Why Is Cancer Genetic Counseling Underutilized by Women Identified as at Risk for Hereditary Breast Cancer? Patient Perceptions of Barriers Following a Referral Letter

Family history information comprises an important tool in identifying and referring patients at risk for hereditary breast and ovarian cancer (HBOC) to cancer genetic counseling. Despite recommendations and support provided by numerous professional organizations, cancer genetic counseling services are underutilized by atrisk patients. This study aimed to: (1) determine the rate of genetic counseling utilization following a referral letter, (2) characterize factors (barriers and supports) which influenced uptake of services, and (3) identify potential strategies for increasing utilization. This study evaluated the uptake of cancer genetic counseling among 603 screening mammography patients identified as having an increased risk for HBOC based on National Comprehensive Cancer Network (NCCN) guidelines. At risk individuals and their primary care providers were mailed a referral letter recommending genetic counseling. Three focus groups (N = 24) were conducted to identify responses to receiving a letter recommending genetic counseling, barriers to seeking genetic counseling, and facilitating factors to utilizing these services. Participant responses were qualitatively analyzed using thematic and cross case analysis. Within one year, 50/603 (8 %) of the identified at-risk women completed a genetic counseling appointment. Participant-perceived barriers which influenced their decision not to seek genetic counseling included lack of relevance and utility, limited knowledge about genetic counseling, concerns about the genetic counseling process, and concerns about cost and insurance coverage. Participant-perceived facilitating factors which would support a decision to seek genetic counseling included greater awareness and education about genetic counseling services when receiving a referral, and improved follow up and guidance from their provider. Findings from this study support the need for patient and primary care provider education, and improved provider-patient communication to increase uptake of genetic counseling services.     

Sex and post-menopause hormone therapy effects on hippocampal volume and verbal memory

Many studies suggest sex differences in memory and hippocampal size, and that hormone therapy (HT) may positively affect these measures in women; however, the parameters of HT use that most likely confer benefits are debated. We evaluated the impact of sex and postmenopausal HT use on verbal learning and memory and hippocampal size in 94 cognitively intact women and 49 men. Using analysis of covariance that controlled for age and education, women had better total word learning and delayed verbal memory performance than men. HT analyses showed that non-HT users performed similarly to men, while HT users performed better than men in Delayed Memory regardless of whether use was current or in the past. Women had larger hippocampal volumes than men regardless of whether they were HT users. Using univariate linear models, we assessed group differences in the predictive value of hippocampal volumes for verbal learning and memory. Hippocampal size significantly predicted memory performance for men and non-HT users, but not for HT users. This lack of relationship between hippocampal size and verbal learning and memory performance in HT users suggests HT use may impact memory through extra-hippocampal neural systems.     

The effects of emotion on younger and older adults’ monitoring of learning

Age-related differences in memory monitoring appear when people learn emotional words. Namely, younger adults’ judgments of learning (JOLs) are higher for positive than neutral words, whereas older adults’ JOLs do not discriminate between positive versus neutral words. In two experiments, we evaluated whether this age-related difference extends to learning positive versus neutral pictures. We also evaluated the contribution of two dimensions of emotion that may impact younger and older adults’ JOLs: valence and arousal. Younger and older adults studied pictures that were positive or neutral and either high or low in arousal. Participants made immediate JOLs and completed memory tests. In both experiments, the magnitude of older adults’ JOLs was influenced by emotion, and both younger and older adults demonstrated an emotional salience effect on JOLs. As important, the magnitude of participants’ JOLs was influenced by valence, and not arousal. Emotional salience effects were also evident on participants’ free recall, and older adults recalled as many pictures as did younger adults. Taken together, these data suggest that older adults do not have a monitoring deficit when learning positive (vs. neutral) pictures and that emotional salience effects on younger and older adults’ JOLs are produced more by valence than by arousal.     

