Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

Not a Laughing Matter: Sexual Harassment as “Material” on Workplace-Based Situation Comedies

In her book Sexual Harassment of Working Women Catherine MacKinnon (1979) suggested that “Trivialization of sexual harassment has been a major means through which its invisibility has been enforced. Humor, which may reflect unconscious hostility, has been a major form of that trivialization” (p. 52). In other words, making jokes at women's expense and treating sexual harassment as not serious have contributed to its persistence. Situation comedies can be seen as gauges for what is considered humorous in American culture. To explore the tone of and mood toward sexual harassment in contemporary American society, themes and content of “humorous” material on 56 episodes of five workplace-based situation comedies were examined. Results showed that although sexual harassment is rarely discussed on situation comedies, gender harassment is frequently used as “material,” which leads to further trivialization of a serious social problem.     

Shape‐ and Trait‐Congruency: Using Appearance‐based Cues as a Basis for Product Recommendations

This research demonstrates that a consumer's physical appearance—and, more specifically, his or her body size—predictably influences the product(s) that the consumer is recommended. Four studies conducted in both field and lab settings show that agents more frequently recommend round (vs. angular) shaped products to heavier targets, notably for products and categories in which body size is irrelevant (e.g., lamps and perfume). We attribute this to a combination of shape‐congruency and trait‐congruency, whereby individuals choose products for others based on shared dimensions of the person and product.     

Poor,Rural Women: Spirituality,Religion, and Wellness Across the Life Span

Researchers have suggested strategies in the spiritual domain for improving wellness. This study explored relationships among spirituality, religiosity, and wellness for poor, rural women in early adulthood, early–middle adulthood, and middle–later adulthood. Implications for evidence‐based strategies to improve wellness for poor, rural women across the life span are provided.     

Patient Perceptions of Telephone vs. In-Person <Emphasis Type="Italic">BRCA1/BRCA2</Emphasis> Genetic Counseling

Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women’s perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants (TC, N?=?272; UC, N?=?282), delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants (OR?=?4.78, 95 % CI?=?3.32, 6.89) while also perceiving lower levels of support (OR?=?0.56, 95 % CI?=?0.40–0.80) and emotional recognition (OR?=?0.53, 95 % CI?=?0.37–0.76). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC (69.4 % vs. 52.8 %; OR?=?3.06, 95 % CI?=?1.39–6.74), while minority women perceived less support in UC vs. TC (58.3 % vs. 38.7 %; OR?=?0.80, 95 % CI?=?0.39–1.65). We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.     

Adolescent-specific patterns of behavior and neural activity during social reinforcement learning

Humans are sophisticated social beings. Social cues from others are exceptionally salient, particularly during adolescence. Understanding how adolescents interpret and learn from variable social signals can provide insight into the observed shift in social sensitivity during this period. The present study tested 120 participants between the ages of 8 and 25 years on a social reinforcement learning task where the probability of receiving positive social feedback was parametrically manipulated. Seventy-eight of these participants completed the task during fMRI scanning. Modeling trial-by-trial learning, children and adults showed higher positive learning rates than did adolescents, suggesting that adolescents demonstrated less differentiation in their reaction times for peers who provided more positive feedback. Forming expectations about receiving positive social reinforcement correlated with neural activity within the medial prefrontal cortex and ventral striatum across age. Adolescents, unlike children and adults, showed greater insular activity during positive prediction error learning and increased activity in the supplementary motor cortex and the putamen when receiving positive social feedback regardless of the expected outcome, suggesting that peer approval may motivate adolescents toward action. While different amounts of positive social reinforcement enhanced learning in children and adults, all positive social reinforcement equally motivated adolescents. Together, these findings indicate that sensitivity to peer approval during adolescence goes beyond simple reinforcement theory accounts and suggest possible explanations for how peers may motivate adolescent behavior.     

Acute Stress,Depression, and Anxiety Symptoms Among English and Spanish Speaking Children with Recent Trauma Exposure

A growing literature suggests the clinical importance of acute stress disorder symptoms in youth following potentially traumatic events. A multisite sample of English and Spanish speaking children and adolescents (N = 479) between the ages of 8–17, along with their caregivers completed interviews and self-report questionnaires between 2 days and 1 month following the event. The results indicate that children with greater total acute stress symptoms reported greater depressive (r = .41, p < .01) and anxiety symptoms (r = .53, p < .01). Examining specific acute stress subscales, reexperiencing was correlated with anxiety (r = .47, p < .01) and arousal was correlated with depression (r = .50, p < .01) and anxiety (r = .55, p < .01). Age was inversely associated with total acute stress symptoms (r = ?.24, p < .01), reexperiencing (r = ?.17, p < .01), avoidance (r = ?.27, p < .01), and arousal (r = ?.19, p < .01) and gender was related to total anxiety symptoms (Spearman’s ρ = .17, p < .01). The current study supports the importance of screening acute stress symptoms and other mental health outcomes following a potentially traumatic event in children and adolescents. Early screening may enable clinicians to identify and acutely intervene to support children’s psychological and physical recovery.