Patients' information needs and decision-making processes: what can be learned from genetic counselees?

This field study investigated the information needs and decision-making strategies of 161 genetic counselees interviewed just prior to counseling. Patients were interested mostly in information about the outcomes and consequences of the alternative options at their disposal and about measures to defuse the risks. They wanted mainly information stated with certainty and were less interested in probability information. There was no difference in the search for information between the alternative eventually chosen and the one not chosen. There was a difference, however, among types of decisions and the interest in the various categories of information. These findings were interpreted within the theoretical model of decision making in natural risky situations (O. Huber, 1997). Practical implications for shared medical decision making are presented.     

Parent attributions of emotion to their children and the cues children use in perceiving their own emotions

A number of studies have demonstrated stable individual differences in the cues that generate emotions and other feeling states. These differences are assumed to arise from the cues parents use to identify their children's emotional states. As children learn about their own emotional states, they come to rely on these same cues. To test one implication of their view, the facial expressions of children (N=41) were manipulated and their feelings assessed. Some children reported emotions consistent with their expressions, while others reported emotions appropriate to the situation. In a separate procedure, their mothers were asked to identify the emotional states of children whose expressions were inconsistent with an account of their circumstances. Mothers who paid more attention to their children's expressive behavior had children who were more responsive to their own expressive behavior. In contrast, the mothers who were more responsive to situational cues had children whose emotions arose from the situational cues as well.The authors would like to thank numerous teachers and administrators of the Worcester Public School system in Worcester, Massachusetts, for their assistance.     

A taxonomy of item response models

A number of models for categorical item response data have been proposed in recent years. The models appear to be quite different. However, they may usefully be organized as members of only three distinct classes, within which the models are distinguished only by assumptions and constraints on their parameters. “Difference models” are appropriate for ordered responses, “divide-by-total” models may be used for either ordered or nominal responses, and “left-side added” models are used for multiple-choice responses with guessing. The details of the taxonomy and the models are described in this paper. The present study was supported in part by two postdoctoral fellowships awarded to Lynne Steinberg: an Educational Testing Service Postdoctoral Fellowship at ETS, Princeton, NJ and an NIMH Individual National Research Service Award at Stanford University, Stanford, CA. Helpful comments by the editor and three anonymous reviewers are gratefully acknowledged.     

Cognition and metacognition at extreme altitudes on Mount Everest

The FACTRETRIEVAL2 test battery, which assesses both retrieval of general information from memory and metacognition about that retrieval, was administered to people before and after a recent expedition to Mount Everest and at extreme altitudes above 6,400 m (higher than any mountain in North America or Europe). The major findings were as follows: First, the same extreme altitudes already known to impair learning did not affect either accuracy or latency of retrieval, and this robustness of retrieval occurred for both recall and forced-choice recognition. Second, extreme altitude did affect metacognition: The climbers showed a decline in their feeling of knowing both while at extreme altitude and after returning to Kathmandu (i.e., both an effect and an aftereffect of extreme altitude). Third, extreme altitude had different effects than alcohol intoxication (previously assessed by Nelson. McSpadden, Fromme, & Marlatt, 1986). Alcohol intoxication affected retrieval without affecting metacognition, whereas extreme altitude affected metacognition without affecting retrieval; this different pattern for extreme altitude versus alcohol intoxication implies that (a) hypoxia does not always yield the same outcome as alcohol intoxication and (b) neither retrieval nor metacognition is strictly more sensitive than the other for detecting changes in independent variables.     

Values of Postpartum Women from the Inner City: An Exploratory Study

An exploratory study of the values of inner-city postpartum women was conducted. Subjects were largely single, with many on/or going on public assistance. Each subject was given the Rokeach Value Scale and asked to prioritize the terminal values (goals) in terms of herself and the instrumental values (means) in terms of what she would like to teach her child. Rankings were compared to corresponding rankings compiled by a national sample, considered a more traditional era, and by marital status within the postpartum mother sample itself. Economic values were ranked higher by inner-city mothers than by the national sample. The top terminal value was family security and the top instrumental value was responsible. When compared by marital status, the only significant difference was the higher ranking of mature love given by married women. Results suggests that the values of the inner-city single postpartum mother can be conceptualized as a mosaic incorporating values shared with the mainstream and values adapted to the conditions of poverty.     

Mediating Effects of Perceived Personal Control in Coping With a Health Threat: The Case of Genetic Counseling1

The potential impact of perceived personal control on coping with a medical threat was investigated in genetic counseling, a clinical setting where issues of personal control are central. Data were collected from 72 counselees at a genetic clinic before, immediately after, and 1 month after initiating genetic counseling. Findings supported the hypothesized mediating model. Higher perceived control (cognitive-interpretive and decisional) and satisfaction with genetic counseling mediated between genetic counseling and the use of less emotion-focused coping strategies. Problem-focused coping was predicted only directly by counselees' knowledge of their problem after genetic counseling. Changes in emotion-focused coping were related to perceived increases in positive affect 1 month later, while changes in use of problem-focused coping were related to perceived decreases in both positive and negative affect.     

The empirical study of teenage work: A behavioral code for the assessment of adolescent job environments

Policy recommendations that adolescents supplement their experience in school with experience in the workplace have been made in the absence of objective data on the nature of most adolescents' activity on the job. This paper presents a coding system for chronicling a variety of microbehaviors in sequence, as they occur, in adolescent job environments. Three elements of each of approximately 100 behaviors performed by a targeted teenage worker are recorded by an on-site observer who enters appropriate code numbers into a portable event recorder: (1) the social context of the behavior; (2) the character of the behavior; and (3) the duration and concomitants of the behavior, when appropriate. Each of 97 working teenagers was observed continuously over a two hour period on the job. Interobserver agreement on the coding of worker behaviors and the social contexts in which they occurred averaged .86 and .97, respectively. In addition to its applicability in research on the effects of working on adolescent development, information obtained using the code can be helpful in the evaluation of youth employment programs, the vocational counseling of adolescents, and the validation of subjective worker reports of job attributes.     

Multifactorial assessment of bulimia nervosa

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.     

Developing coordination of services between a mental health center and a public school system

A child-and-family oriented community mental health center of necessity is concerned with the manner in which the school system in its community is providing for the psychological, social, and emotional development of children. Fortunately, over the last decade, the number of school systems that are aware of their responsibility in this regard has greatly increased, and many affluent and enlightened school systems have moved to develop extensive pupil personnel services, functioning in many ways as in-house mental health programs. Where there are mental health providers both within the community and within the school system, however, problems may develop such as professional competition, overlapping functions, and differences with regard to how mental health problems are best dealt with. This paper will examine the relationship of a town-supported mental health program and the town's public school system. Highlighted will be the variety of problems which develop, including those mentioned above, and strategies adopted to resolve the problems.