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Ball EM, Costello RA, Ballen CJ, Graze RM, Burkholder EW. Challenging Misconceptions about Race in Undergraduate Genetics. CBE LIFE SCIENCES EDUCATION 2024; 23:ar32. [PMID: 38981004 DOI: 10.1187/cbe.23-12-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Racial biases, which harm marginalized and excluded communities, may be combatted by clarifying misconceptions about race during biology lessons. We developed a human genetics laboratory activity that challenges the misconception that race is biological (biological essentialism). We assessed the relationship between this activity and student outcomes using a survey of students' attitudes about biological essentialism and color-evasive ideology and a concept inventory about phylogeny and human diversity. Students in the human genetics laboratory activity showed a significant decrease in their acceptance of biological essentialism compared with a control group, but did not show changes in color-evasive ideology. Students in both groups exhibited increased knowledge in both areas of the concept inventory, but the gains were larger in the human genetics laboratory. In the second iteration of this activity, we found that only white students' decreases in biological essentialist beliefs were significant and the activity failed to decrease color-evasive ideologies for all students. Concept inventory gains were similar and significant for both white and non-white students in this iteration. Our findings underscore the effectiveness of addressing misconceptions about the biological origins of race and encourage more research on ways to effectively change damaging student attitudes about race in undergraduate genetics education.
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Affiliation(s)
- Erin M Ball
- Department of Biological Sciences, Auburn University, Auburn, AL 36849
| | - Robin A Costello
- Department of Biological Sciences, Auburn University, Auburn, AL 36849
| | - Cissy J Ballen
- Department of Biological Sciences, Auburn University, Auburn, AL 36849
| | - Rita M Graze
- Department of Biological Sciences, Auburn University, Auburn, AL 36849
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Wynn J, Karlsen A, Huber B, Levine A, Salem A, White LC, Luby M, Bezborodko E, Xiao S, Chung WK, Klitzman RL, Appelbaum PS. Impact of a Genetic Diagnosis for a Child's Autism on Parental Perceptions. J Autism Dev Disord 2024:10.1007/s10803-024-06273-x. [PMID: 38578549 DOI: 10.1007/s10803-024-06273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 04/06/2024]
Abstract
Genetic testing is recommended as part of an autism assessment, and most parents support genetic testing for their minor children. However, the impact on parents of receiving a monogenetic/ copy number variant diagnosis for autism in their child is not well understood. To explore this, we surveyed and interviewed parents of children in the SPARK study, a study of autism that includes genetic testing. Surveys were administered one month before and one and 12 months after parents received their child's genetic result. Interviews were conducted approximately one month after results disclosure. A genetic diagnosis (GD) for their child appeared to reduce parents' sense of self-blame and feelings of guilt, and this impact was relatively stable. The data also indicate a modest impact on parents' actions related to the condition, perceptions of themselves, and some aspects of life planning for their child, as measured by quantitative instruments at one month and 12 months after receipt of results. Other measures of parental identity and expectations for their child, in contrast, showed little change following receipt of genetic findings. Overall, parents who were told that no GD was identified showed minimal changes in their responses over time. These results suggest a discernable but relatively limited impact of genetic test results on parents of children with autism. These results should be reassuring to clinicians caring for children with autism and are consistent with studies in other areas of medicine that have suggested that genetic results tend to have fewer effects-negative or positive-than were anticipated.
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Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
| | - Anna Karlsen
- Columbia University Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Benjamin Huber
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alina Levine
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amanie Salem
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Ekaterina Bezborodko
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Simons Foundation, New York, NY, USA
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert L Klitzman
- Department of Psychiatry and Masters of Bioethics Program, and New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Paul S Appelbaum
- Department of Psychiatry, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
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Martin SC, Scott AM, Stone AM. Women's Metaphors About BRCA Gene Testing and How They Can Inform Health Communication Theory and Practice. HEALTH COMMUNICATION 2024; 39:603-615. [PMID: 36775863 DOI: 10.1080/10410236.2023.2178051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman's risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women's experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora's box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women's experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk.
