Awareness,Perceptions, and Provider Recommendation Related to Genetic Testing for Hereditary Breast Cancer Risk among At-Risk Hispanic Women: Similarities and Variations by Sub-Ethnicity

This study explored awareness of risk factors for hereditary breast and ovarian cancer (HBOC), awareness, knowledge and concerns about genetic testing, and preference for how to have genetic testing recommended by a care provider among at-risk Hispanic women. Differences in these factors among Mexican, Cuban, and Puerto Rican women were also examined. Women with a personal or family history of breast or ovarian cancer from the Tampa Bay Area participated in a qualitative interview (N = 53). Data were analyzed using a combination of open and axial coding with a grounded theory approach. Study participants in all groups reported: being aware that family history was a breast cancer risk factor, limited knowledge of genetic testing, fear of test results, concerns about children’s risks, and no physician referral for genetic testing. Noteworthy sub-ethnic differences included preferences for physician recommendation and information about genetic testing. This study provides important preliminary information about areas related to HBOC that require additional education in the Hispanic community as a whole and by sub-ethnicity.     

Unpacking the Blockers: Understanding Perceptions and Social Constraints of Health Communication in Hereditary Breast Ovarian Cancer (HBOC) Susceptibility Families

Family communication is essential for accurate cancer risk assessment and counseling; family blockers play a role in this communication process. This qualitative analysis of social exchanges is an extension of earlier work characterizing those who are perceived by study participants as health information gatherers, disseminators, and blockers within families with Hereditary Breast and Ovarian Cancer (HBOC) susceptibility. Eighty-nine women, ages 23–56 years, enrolled in a Breast Imaging Study (BIS) and participated in a sub-study utilizing a social assessment tool known as the Colored Ecological Genetic Relational Map (CEGRM). Purposive sampling ensured that participants varied according to numbers of participating family members e.g., ranging from 1 to 6. Eighty-nine women from 42 families (1–8 relatives/family) participated. They collectively designated 65 blockers, both male and female. Situational factors, beliefs, attitudes and cultural traditions, privacy and protectiveness comprised perceived reasons for blocking intra-family health communications. Longitudinal data collected over 4 years showed families where blocking behavior was universally recognized and stable over time, as well as other families where blocking was less consistent. Self-blocking was observed among a significant minority of participating women. Blocking of health communications among family members with HBOC was variable, complex, and multifaceted. The reasons for blocking were heterogeneous; duration of the blocking appeared to depend on the reasons for blocking. Blocking often seemed to involve bi-directional feedback loops, in keeping with Lepore’s Social Constraints and Modulation Theory. Privacy and protectiveness predominated as explanations for long-term blocking.     

On Using a Cancer Center Cancer Registry to Identify Newly Affected Women Eligible for Hereditary Breast Cancer Syndrome Testing: Practical Considerations

The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., “tester” category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., “nontester” category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.     

Family involvement for children with disruptive behaviors: The role of parenting stress and motivational beliefs

Children with disruptive behaviors are at risk for adverse outcomes. Family involvement is a significant predictor of positive child behavior outcomes; however, little research has investigated parent psychological variables that influence family involvement for children with disruptive behaviors. This study investigated the role of parental motivational beliefs (i.e., role construction and efficacy) as a potential mechanism by which parenting stress impacts family involvement for families of children with disruptive behaviors. Results indicated that parent role construction mediated the relation between parenting stress and all aspects of family involvement examined (i.e., home-based involvement, school-based involvement, and home-school communication). Parent efficacy mediated the relation between parenting stress and home-based involvement only. Parents of children with disruptive behaviors reporting stress may experience negative beliefs about their role and efficacy to support their child's education, which may thereby negatively influence their actual involvement. Therefore, parent motivational beliefs may serve as an important point for intervention to support involvement of families of children with disruptive behavior.     

A Mixed-Methods Analysis of Feminist Beliefs and Feminist Identity Development Among College Women Survivors of Gender-Based Violence

Using a mixed-methods approach, we explored how college women’s lifetime experiences of physical or sexual gender-based violence (GBV) were associated with appraisals of GBV and their feminist beliefs or identity (N = 32). Women commented on their increased awareness of the prevalence of GBV, their desire to help other women, and their beliefs about the trustworthiness of men and the current state of gender equality. Women who perceived no or minimal influence of sexism on GBV attributed their GBV experiences to a flaw in themselves or the perpetrators (i.e., self-blame, poor vigilance) or as a reasonable disciplinary measure for their ‘misbehavior.’ We also found that some women reported agreement with pro-feminist beliefs, yet rejected a feminist identity. Our findings illustrate how feminist stigma and sexism might prevent women who endorse core feminist beliefs from characterizing GBV as a sexist event. Given the potential harmful consequences of GBV and other forms of sexism, connecting women with meaningful resources, such as empowering educational programs, nurturing peer-to-peer women’s support groups, and awareness campaigns, may help to facilitate sisterhood and alleviate distress. Our findings also support the need for clinical assessment of how GBV may have affected beliefs about gender, self, world, and others.     

