Robert T. Croyle

PSYCHOLOGICAL RESPONSES TO BRCA1 MUTATION TESTING: PRELIMINARY FINDINGS

The short-term psychological responses of 60 adult women tested for a BRCA1 gene mutation associated with a high risk of breast and ovarian cancer were investigated. Participants were members of a large kindred enrolled in an ongoing prospective study of the psychosocial impact of genetic testing. Initial results from participants who completed both the pretest baseline and the 1-2 week posttest follow-up interviews are reported. Gene mutation carriers manifested significantly higher levels of test-related psychological distress, as measured by the Impact of Event Scale, when compared with noncarriers. The highest levels of test-related distress were observed among mutation carriers with no history of cancer or cancer-related surgery. Although general distress (state anxiety) declined after testing, carriers were more distressed than noncarriers at follow-up.

Preventing 3 Million Premature Deaths and Helping 5 Million Smokers Quit: A National Action Plan for Tobacco Cessation

In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittees report, A National Action Plan for Tobacco Cessation, outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers Health Fund to finance the programs (through a 2 US dollar per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan.

Screening behaviors among African American women at high risk for breast cancer: do beliefs about god matter?

PURPOSE/OBJECTIVESnTo examine the relationship between beliefs about God as a controlling force in health and adherence to breast cancer screening among high-risk African American women.nnnDESIGNnCross-sectional cohort.nnnSETTINGnIn-person interviews in rural, southeastern Louisiana and telephone interviews conducted at the University of Utah.nnnSAMPLEn52 females who were members of a large kindred with a BRCA1 mutation; no subjects had breast cancer.nnnMETHODSnSurvey through in-person or telephone interviews.nnnMAIN RESEARCH VARIABLESnBelief in God as a controlling agent over health measured by the God Locus of Health Control (GLHC) scale; screening behaviors measured by self-report. Adherence was based on consensus-approved recommendations for BRCA1 carriers or women at risk of being carriers.nnnFINDINGSnBivariate analysis indicated that presence of a primary care provider and low GLHC scores were associated with seeking clinical breast examination (CBE) and mammography. With the variable presence of a primary care provider excluded, GLHC scores were inversely associated with seeking CBE and mammography.nnnCONCLUSIONSnAfrican American women at increased risk for breast cancer and with high GLHC scores may have a decreased inclination to adhere to CBE and mammography recommendations.nnnIMPLICATIONS FOR NURSINGnAssessing religious and spiritual beliefs and incorporating belief systems into education and counseling sessions may improve understanding and acceptance of presented material.

Psychological minimization of cholesterol test results: Moderators of appraisal in college students and community residents.

College students received randomly assigned desirable or borderline-high cholesterol test results. Borderline-high Ss rated high cholesterol as a less serious threat to health, viewed the test as less accurate, and perceived high cholesterol as more common than did those given desirable readings. High self-esteem or blunting coping style predicted lower distress after borderline-high readings but did not moderate cognitive appraisal. In Study 2, minimization was again observed among participants in a community screening, primarily among those who had never been tested. Although the never-tested group was younger and less knowledgeable about cholesterol, these factors did not account for minimization. The results support the generalizability of laboratory data on risk appraisal and provide new evidence regarding the nature and determinants of threat minimization.

Attitudes toward genetic testing for colon cancer risk

This study examined public interest regarding genetic testing for colon cancer susceptibility. Survey data were collected from 383 adults in Utah. Respondents were very (47.3%) or somewhat (36.6%) interested in taking this genetic test. Nearly 95% reported that they would share their results with others. Individuals with higher income and with a perceived risk of getting colon cancer were the most interested in testing. Individuals without health insurance and widowed individuals were the least likely to share their test results. If respondents were told that they carried a gene for colon cancer, most would be concerned with how to reduce their risk of getting the disease.

Cancer-Related Health Disparities in Women

OBJECTIVESnThis article synthesizes information about cancer in 9 populations of minority women: Mexican American, Puerto Rican, Cuban American, African American, Asian American, Native Hawaiian, American Samoan, American Indian, and Alaska Native.nnnMETHODSnCancer registry data, social indicators, government sources, and published articles were searched for information on the background and cancer experience of these 9 racial/ethnic groups.nnnRESULTSnApproximately 35 million women in these racial/ethnic groups live in the United States, and their numbers are increasing rapidly. Since 1992, incidence rates for major cancer sites have slowed or decreased among these groups, but declines in mortality have not occurred or have been smaller than for Whites. Gaps in early detection have narrowed, but minority women still lag behind Whites. Smoking and obesity remain common in these populations.nnnCONCLUSIONSnMore culturally appropriate interventions and research are needed, and these efforts must involve the community and raise the quality of health services.

The effects of social context and defensiveness on the physiological responses of repressive copers.

In previous research (T.L. Newton & R.J. Contrada, 1992), social context was found to moderate exaggerated physiological reactivity among individuals identified as using a repressive coping style. In this experiment, 119 undergraduates were classified into low-anxious, high-anxious, repressor, and defensive high-anxious coping categories. All participants completed a stressful speech task under either a public or private social context condition. The experimental social context was related to physiological reactivity and self-reported affect but did not moderate reactivity among repressive copers. Additionally, reactivity among repressive copers was not attributable to high defensiveness alone. Consistent with a theory of emotional inhibition, nonspecific skin conductance responses, but not heart rate, discriminated between repressors and nonrepressors.

The Effects of Stealing Thunder in Criminal and Civil Trials

The effectiveness of a persuasion technique referred to asstealing thunder was assessed in two simulated jury trials. Stealing thunder is defined as revealing negative information about oneself (or, in a legal setting, ones client) before it is revealed or elicited by another person. In Study 1, 257 college students read or heard one of three versions of a criminal assault trial in which a damaging piece of evidence about the defendant was absent (no thunder), brought up by the prosecutor (thunder), or brought up by the defense attorney and repeated by the prosecutor (stolen thunder). In Study 2, 148 college students heard a civil negligence trial in which damaging evidence about the key plaintiffs witness was absent (no thunder), brought up by the defendants attorney (thunder), or brought up by the witness himself (stolen thunder). In both studies, stealing thunder significantly reduced the impact of the negative information. A path analysis of the processes underlying the effect suggested that verdicts were affected because of enhanced credibility.

Illness cognition and behavior: An experimental approach

The study of illness cognition and behavior has relied primarily on nonexperimental research designs. In this paper we review the results of a program of experimental investigations of psychological reactions to health threats. Most of the studies employ a new experimental paradigm developed to study illness cognition and behavior in the laboratory. The paradigm has been used in several experiments to examine the cognitive and motivational processes underlying reactions to medical test results. A converging series of studies has shown that denial, manifested in a variety of ways, is a common initial reaction to threatening information. In addition, the studies demonstrate that the perceived prevalence of a health disorder is an important determinant of its perceived seriousness. The insights gained from these studies illustrate the complementary roles of basic experimental research and more naturalistic observational research in the formulation of comprehensive theories of health and illness behavior.

Appraisal of health threats: Cognition, motivation, and social comparison

Recent experimental research has examined the determinants of illness-related cognitive appraisals. This work is reviewed and discussed within the context of Lazarus and Folkmans (1984) stress and coping model. The data from this research support and extend the model, but are best accounted for by Leventhal, Nerenz, and Steeles (1984) self-regulation theory of illness behavior. Neither model adequately addresses the role of social comparison and influence, which, together with a motivationally biased system of cognitive appraisal, provides individuals with a highly adaptive repertoire of strategies for maintaining emotional equilibrium and a positive view of their own health status.