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Affiliation(s)
- Summer C Martin
- Department of Human Communication Studies, California State University, Fullerton
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Abstract
Genetic concepts are regularly used in arguments about racial inequality. This review summarizes research about the relationship between genetics education and a particular form of racial prejudice known as genetic essentialism. Genetic essentialism is a cognitive form of prejudice that is used to rationalize inequality. Studies suggest that belief in genetic essentialism among genetics students can be increased or decreased based on what students learn about human genetics and why they learn it. Research suggests that genetics education does little to prevent the development of genetic essentialism, and it may even exacerbate belief in it. However, some forms of genetics education can avert this problem. In particular, if instructors teach genetics to help students understand the flaws in genetic essentialist arguments, then it is possible to reduce belief in genetic essentialism among biology students. This review outlines our knowledge about how to accomplish this goal and the research that needs to be done to end genetic essentialism through genetics education.
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Affiliation(s)
- Brian M Donovan
- BSCS Science Learning, 5415 Mark Dabling Boulevard, Colorado Springs, CO 80918, USA
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Docherty A, Kious B, Brown T, Francis L, Stark L, Keeshin B, Botkin J, DiBlasi E, Gray D, Coon H. Ethical concerns relating to genetic risk scores for suicide. Am J Med Genet B Neuropsychiatr Genet 2021; 186:433-444. [PMID: 34472199 PMCID: PMC8692426 DOI: 10.1002/ajmg.b.32871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/02/2023]
Abstract
Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.
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Affiliation(s)
- Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Brent Kious
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Teneille Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Leslie Francis
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Louisa Stark
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Genetic Science Learning Center, University of Utah, Salt Lake City, UT USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT USA
| | - Jeffrey Botkin
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Doug Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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Haskel-Ittah M, Duncan RG, Yarden A. Students' Understanding of the Dynamic Nature of Genetics: Characterizing Undergraduates' Explanations for Interaction between Genetics and Environment. CBE LIFE SCIENCES EDUCATION 2020; 19:ar37. [PMID: 32822276 PMCID: PMC8711817 DOI: 10.1187/cbe.19-11-0221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/25/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
The idea of the interaction between genes and environment in the formation of traits is an important component of genetic literacy, because it explains the plastic nature of phenotypes. However, most studies in genetics education characterize challenges in understanding and reasoning about genetic phenomena that do not involve modulation by the environment. Therefore, we do not know enough to inform the development of effective instructional materials that address the influences of environmental factors on genes and traits, that is, phenotypic plasticity. The current study explores college students' understanding of phenotypic plasticity. We interviewed biological sciences undergraduates who are at different stages of their undergraduate studies and asked them to explain several phenomena that involved phenotypic plasticity. Analysis of the interviews revealed two types of mechanistic accounts: one type described the interaction as involving the environment directly acting on a passive organism; while the other described the interaction as mediated by a sensing-and-responding mechanism. While both accounts are plausible, the second account is critical for reasoning about phenotypic plasticity. We also found that contextual features of the phenomena may affect the type of account generated. Based on these findings, we recommend focusing instruction on the ways in which organisms sense and respond.
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Affiliation(s)
- Michal Haskel-Ittah
- Department of Science Teaching, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Ravit Golan Duncan
- Graduate School of Education and the School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901; Visiting Faculty Program Fellow at the Weizmann Institute of Science, Rehovot 76100
| | - Anat Yarden
- Department of Science Teaching, Weizmann Institute of Science, Rehovot 76100, Israel
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Lynch KE, Morandini JS, Dar-Nimrod I, Griffiths PE. Causal Reasoning About Human Behavior Genetics: Synthesis and Future Directions. Behav Genet 2018; 49:221-234. [DOI: 10.1007/s10519-018-9909-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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Adelsperger S, Prows CA, Myers MF, Perry CL, Chandler A, Holm IA, Lynch JA. Parental Perception of Self-Empowerment in Pediatric Pharmacogenetic Testing: The Reactions of Parents to the Communication of Actual and Hypothetical CYP2D6 Test Results. HEALTH COMMUNICATION 2017; 32:1104-1111. [PMID: 27573590 PMCID: PMC5332344 DOI: 10.1080/10410236.2016.1214216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Concerns about the ethical and social implications of genetics persist as more applications of genetic and genomic technology have become available. Pediatric testing for genetic influences on response to opioids like codeine is one area of application. We interviewed parents of children enrolled in a mixed-methods study following the communication of actual or hypothetical results for CYP2D6, which impacts opioid response. Forty-one parents of children naive to opioids and 42 parents of children previously exposed to opioids participated in qualitative interviews. Findings did not differ by the child's opioid exposure or by actual versus hypothetical results. Parents' responses centered on the experience of the parent(s) and the potential impact of that information on the parent, rather than the result's impact on the child. Parents also emphasized that the results did not impact their perceptions of the child, reaffirming that the child was still "normal" regardless of test result. When asked about the impact of receiving secondary results, parents' responses emphasized how the results would impact their ability to advocate for the child or impact their state of mind. While the answers reflect parents' role as surrogate decision maker for their child, they also reinforced concerns that health care decisions might be influenced by secondary parental concerns as much as by the best interests of the child. Emphasis on the child's "normality" challenges concerns about the impact of genetic essentialism, but further research is required to see whether the type of testing done or the way results were communicated shaped this response.
