Patricia Goodson

Barriers to the provision of genetic services by primary care physicians: a systematic review of the literature.

Purpose: The purpose of this literature review is to report primary care physicians’ perceived barriers concerning the provision of genetic services.Methods: Sixty-eight papers were identified in six electronic databases. Only publications classified as empirical studies (N = 18) were included in this review.Results: Barriers identified most frequently in reviewed studies were inadequate knowledge of basic genetics, lack of detailed or updated family histories, lack of confidence, and lack of referral guidelines.Conclusion: Although many primary care physicians perceive genetics as a low practice priority, they do report a need for educational programs in genetics, informational resources, and referral guidelines.

Maintaining prevention in practice: Survival of PPIP in primary care settings

INTRODUCTION Put Prevention Into Practice (PPIP) consists of a kit of office-based tools intended to support the provision of preventive services by primary care providers. The purpose of this study was to examine the institutionalization of PPIP within five primary care clinics funded by the Texas Department of Health to implement PPIP, and to examine the organizational determinants of program institutionalization. METHODS We utilized an adaptation of the Level of Institutionalizaton (LoIn) scales for qualitative data collection and for development of an institutionalization score for each site. The determinants of institutionalization were derived from the organizational behavior and health promotion literatures and used as categories for analysis. In addition, for purposes of triangulation, chart audit data for three documentation behaviors were also collected. RESULTS PPIP has been maintained--at varying degrees of integration--in four of the five sites studied, for 6 years after adoption. Organizational factors that facilitated the institutionalization process were the sites institutional strength, the integration of PIPP within extant programs and services, visibility of the program within and outside the site, planning for the termination of grant funding, and presence of a program champion with mid- to upper-level managerial authority. Successful initiation of the program was not a predictor of institutionalization outcomes. CONCLUSIONS We have highlighted the need to consider organizational determinants of institutionalization in relation to their specific sociopolitical contexts, and in relation to each other, not in isolation.

Sex on the Internet: College Students' Emotional Arousal When Viewing Sexually Explicit Materials On-Line

Little is known concerning the behaviors, attitudes, and emotions of Internet users who go on-line to search for sexually explicit materials. This study examines a range of emotions elicited by viewing sexually explicit materials on-line in a sample of undergraduate students from a public university in Texas. Of the 506 students in the sample, 196 (43.5%) had accessed these types of materials on the Internet at least once. This study examines gender, ethnic, and gender-ethnic differences in the reporting of 11 different emotions such as feelings of entertainment, sexual arousal, guilt, and anxiety. The authors also examined the relationship between selected predictor variables and individual emotions. Results revealed that sexual arousal was the 4th most frequently reported emotion, preceded by feeling entertained, disgusted, and having a general feeling of excitement and anticipation. Ethnic differences were encountered only for feelings of anxiety about being caught while viewing explicit materials; gender differences were found for feeling entertained, sexually aroused, angry, and disgusted. Regression models were used to test the association between gender, ethnicity, degree of religiosity, expectations and expectancies toward using the Internet for viewing sexually explicit materials, and individual emotions. For non-negative emotions, the strongest predictors emerging from the models were expectations and expectancies (or attitudes). For negative emotions, none of the predictor variables exhibited a linear association with the emotions.

Use (and Misuse) of the Responsible Drinking Message in Public Health and Alcohol Advertising: A Review

The objective is to present a comparative analysis examining the alcohol industry’s and scholarly researchers’ use of the concept “responsible drinking.” Electronic databases associated with health, education, sociology, psychology, and medicine were the date sources. Results were limited to English, peer-reviewed articles and commentaries specifically addressing “responsible drinking.” Search descriptors included responsible, responsibility, drinking, alcohol, brewer, and campaign. Eighteen articles constituted the final sample. The matrix method was utilized to organize and abstract pertinent information. Misunderstanding stemming from the inconsistency and counterintuitive nature of brewer-sponsored “responsible drinking” campaigns is further compounded by researchers’ use of the term and concept of “responsible drinking” in their scholarly reports. In articulating the definition of “responsible drinking,” researchers employ subjective notions and personal ideas, thus not differentiating the construct’s meaning from the one acquired in brewer-sponsored campaigns. Researchers are consistently inconsistent when identifying specific health measures that promote and/or contradict responsible alcohol consumption. To evade the subjective notions of researchers and restrictive impressions attached by the alcohol industry, the manner in which individuals interpret, perceive, and practice responsible drinking must be systematically explored and examined using theoretically based constructs.

Decision to abort after a prenatal diagnosis of sex chromosome abnormality: a systematic review of the literature

We performed a systematic review of factors affecting parental decisions to continue or terminate a pregnancy after prenatal diagnosis of a sex chromosome abnormality, as reported in published studies from 1987 to May 2011. Based on the Matrix Method for systematic reviews, 19 studies were found in five electronic databases, meeting specific inclusion/exclusion criteria. Abstracted data were organized in a matrix. Alongside the search for factors influencing parental decisions, each study was judged on its methodological quality and assigned a methodological quality score. Decisions either to terminate or to continue a sex chromosome abnormality-affected pregnancy shared five similar factors: specific type of sex chromosome abnormality, gestational week at diagnosis, parents’ age, providers’ genetic expertise, and number of children/desire for (more) children. Factors unique to termination decisions included parents’ fear/anxiety and directive counseling. Factors uniquely associated with continuation decisions were parents’ socioeconomic status and ethnicity. The studies’ average methodological quality score was 10.6 (SD = 1.67; range, 8–14). Findings from this review can be useful in adapting and modifying guidelines for genetic counseling after prenatal diagnosis of a sex chromosome abnormality. Moreover, improving the quality of future studies on this topic may allow clearer understanding of the most influential factors affecting parental decisions.Genet Med 2012:14(1):27–38

