Genetic Risk Assessment for Women with Epithelial Ovarian Cancer: Referral Patterns and Outcomes in a University Gynecologic Oncology Clinic

Little is known about genetic service utilization and ovarian cancer. We identified the frequency and outcome of genetic counseling referral, predictors of referral, and referral uptake for ovarian cancer patients. Using pathology reports, we identified all epithelial ovarian cancer patients seen in a university gynecologic oncology clinic (1/04–8/06). Electronic medical records (EMR) were used to document genetic service referral, time from diagnosis-to-referral, point-in-treatment at referral, personal/family cancer history, demographics, and genetic test results. Groups were compared using chi-squared and Fisher’s exact test for categorical variables and t-tests for continuous variables. The study population consisted of 376 women with ovarian cancer, 72 (19 %) of who were referred for genetic counseling/testing, primarily during surveillance. Of those referred, 42 (58 %) had personal or family genetic counseling and 34 (47 %) were ultimately tested or identified due to known family mutation. Family history and prior cancer were associated with referral. Family history, living in a larger community, higher-stage disease, and serous histology were associated with undergoing genetic counseling. Risk assessment identified 20 BRCA1/2 (5.3 %) and 1 HNPCC (0.3 %) mutation carriers. Based on recent estimates that 11.7–16.6 % of women with ovarian cancer are BRCA carriers and 2 % are HNPCC carriers, results suggest under-identification of carriers and under-utilization of genetic services by providers and patients. Interventions to increase medical providers’ referrals, even in a specialized oncology clinic, are necessary and may include innovations in educating these providers using web-based methods. Ease of referral by the introduction of an electronic cancer genetic referral form represents another new direction that may increase genetic risk assessment for high-risk women with ovarian cancer.     

Transtheoretical Model Constructs for Physical Activity Behavior are Invariant across Time among Ethnically Diverse Adults in Hawaii

OBJECTIVES: Physical activity (PA) research applying the Transtheoretical Model (TTM) to examine group differences and/or change over time requires preliminary evidence of factorial validity and invariance. The current study examined the factorial validity and longitudinal invariance of TTM constructs recently revised for PA. METHOD: Participants from an ethnically diverse sample in Hawaii (N=700) completed questionnaires capturing each TTM construct. RESULTS: Factorial validity was confirmed for each construct using confirmatory factor analysis with full-information maximum likelihood. Longitudinal invariance was evidenced across a shorter (3-month) and longer (6-month) time period via nested model comparisons. CONCLUSIONS: The questionnaires for each validated TTM construct are provided, and can now be generalized across similar subgroups and time points. Further validation of the provided measures is suggested in additional populations and across extended time points.     

PARTICIPATIVE EDUCATION FOR CHILDREN: AN EFFECTIVE APPROACH TO INCREASE SAFETY BELT USE

Vehicle license plate numbers and the shoulder belt use of front-seat occupants were recorded unobtrusively when parents delivered and picked up their children at a Montessori school during 5-day baseline, intervention, and follow-up phases. Practicing and presenting a 15-min safety belt skit increased the safety belt use of those 6 kindergarten children who were not consistent belt users 82% above their preintervention baseline belt use mean of 47%. The belt use of these children's parents (who watched the skit) increased to 56% above their baseline mean of 36%. Also, mean safety belt use of 11 primary school children who watched the skit increased to 70% above their baseline of 28%. Mean safety belt use of the older children's parents (who didn't watch the skit) remained at approximately 31% for each phase, regardless of whether children were vehicle occupants. The follow-up observations, taken 3 months after the intervention, revealed 60% belt use for the kindergartners, 48% for the primary school children, and 71% for the kindergartners' parents when the children were vehicle occupants but only 30% when the parents were driving alone.     

Conformity as a function of task generalization and relative competence

Subject correctness and group agreement were varied for college subjects engaged in a light discrimination task. On another task, employing multiple-choice questions about Canada, the dependent variable of conformity was assessed to examine generalization of relative competence formed on the light discrimination task. It was seen that (1) relative competence was seen to mediate conformity for a specific task (Canadian Knowledge Inventory), but did not generalize across tasks (i.e. from the light discrimination task to the Canadian Knowledge Inventory); (2) with respect to the Canadian Knowledge Inventory, subjects who perceived themselves as more competent than the group did not conform as much as those who either perceived themselves as less competent than or as competent as the group; (3) the experimental manipulations did not affect conformity, further supporting the findings that perceived competence does not generalize across classes of tasks; (4) females conformed more than males: and (5) nonsuspicious subjects conformed more than suspicious subjects.     

Generalization of relative competence mediating conformity across differing tasks

Subject correctness and group agreement were initially varied for college subjects performing a multiple-choice informational task (Canadian Knowledge Inventory). On a subsequent perceptual task (Raven's Standard Progressive Matrices), the dependent variable of conformity was assessed to examine generalization of relative competence formed on the informational task. It was seen that: (1) Those who perceived themselves to be less competent than the group on the first task exhibited the greatest level of conformity on the second task, thus replicating previous research on perceived relative competence as a determinant of conformity; (2) suspicion reduced conformity.     

Prompting a consumer behavior for pollution control

A field application of behavior modification studied the relative effectiveness of different prompting procedures for increasing the probability that customers entering a grocery store would select their soft drinks in returnable rather than nonreturnable containers. Six different 2-hr experimental conditions during which bottle purchases were recorded were (1) No Prompt (i.e., control), (2) one student gave incoming customers a handbill urging the purchase of soft drinks in returnable bottles, (3) distribution of the handbill by one student and public charting of each customer's bottle purchases by another student, (4) handbill distribution and charting by a five-member group, (5) handbills distributed and purchases charted by three females. The variant prompting techniques were equally effective, and in general increased the percentage of returnable-bottle customers by an average of 25%.