Parents' preferences for return of results in pediatric genomic research.

BACKGROUND: The aim of this study was to ascertain parental preferences for the return of genetic research results on themselves and their children and their choices for genetic research results to receive. METHODS: A mail survey was sent to 6,874 families seen at Boston Children's Hospital. The survey included questions assessing the respondents' preferences regarding the types of result they wanted to receive on themselves and their children. RESULTS: Most of the 1,060 respondents 'probably' or 'definitely' wanted to receive genetic research results about themselves (84.6%) and their children (88.0%). Among those who wanted to receive results, 83.4% wanted to receive all research results for themselves and 87.8% for their children. When questions about specific types of research results were combined into a composite measure, fewer respondents chose to receive all results for themselves (53.5%) and for their children (56.9%). CONCLUSION: Although most parents report a desire to receive all research results on a general question, almost half chose to receive only a subset of research results when presented with specific types of research results. Our findings suggest that participants might not understand the implications of their choice of individual research results to receive unless faced with specific types of results.

Risk and reluctance: understanding impediments to colorectal cancer screening.

PURPOSE: Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy. METHODS: We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus. RESULTS: CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable. CONCLUSIONS: We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.

Giving means receiving: the protective effect of social capital on binge drinking on college campuses.

OBJECTIVES: We tested whether higher levels of social capital on college campuses protected against individual risks of binge drinking. METHODS: We used a nationally representative survey of 17,592 young people enrolled at 140 4-year colleges. Social capital was operationalized as individuals' average time committed to volunteering in the past month aggregated to the campus level. RESULTS: In multivariate analyses controlling for individual volunteering, sociodemographics, and several college characteristics, individuals from campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking (P < .001) than their peers at other schools. CONCLUSIONS: Social capital may play an important role in preventing binge drinking in the college setting.

Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions.

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.

What colleges are doing about student binge drinking. A survey of college administrators.

In 1999, the Harvard School of Public Health College Alcohol Study surveyed 734 US college administrators to learn what colleges were doing to prevent binge drinking. Respondents rated the severity of student alcohol-abuse problems and described prevention efforts and institutional investments in prevention infrastructure. Prevention practices were widespread in the areas of general education about alcohol, use of policy controls to limit access to alcohol, restricting advertising at home-game sporting events, and allocation of living space to alcohol-free dormitories. Programming was less prevalent for more targeted alcohol education, outreach, and restrictions on alcohol advertising in campus media. Nationally, most of the surveyed colleges reported having a campus alcohol specialist, many had task forces, and about half were performing in-house data collection. Less common were program evaluations, community agreements, or neighborhood exchanges. Prevention practices varied with institutional characteristics and the surveyed administrators' perceptions of the severity of alcohol problems.

Alcohol use, abuse, and related problems among children of problem drinkers: findings from a national survey of college alcohol use.

The purpose of this study was to estimate the prevalence of parental problem drinking reported by a national sample of college students and to examine the relations between such reports and respondents' patterns of drinking, alcohol abuse, abstinence, and utilization of treatment/counseling. Responses to mailed questionnaires completed by a random sample of 17,592 students at a representative national sample of 140 four-year colleges were analyzed using logistic regression. About 10% of college students reported problem-drinking parents. These children of problem drinkers (COPDs) exhibited a bimodal pattern of drinking behavior, showing higher than normal odds of past year abstinence or heavy episodic drinking. Males were more likely than females to report heavy episodic drinking, and children of affected mothers were at greatest risk. Approximately 23% of COPDs met proxy DSM-IV alcohol abuse criteria COPDs in college are a heterogeneous group showing both vulnerability and resistance. Those reporting treatment are more likely to be abstainers.