Reproducing the Motherboard: The Invisible Labor of Discourses that Gender Digital Fields

Within the digital workforce, women are disappearing. While there are many factors that could be ‘blamed’ for this phenomenon, this article takes issue with the sexist and patriarchal discourses that are deployed within the digital workforce. In many ways, sexist discourses are taken for granted within the digital workplace; and in that way, the discourses themselves are rendered invisible through a lack of concerted uncovering of the ways that these sexist discourses produce—and reproduce—women as sexual objects and outsiders in this field of work. The sexist and patriarchal discourses I address in this article validate the gender binary even as there is gendered play. It is this ‘play’ that also makes counter-hegemonic discourse and discursive acts productive (and reproductive), as I argue toward the end of the paper. Schools are a place where counter-hegemonic discourses and acts can be nurtured and, hopefully, affect and counteract the disappearance of women in digital fields.     

Predictors of Early Community Involvement: Advancing the Self and Caring for Others

Recent research on community involvement points to the importance of both agentic (advancing the self) and communal motives (serving others) as key predictors, though few studies have examined both simultaneously. At the same time, research has identified generativity, defined as concern for future generations as a legacy of the self, as particularly relevant for community involvement. Moreover, generativity involves both agentic and communal motives, meaning that advancing personal goals and caring for others are integrated in this construct. Therefore, the purpose of this study was to examine how individual differences in attributes pertaining to self and to others—specifically, self‐esteem, initiative, and empathy—related to both generativity and community involvement. A sample of adolescents (N = 160; 64% female, M_age = 17) and a sample of young adults (N = 237; 84% female, M_age = 20) completed a survey including measures of community involvement and generativity. Generative concern fully mediated the associations between individual differences (self‐esteem, initiative, and empathy) and community involvement, suggesting that the early generativity has a role in fostering capacities and contribution in youth. These developmental indicators pertaining to self and others link to actions that benefit the community through a desire to benefit future generations.     

Gang Affiliation as a Measure of Social Structure in Social Structure Social Learning Theory

The current study seeks to evaluate the use of gang membership as a measure of social structure in social structure social learning theory. The Evaluation of Gang Resistance Education and Training Program in the United States, 1995–1999 dataset was used with structural equation modeling to test if inclusion of gang membership as a social structure variable was a better predictor of deviance than social learning elements alone. The analysis suggests that gang membership will have an impact on the mechanisms of social learning, supporting the use of gang membership as a measure of social structure.     

Self-esteem in childhood and adolescence: Vaccine or epiphenomenon?

Recent accounts of the adaptive significance of self-esteem during childhood and adolescence have varied dramatically and fueled the emergence of a “self-esteem debate.” On one side of the debate, self-esteem is portrayed as a powerful positive influence on youth adjustment. By contrast, the other side has argued that hypothesized effects of self-esteem do not exist at all. A review of empirical findings suggests that both views are oversimplified and inaccurate. The adaptive implications of self-esteem during childhood and adolescence instead appear to be complex and differentiated, ranging from highly beneficial to possibly even negative. Recent results indicate the importance of considering (a) multiple, distinct facets of self-esteem; (b) the moderating influence of youth characteristics, environmental experiences, and processes in the formation and maintenance of self-esteem; and (c) bidirectional, recursive linkages between self-esteem and adaptive functioning throughout development. The adaptive implications of self-esteem for children and adolescents also appear to be most usefully investigated within the context of broader frameworks that allow for consideration of the role of self-esteem as an intervening or mediational process and its interdependent relationships with other aspects of the developing self-system. Implications for interventions designed to enhance youth self-esteem are discussed.     

Slower eating rate reduces the food intake of men, but not women: implications for behavioral weight control

This study tested a central tenet of behavioral weight control: does slower eating rate reduce food intake and positively affect appetite ratings. This study used direct behavioral observation of participants' (n=48; 25BMI35) eating behavior using Universal Eating Monitors. Food intake and ratings of "desire to eat" (collected each minute during meals) were represented as a function of time. Based on an acclimation meal, participants' eating rate was modified by instructing them to eat a bite of food when prompted by a computer, which generated three types of meals: (1) baseline (eating rate was the same as the acclimation meal), (2) reduced-rate (eating rate was reduced by 50%), and (3) combined-rate (eating rate at the beginning of the meal was identical to that of the acclimation meal, subsequently eating rate was reduced by 50%). All meals were ad libitum. Slower eating rate during the reduced-rate and combined-rate meals resulted in less food intake compared to the baseline meal for men, but not women. Ratings of desire to eat, normalized for the amount of food consumed, were lower during the combined-rate meal for men and women. Thus, this basic premise of behavioral weight control was supported for men, but not for women.