Adolescent Sexual Abstinence: A Test of an Integrative Theoretical Framework

The purpose of this study was to test an integrative theoretical framework in explaining adolescents’ sexual abstinence and intentions to remain abstinent and refine the framework to reflect which elements contribute more powerfully to the explanation of abstinence and intentions. We administered an anonymous, theory-based questionnaire to two nonrandom samples of seventh- and eighth-graders (n = 451 and 447, respectively). Measurement modeling provided sufficient evidence for establishing construct validity. A refined structural equation model demonstrated good fit. Pro-abstinence standards predicted stronger beliefs toward staying abstinent, stronger perceptions that others endorse pro-abstinence norms, and a greater self-efficacy to remain sexually abstinent until marriage. In turn, beliefs, norms, and self-efficacy were predictive of intentions, which predicted sexual abstinence at a later time point. Similar findings emerged in a replication using a second set of sample data. Results suggest that this integrative theoretical framework is useful in explaining adolescents’ intention and their subsequent sexual abstinence.

Is Abstinence Education Theory Based? The Underlying Logic of Abstinence Education Programs in Texas

Authors examined the logic (or the implicit theory) underlying 16 abstinence-only-until-marriage programs in Texas (50% of all programs funded under the federal welfare reform legislation during 2001 and 2002). Defined as a set of propositions regarding the relationship between program activities and their intended outcomes, program staffs implicit theories were summarized and compared to (a) data from studies on adolescent sexual behavior, (b) a theory-based model of youth abstinent behavior, and (c) preliminary findings from the national evaluation of Title V programs. Authors interviewed 62 program directors and instructors and employed selected principles of grounded theory to analyze interview data. Findings indicated that abstinence education staff could clearly articulate the logic guiding program activity choices. Comparisons between interviewdata and a theory-based model of adolescent sexual behavior revealed striking similarities. Implications of these findings for conceptualizing and evaluating abstinence-only-until-marriage (or similar) programs are examined.

Perceived barriers to children’s active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children’s daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children’s ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children’s ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child’s ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers’ awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Conservative Protestantism and attitudes toward family planning in a sample of seminarians.

We begin by developing arguments linking aspects of Conservative Protestant theology with attitudes toward family planning. We then develop a theoretical model, and test hypotheses distilled from this model using data on a sample of Protestant seminary students (base N = 635) drawn in 1995-96. As expected, seminarians from Conservative Protestant denominations are less supportive of family planning than their mainline counterparts, although respondents in both groups express broadly favorable views of family planning. This observed denominational pattern is accounted for by the disproportionate tendency of fundamentalist and evangelical students to view the Bible as the inerrant Word of God. In turn, the strong relationship between inerrancy and family planning attitudes seems to reflect the inclination of inerrantists : (a) to interpret a key fertility-related passage, Gen. 1:28a, as a command and/or a blessing from God directed at individuals and couples; and (b) to harbor more conservative attitudes regarding human sexuality. Several alternative explanations for the denominational variations in family planning attitudes are also explored. We conclude by discussing the implications of our findings for future research on Conservative Protestant attitudinal distinctiveness, and on the links between religion and health issues.

Children’s active commuting to school: an interplay of self-efficacy, social economic disadvantage, and environmental characteristics

BackgroundActive commuting to school (ACS) can promote children’s physical activity and may help prevent childhood obesity. Previous researchers in various disciplines, e.g., health, urban planning, and transportation, have identified various predictors of ACS. However, little research has been carried out into investigating the effect of self-efficacy on ACS. The purpose of this study is to investigate the roles of children’s and parents’ self-efficacy in children’s ACS, controlling for sociodemographic and objective environmental characteristics.MethodsThis study is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, which includes data from 857 parent/child pairs from 74 schools who lived within two miles of school in Texas. Measures included children’s usual modes of commuting to school, participants’ sociodemographics, perceived self-efficacy toward ACS, sources of children’s self-efficacy, school settings, and objective environmental constraints. Multilevel structural equation modeling (SEM) was employed to test the hypothesized pathways using Mplus 7.0.ResultsAround 18% of the children were active commuters. Two sources of children’s self-efficacy were identified, i.e., emotional states (β = 0.36, p < 0.001) and social modeling (β = 0.28, p < 0.01). Compared with children’s self-efficacy (β = 0.16, p < 0.001), parents’ self-efficacy (β = 0.63, p < 0.001) had a stronger influence on children’s ACS. Participants’ social economic disadvantage (β = 0.40, p < 0.001), environmental constraints (β = −0.49, p < 0.001), and school setting (β = −0.17, p = 0.029) all had statistically significant direct effects on children’s ACS.ConclusionsFuture initiatives should consider both parents’ and children’s self-efficacy in developing strategies for promoting children’s ACS. Social disadvantage and environmental constraints also need to be addressed for effective interventions. The work reported here provides support for the continuing exploration of the role of self-efficacy in children’s ACS.