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Affiliation(s)
- Sarah Adelsperger
- a College of Medicine , University of Cincinnati
- b Division of Human Genetics , Cincinnati Children's Hospital Medical Center
| | - Cynthia A Prows
- b Division of Human Genetics , Cincinnati Children's Hospital Medical Center
| | - Melanie F Myers
- a College of Medicine , University of Cincinnati
- b Division of Human Genetics , Cincinnati Children's Hospital Medical Center
| | | | - Ariel Chandler
- c Division of Genetics and Genomics , Boston Children's Hospital
| | - Ingrid A Holm
- c Division of Genetics and Genomics , Boston Children's Hospital
| | - John A Lynch
- d Department of Communication , University of Cincinnati
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Zhu X, Smith RA, Parrott RL. Living with a Rare Health Condition: The Influence of a Support Community and Public Stigma on Communication, Stress, and Available Support. JOURNAL OF APPLIED COMMUNICATION RESEARCH : JACR 2017; 45:179-198. [PMID: 29398734 PMCID: PMC5793934 DOI: 10.1080/00909882.2017.1288292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People affected by rare diseases often have limited coping resources and sometimes face stigma. They build communities with others who share their conditions, but not all members may benefit from these communities. This study investigated how adults with a rare genetic health condition (Alpha-1 antitrypsin deficiency; AATD) think about both the Alpha-1 community and public stigma about AATD, and how these cognitions were associated with their communication responses and well-being. The results showed that people with AATD encountered stigmatization from various sources, including family, employers, healthcare providers, and insurance companies. Stronger public stigma predicted more secrecy, more stress, and less available support. Stronger group identification with the Alpha-1 community predicted less secrecy; stronger group activism predicted more available support and more communication to challenge stigmatizers. Post-hoc analyses showed significant interactions between public stigma and group cognitions on communication to challenge stigmatizers. Practical implications for bolstering communities to improve the well-being of people with rare diseases were discussed.
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Affiliation(s)
- Xun Zhu
- Communication Arts & Sciences, Pennsylvania State University, 316 Sparks Building, University Park, PA 16802
| | - Rachel A Smith
- Communication Arts & Sciences, Pennsylvania State University, 216 Sparks Building, University Park, PA 16802, (814) 865-4201
| | - Roxanne L Parrott
- Communication Arts & Sciences and Health Policy & Administration, Pennsylvania State University
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Krieger JL, Neil JM, Strekalova YA, Sarge MA. Linguistic Strategies for Improving Informed Consent in Clinical Trials Among Low Health Literacy Patients. J Natl Cancer Inst 2017; 109:2905672. [PMID: 27794035 PMCID: PMC5441300 DOI: 10.1093/jnci/djw233] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/10/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022] Open
Abstract
Background Improving informed consent to participate in randomized clinical trials (RCTs) is a key challenge in cancer communication. The current study examines strategies for enhancing randomization comprehension among patients with diverse levels of health literacy and identifies cognitive and affective predictors of intentions to participate in cancer RCTs. Methods Using a post-test-only experimental design, cancer patients (n = 500) were randomly assigned to receive one of three message conditions for explaining randomization (ie, plain language condition, gambling metaphor, benign metaphor) or a control message. All statistical tests were two-sided. Results Health literacy was a statistically significant moderator of randomization comprehension (P = .03). Among participants with the lowest levels of health literacy, the benign metaphor resulted in greater comprehension of randomization as compared with plain language (P = .04) and control (P = .004) messages. Among participants with the highest levels of health literacy, the gambling metaphor resulted in greater randomization comprehension as compared with the benign metaphor (P = .04). A serial mediation model showed a statistically significant negative indirect effect of comprehension on behavioral intention through personal relevance of RCTs and anxiety associated with participation in RCTs (P < .001). Conclusions The effectiveness of metaphors for explaining randomization depends on health literacy, with a benign metaphor being particularly effective for patients at the lower end of the health literacy spectrum. The theoretical model demonstrates the cognitive and affective predictors of behavioral intention to participate in cancer RCTs and offers guidance on how future research should employ communication strategies to improve the informed consent processes.