Evolution of the Colored Eco-Genetic Relationship Map (CEGRM) for Assessing Social Functioning in Women in Hereditary Breast-Ovarian (HBOC) Families

The CEGRM was initially conceived as a simple, concise, visual representation of the social interaction domains of information, tangible services and emotional exchanges (Kenen, R., & Peters, J. (2001). J Genet Counsel, 10, 289–309). A blend of the genetic pedigree, genogram, and ecomap, the CEGRM was developed to facilitate contemporary genetic counseling goals. An exploratory pilot study of 20 subjects showed that it was feasible, comfortable and efficiently accomplished, and that the process was useful both for assessment and as an intervention with study participants (Peters, J. A., Kenen, R., Giusti, R., Loud, J., Weissman, N., & Greene, M. H. (2004). Am J Med Genet Part A, 130A, 258–264). Subsequently, we have extended the CEGRM to 150 women from hereditary breast/ovarian cancer (HBOC) families; three different investigators have successfully administered this tool. The preliminary findings from the exploratory study were confirmed in the larger sample. Engaging in the interactive, insight-promoting CEGRM process provides a novel tool for assessing the social context of genetic testing, and helping high-risk women better understand and integrate genetic information into their personal and family identities, health beliefs, and decisions.     

Paranormal Beliefs and the Barnum Effect

The acceptance phenomenon (i.e., the general tendency for persons to accept almost any bogus personality feedback; Layne, 1979) may be related to certain paranormal beliefs (Alcock, 1981; Hyman, 1981). Paranormal beliefs are beliefs in phenomena that, if authentic, violate basic limiting principles of science (Broad, 1953; Tobacyk & Milford, 1983). One specific illustration of the acceptance phenomenon is the "Barnum effect," which refers to acceptance of bogus personality feedback consisting of relatively trivial statements with a high base rate (Layne, 1979; Snyder, Shenkel, & Lowery, 1977). The Barnum effect has been implicated in personal validation and in "cold reading," both of which are used routinely by many astrologers, clairvoyants, faith healers, fortune tellers, graphologists, mediums, Tarot Card readers, and others (Hyman, 1981). It was hypothesized that paranormal beliefs emphasizing divinatory procedures that produce personalized feedback (i.e., precognition, spiritualism, superstition, and witchcraft) are associated with greater susceptibility to the Barnum effect.     

Manic depression and religious experience: The use of religion in therapy

In the article, I explore the use of spiritual strategies in the treatment of manic depression in religiously oriented psychiatric inpatients. Manic depression, a disorder primarily of mood, is characterized by bouts of mania alternating with depression. Religious themes and mystical experiences pervade the language of manic depressive illness, e.g., sensing one is God, being given a divine mission, receiving divine messages, having ecstatic experiences, and so on. Debate exists concerning the effectiveness of spiritual interventions in manic patients. I suggest that a trained religious leader may be able to work therapeutically with such patients, provided that two goals are kept in mind: emphasizing beliefs that facilitate positive coping and challenging irrational religious beliefs (i.e., beliefs that lead to negative coping). When examined psychoanalytically, patients’ religious symbols and beliefs reveal deeply held beliefs about themselves. In particular, splitting and idealization and devaluation can be seen in their religious belief system. The role of culture in promoting maladaptive belief systems must not be overlooked. In employing spiritual interventions in patients diagnosed with manic depression, potential dangers are imposing one's values on patients and overstating the importance of spirituality.     

How Self‐Image and Compassionate Goals Shape Intrapsychic Experiences

Self‐image goals focus on constructing, maintaining, and defending desired public and private images of the self, whereas compassionate goals focus on being supportive and not harming others. We suggest that these goals shape construals of others in relation to the self, which in turn, shape affective experiences. We review research showing that when people have self‐image goals, they construe others as competitors, which leads to feeling uneasy with others (i.e., conflicted, confused, and fearful), and that when they have compassionate goals, they construe others as collaborators and have more constructive approaches to interpersonal problems, which leads to feeling at ease with others (i.e., peaceful, clear, and loving) and less upset with them. Thus, interpersonal goals shape construals of others, which in turn shape intrapsychic experiences of the world and of the self.     

