and decision about how many children to have. We also observe significant interactions between the importance of religion or religious faith and religious tradition, but we find no consistent patterns across our decision‐making outcomes. Our preliminary conclusions raise significant questions about the broader relationship between religion, perception, and decision making.     

Examining Explanatory Biases in Young Children's Biological Reasoning

Despite the well-established literature on explanation in early childhood, little is known about what constrains children's explanations. State change and negative outcomes were examined as potential explanatory biases in the domain of naïve biology, extending upon previous work in the domain of naïve physics. In two studies, preschool children (N = 70, 3- to 5-year-olds) were informed of the distinct health outcomes of characters in four between-subjects conditions (i.e., becoming ill, recovering from illness, continuous health, and continuous illness) and were asked to provide explanations. Whereas children in both studies provided relevant information for health outcomes, they more often explained outcomes that included a salient health-state change. Presence of a state change also influenced the interpretation of potentially relevant information and improved memory for health outcomes. We discuss how biases in children's explanations constrain children's reasoning and may exacerbate difficulties with reasoning about important health-related topics such as illness prevention.     

Discussing Adolescent Sexual Health in African-American Churches

This study describes the ways in which two African-American churches discuss adolescent sexual health topics. Six focus groups were conducted in two churches in Flint, Michigan, that reported no formal sexual health programming for their congregants. Three themes emerged to highlight the different perspectives about the role of churches in adolescent sexual decision-making and sexual health education: (1) churches as sources of sexual information, (2) churches as complex communities, and (3) recommendations for sexual education in churches. Participant responses suggest that churches can and should serve a resource for sexual health information. Implications for practice and research are discussed.