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Affiliation(s)
- Janice L. Krieger
- Affiliations of authors: STEM Translational Communication Center (JLK, JMN, YAS), Department of Advertising (JLK), and Division of Graduate Studies and Research (YAS), College of Journalism and Communications, University of Florida; Department of Advertising, College of Media and Communication, Texas Tech University (MAS), Gainesville, FL, Lubbock, TX
| | - Jordan M. Neil
- Affiliations of authors: STEM Translational Communication Center (JLK, JMN, YAS), Department of Advertising (JLK), and Division of Graduate Studies and Research (YAS), College of Journalism and Communications, University of Florida; Department of Advertising, College of Media and Communication, Texas Tech University (MAS), Gainesville, FL, Lubbock, TX
| | - Yulia A. Strekalova
- Affiliations of authors: STEM Translational Communication Center (JLK, JMN, YAS), Department of Advertising (JLK), and Division of Graduate Studies and Research (YAS), College of Journalism and Communications, University of Florida; Department of Advertising, College of Media and Communication, Texas Tech University (MAS), Gainesville, FL, Lubbock, TX
| | - Melanie A. Sarge
- Affiliations of authors: STEM Translational Communication Center (JLK, JMN, YAS), Department of Advertising (JLK), and Division of Graduate Studies and Research (YAS), College of Journalism and Communications, University of Florida; Department of Advertising, College of Media and Communication, Texas Tech University (MAS), Gainesville, FL, Lubbock, TX
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Heine S, Dar-Nimrod I, Cheung B, Proulx T. Essentially Biased. ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2017. [DOI: 10.1016/bs.aesp.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Perlman DC, Jordan AE. To neither target, capture, surveille, nor wage war: On-going need for attention to metaphor theory in care and prevention for people who use drugs. J Addict Dis 2016; 36:1-4. [PMID: 27827568 DOI: 10.1080/10550887.2016.1258169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Metaphors, and the frames they evoke, potently influence how people understand issues. These concepts of discourse, metaphor, and framing have been productively used in a range of studies including in the field of addiction. In public health and clinical discourse on people who use drugs, use of terms such as "targeting," "surveilling," and "capturing," along with "war on drugs" frames and referring to drug treatment as "substitution" may reinforce negative perceptions of people who use drugs. Avoiding military metaphors and explicitly leveraging metaphors that emphasize humanity, social cohesion, and agency have the potential to improve public health for people who use drugs.
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Affiliation(s)
- David C Perlman
- a Icahn School of Medicine at Mount Sinai , Mount Sinai Beth Israel , New York , New York , USA.,b Center for Drug Use and HIV Research , New York , New York , USA
| | - Ashly E Jordan
- c City University of New York, School of Public Health , New York , New York , USA.,d Center for Drug Use and HIV Research , New York , New York , USA
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McBride CM, Koehly LM. Imagining roles for epigenetics in health promotion research. J Behav Med 2016; 40:229-238. [PMID: 27412775 PMCID: PMC5332486 DOI: 10.1007/s10865-016-9764-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/01/2016] [Indexed: 12/20/2022]
Abstract
Discoveries from the Human Genome Project have invigorated discussions of epigenetic effects-modifiable chemical processes that influence DNA's ability to give instructions to turn gene expression on or off-on health outcomes. We suggest three domains in which new understandings of epigenetics could inform innovations in health promotion research: (1) increase the motivational potency of health communications (e.g., explaining individual differences in health outcomes to interrupt optimistic biases about health exposures); (2) illuminate new approaches to targeted and tailored health promotion interventions (e.g., relapse prevention targeted to epigenetic responses to intervention participation); and (3) inform more sensitive measures of intervention impact, (e.g., replace or augment self-reported adherence). We suggest a three-step process for using epigenetics in health promotion research that emphasizes integrating epigenetic mechanisms into conceptual model development that then informs selection of intervention approaches and outcomes. Lastly, we pose examples of relevant scientific questions worth exploring.