Discrepancies Between Parent and Adolescent Beliefs About Daily Life Topics and Performance on an Emotion Recognition Task

Parents and children and adolescents commonly disagree in their perceptions of a variety of behaviors, including the family relationship and environment, and child and adolescent psychopathology. To this end, numerous studies have examined to what extent increased discrepant perceptions—particularly with regard to perceptions of the family relationship and environment—predict increased child and adolescent psychopathology. Parents’ and children and adolescents’ abilities to decode and identify others’ emotions (i.e., emotion recognition) may play a role in the link between discrepant perceptions and child and adolescent psychopathology. We examined parents’ and adolescents’ emotion recognition abilities in relation to discrepancies between parent and adolescent perceptions of daily life topics. In a sample of 50 parents and adolescents ages 14-to-17 years (M?=?15.4 years, 20 males, 54 % African-American), parents and adolescents were each administered a widely used performance-based measure of emotion recognition. Parents and adolescents were also administered a structured interview designed to directly assess each of their perceptions of the extent to which discrepancies existed in their beliefs about daily life topics (e.g., whether adolescents should complete their homework and carry out household chores). Interestingly, lower parent and adolescent emotion recognition performance significantly related to greater parent and adolescent perceived discrepant beliefs about daily life topics. We observed this relation whilst accounting for adolescent age and gender and levels of parent-adolescent conflict. These findings have important implications for understanding and using informant discrepancies in both basic developmental psychopathology research and applied research in clinic settings (e.g., discrepant views on therapeutic goals).     

Effects of a prosocial television soap opera in promoting women's status

The effects of exposure to "Hum Log," India's first long-running television soap opera, on viewers' beliefs about women's status, freedom of choice, and family planning were assessed in a survey of 1170 respondents from three geographic areas. The soap opera is intended to promote prosocial beliefs about the role of women in India. A structural equation model was developed to measure the impact of awareness, involvement, and television dependency on personal beliefs. Viewers who were most exposed to "Hum Log" were more involved with its characters and more dependent on Indian television for education and entertainment, but were no more aware than their less exposed counterparts of the prosocial beliefs promoted by the soap opera. There was no significant association between viewers' involvement with the characters and their beliefs about women's equality, freedom of choice, or family planning. Moreover, viewers who were more dependent on television did not exhibit significantly stronger beliefs about these issues. There was a significant association between awareness of the prosocial messages promoted in "Hum Log" and viewer beliefs in freedom of choice and family planning. Overall, it appears that, while "Hum Log" enjoys a large and dedicated audience, its messages regarding women's equality are not being assimilated on a large scale. An analysis of the female characters in the soap opera reveals that, in many cases, the self-sufficient, career-oriented women experienced negative social consequences, while characters who pursued more traditional female roles were rewarded. Thus, while there is no evidence that "Hum Log" is making a significant contribution toward changing the way women are viewed in India, its popularity paves the way for future prosocial programming     

教育价值观和逆境信念在家庭经济压力与初中生学业成就之间的作用

大量研究表明,家庭经济压力对青少年学业成就具有显著的不利影响。但是,目前学界对家庭经济压力“怎样”（中介机制）以及“何时”（调节机制）影响青少年学业成就仍知之甚少。本研究在整合贫困文化模型及心理韧性理论的基础上构建一个有调节的中介模型,考察青少年教育价值观（读书是否有用）在家庭经济压力与学业成就之间的中介作用,同时检验中国文化逆境信念对该中介路径的调节作用。采用随机整群抽样,选取四川省9所普通中学1613名初中生（平均年龄13.42岁,SD = 1.22）作为研究对象。被试匿名填写家庭经济压力问卷、教育价值观问卷、中国文化逆境信念量表以及学业成就问卷。结果表明：（1）在控制了性别、年龄等人口学变量后,家庭经济压力显著负向预测学业成就。（2）教育价值观在家庭经济压力与学业成就之间具有部分中介作用。（3）积极逆境信念能缓冲家庭经济压力对教育价值观的消极作用,进而减少对学业成就的不利影响。本研究证实了“读书无用论”是经济困难与学业成就的重要联系机制,并肯定了中国文化逆境信念对经济困难青少年的保护作用。这一内在保护机制的揭示对教育实践有一定的启示。     

Spiritual Coping, Family History, and Perceived Risk for Breast Cancer—Can We Make Sense of it?