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Affiliation(s)
- Colleen M McBride
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, GCR 564, Atlanta, GA, 30322, USA.
| | - Laura M Koehly
- National Human Genome Research Institute, Bethesda, MD, USA
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Parrott RL, Smith RA, Hong SJ, Worthington A. Congruence-Incongruence Patterns in Alpha-1 Antitrypsin Deficiency Couples' Genetic Determinist Beliefs and Perceived Control over Genes: Implications for Clinical and Public Health Genomic Communication. J Genet Couns 2015; 24:532-40. [PMID: 25413221 PMCID: PMC4437887 DOI: 10.1007/s10897-014-9786-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
Genomics makes possible the isolation of multiple genes as co-factors that increase, but do not determine, risk for many adult-onset medical conditions, including alpha-1 antitrypsin deficiency (AATD). Those diagnosed with an adult-onset medical condition, such as AATD, are often married and make decisions about testing and care as a couple. We examined genetic essentialist and threat beliefs, focusing on beliefs about the genetic contribution to disease susceptibility and severity, as well as perceptions of control related to genes and health for married couples (N =59), in which one spouse has been tested for genetic mutations associated with AATD. The intraclass correlation for spouses' beliefs about genetic essentialism was strong and statistically significant, but the associations for their other beliefs were not. Incongruence between AATD participants and their spouses regarding genes' influence on disease severity directly related to incongruent perceptions of control and genetic contribution to disease susceptibility. Results revealed an inverse relationship to AATD participants' perceptions of behavioral control and a direct relationship to their beliefs about genes' influence on disease severity. This suggests a pattern of incongruence in which AATD participants have low levels of perceived control over genes' influence on health and high levels of perceived genetic influence on disease severity compared to spouses. With public health communication efforts lagging behind the science of genomics, insights regarding the congruence or incongruence associated with married couples' beliefs about genes' influence on disease afford pathways to guide clinical and public health communication about genomics.
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Affiliation(s)
- Roxanne L Parrott
- Communication Arts and Sciences, The Pennsylvania State University, University Park, PA, USA,
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Parrott R. Communicating about family health history: heredity, culture, iatrogenesis and the public good. Br J Soc Med 2015; 69:3-5. [DOI: 10.1136/jech-2014-203874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hitch K, Joseph G, Guiltinan J, Kianmahd J, Youngblom J, Blanco A. Lynch syndrome patients' views of and preferences for return of results following whole exome sequencing. J Genet Couns 2014; 23:539-51. [PMID: 24449059 DOI: 10.1007/s10897-014-9687-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/05/2014] [Indexed: 01/24/2023]
Abstract
Whole exome sequencing (WES) uses next generation sequencing technology to provide information on nearly all functional, protein-coding regions in an individual's genome. Due to the vast amount of information and incidental findings that can be generated from this technology, patient preferences must be investigated to help clinicians consent and return results to patients. Patients (n = 19) who were previously clinically diagnosed with Lynch syndrome, but received uninformative negative Lynch syndrome genetic results through traditional molecular testing methods participated in semi-structured interviews after WES testing but before return of results to explore their views of WES and preferences for return of results. Analyses of interview results found that nearly all participants believed that the benefits of receiving all possible results generated from WES outweighed the undesirable effects. The majority of participants conveyed that relative to coping with a cancer diagnosis, information generated from WES would be manageable. Importantly, participants' experience with Lynch syndrome influenced their notions of genetic determinism, tolerance for uncertain results, and family communication plans. Participants would prefer to receive WES results in person from a genetic counselor or medical geneticist so that an expert could help explain the meaning and implications of the potentially large quantity and range of complicated results. These results underscore the need to study various populations with regard to the clinical use of WES in order to effectively and empathetically communicate the possible implications of this new technology and return results.
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Affiliation(s)
- Kelly Hitch
- California State University, Stanislaus, Turlock, CA, USA,
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