Differences in spiritual beliefs and practices could influence perceptions of the role of genetic risk factors on personal cancer risk. We explored spiritual coping and breast cancer risk perceptions among women with and without a reported family history of breast cancer. Analyses were conducted on data from 899 women in primary care clinics who did not have breast cancer. Structural equation modeling (SEM), linear, and logistic modeling tested an interaction of family history of breast cancer on the relationship between spiritual coping and risk perceptions. Overall analyses demonstrated an inverse relationship between spiritual coping and breast cancer risk perceptions and a modifying effect of family history. More frequent spiritual coping was associated with lower risk perceptions for women with positive family histories, but not for those with negative family histories. Results support further research in this area that could influence communication of risk information to cancer genetic counseling patients.     

THEORETICAL FRAMEWORKS FOR STUDYING FEMALE MARRIAGE MIGRANTS

Transnational marriages account for a significant proportion of family-based immigration to North America. An increasing number of immigrant men are choosing to marry women from their countries of origin, and an increasing number of nonimmigrant men are choosing to marry women from other countries. Existing studies on the experiences of foreign brides entering North America have highlighted their vulnerability to spousal maltreatment, including unique forms of immigration abuse (e.g., threats of deportation). Their vulnerability to maltreatment has been attributed to the gender-insensitive nature of family immigration policies, the women's lack of awareness of their rights and immigration status, and their husbands' cultural beliefs about women's roles. This article describes three interrelated theoretical frameworks that can inform further research, practice, and policy development related to female marriage migrants. The frameworks draw on cross-cultural models of gender-based violence, seminal work on the psychology of women, and international human rights research.     

Masculinity,Femininity, and Reported Paranormal Beliefs

Previous research has found that women are more likely than men to report belief in nonmaterial paranormal phenomena (e.g., psychics). There are inconsistent findings about whether men are more likely than women to report belief in material paranormal phenomena (e.g., bigfoot/sasquatch), and no prior survey research has examined gender expression (as masculine or feminine) as it relates to paranormal beliefs. This paper asks: How do gender identity and gender expression relate to reported paranormal beliefs? It answers this question using a large sample (n = 2504) of Canadians. Femininity helps explain differences between cisgender women and men on reported beliefs about foreseeing the future and telekinesis, but less so about reported belief in ghosts. Intriguingly, reported gender atypicality is associated with reported belief in all paranormal phenomena among cisgender women and among cisgender men. The results highlight the importance of measuring gender expression for beliefs that science cannot verify.     

“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.     

System influences on posthomicide beliefs and distress

Criminal justice system experiences in 150 family members of homicide victims were investigated. The study had two goals: (a) to document the experiences of homicide survivors in the criminal justice system, including case outcomes, criminal justice system activities, and satisfaction with system personnel; and (b) to determine if experiences with the police impacted posthomicide beliefs (cognitive assumptions about the world and one’s relationship to it) and psychological distress. The sample, which was identified through the Medical Examiner’s Office, was drawn from all criminal homicides from 1.5 to 5 years prior to selection. Results showed that family members of homicide victims were very dissatisfied with their experiences in the criminal justice system. Additionally, whereas objective system outcomes (e.g, arrest) did not directly affect posthomicide beliefs and distress, subjective system outcomes (e.g., police satisfaction) directly affected beliefs and indirectly affected distress. There was some support for both equity theory and a cognitive theory of change, the two theories that guided the model specification. This study was funded by a predoctoral National Research Service Award fellowship to Martie Thompson, from the Violence and Traumatic Stress Research Branch at the National Institute of Mental Health. We thank Paula Vardaman for her help with sample recruitment and data collection, Nancy Deore and Kelly Harlan for their help with data collection, and Ann Price for help with data entry. Additionally, we would like to thank Lieutenant Agan of the Atlanta Homicide Division, the staff at the Fulton County Medical Examiner’s Office, and the staff at the Victim Witness Assistance Program for making this study possible by providing access to their files. Finally, we thank Morton Bard for his feedback in quastionnaire development and study design.     

Predictors and Correlates of Collective Action

Social identity theory suggests that feminist identity should predict engagement in collective action on behalf of women. We examined predictors of collective action by asking female college students (N = 215) to complete a set of questionnaires that measure life experiences, beliefs about feminism and collective action, feminist self-labeling, and involvement in women-focused collective activities. Life experiences (i.e., having a feminist mother, having taken a women's studies class, and having experienced sex discrimination), feminist attitudes and beliefs, feminist self-labeling, and belief in collective action were positively correlated with collective action, whereas conservatism was negatively correlated with collective action. A logistic stepwise regression revealed that the Synthesis stage of feminist identity development was the only variable that uniquely contributed to predicting feminist activism.