Medicare beneficiary barriers to genetic counselor services: Implications for patient policy, decision-making, and care.

If passed, the "Access to Genetic Counselor Services Act" will authorize genetic counselors to provide services under Medicare part B. We assert that Medicare policy should be updated through the enactment of this legislation to provide Medicare beneficiaries with direct access to genetic counselor services. In this article, we discuss the background, history, and some recent research relevant to patient access to genetic counselors to provide context and perspective regarding the rationale, justification, and potential results of the proposed legislation. We outline the potential impact of Medicare policy reform, including the effect on access to genetic counselors in high-demand areas or underserved communities. Although the proposed legislation pertains only to Medicare, we argue that private systems will also be impacted by passage as this may lead to an increase in hiring and retention of genetic counselors by health systems, thereby improving access to genetic counselors across the US.

Childhood emotional abuse, self/other attachment, and hopelessness in African-American women.

There is evidence that individuals emotionally abused as children endorse more hopelessness, a precursor of suicidal behavior in adulthood. However, there has been little focus on this association among African-Americans or on factors that may mediate the childhood emotional abuse (CEA) - adult hopelessness link. The present study examined whether CEA is linked to hopelessness in adulthood in African-American women suicide attempters and if adult self and other attachment models mediate this association. Participants included 116 African-American women recruited from a large, urban hospital. Results revealed that CEA had no direct effect on hopelessness in adulthood, but did have an indirect effect on hopelessness through attachment models. Bootstrapping analyses showed that higher levels of CEA were related to more negative self and other attachment models, which were then linked to higher levels of hopelessness. Implications for targeting attachment in suicide intervention programs are discussed.

Disparity in Access to Oncology Precision Care: A Geospatial Analysis of Driving Distances to Genetic Counselors in the U.S.

In the US, the growing demand for precision medicine, particularly in oncology, continues to put pressure on the availability of genetic counselors to meet that demand. This is especially true in certain geographic locations due to the uneven distribution of genetic counselors throughout the US. To assess these disparities, access to genetic counselors of all specialties is explored by geography, cancer type, and social determinants of health. Geospatial technology was used to combine and analyze genetic counselor locations and cancer incidence at the county level across the US, with a particular focus on tumors associated with BRCA mutations including ovarian, pancreatic, prostate and breast. Access distributions were quantified, and associations with region, cancer type, and socioeconomic variables were investigated using correlational tests. Nationally, in 2020, there were 4,813 genetic counselors, or 1.49 genetic counselors per 100,000 people, varying between 0.17 to 5.7 per 100,000 at the state level. Seventy-one percent of U.S. residents live within a 30-minute drive-time to a genetic counselor. Drive-times, however, are not equally distributed across the country - while 82% of people in metropolitan areas are 30 minutes from a genetic counselor, only 6% of people in nonmetro areas live within 30 minutes' drive time. There are statistically significant differences in access across geographical regions, socioeconomics and cancer types. Access to genetic counselors for cancer patients differs across groups, including regional, socioeconomic, and cancer type. These findings highlight areas of the country that may benefit from increased genetic counseling provider supply, by increasing the number of genetic counselors in a region or by expanding the use of telegenetics a term used to describe virtual genetic counseling consults that occur via videoconference. Policy intervention to allow genetic counselors to bill for their services may be an effective route for increasing availability of genetic counselors' services However, genetic counselors in direct patient care settings also face other challenges such as salary, job satisfaction, job recognition, overwork/burnout, and appropriate administrative/clinical support, and addressing these issues should also be considered along with policy support. These results could support targeted policy reform and alternative service models to increase access to identified pockets of unmet need, such as telemedicine. Data and analysis are available to the public through an interactive dashboard.

Evidence for Multiple Classes of Sexually-Violent College Men.

OBJECTIVE: Research on college sexual violence perpetration suggests there are multiple groups of male perpetrators. It is important to understand the distinctions between perpetrator subgroups to determine appropriate prevention strategies, as multiple strategies may be necessary to address multiple types of perpetrators. However, previous studies on subgroups of sexually-violent college men have relied on theoretically based distinctions, and there is currently no consensus on how to best classify perpetrators based on their sexually violent behaviors. The purpose of the current study was to take a data-driven approach to identifying subgroups of sexually-violent college men to help clarify: 1) the number and size of cohesive subgroups of sexually-violent college men, and 2) the types of behaviors that characterize each group. METHODS: 1,982 college men across five universities in the U.S. self-reported their past sexually-violent behaviors, using the Sexual Experiences Survey (SES; Koss et al., 2007). RESULTS: Latent class analysis uncovered evidence for three groups: (1) a group unlikely to perpetrate any SV (88.6%); (2) a group likely to perpetrate SV using coercive tactics (verbal coercion or victim intoxication), but unlikely to use physical force (9.8%); and (3) a group likely to perpetrate the full range of SV (1.5%). Although the coercive tactics group was composed of men unlikely to use forceful tactics, it included the majority who attempted or completed rape based on legal definitions. CONCLUSIONS: Our findings suggest that there are multiple, distinct perpetrator subgroups and signal the need for multiple prevention approaches, including approaches that address campus social norms.

Compassion-Based Meditation in African Americans: Self-Criticism Mediates Changes in Depression.

This study examines self-criticism as a mechanism through which compassion meditation reduces depressive symptoms in low-income African American men and women (N = 59) who had recently attempted suicide. After completing several measures, including the Levels of Self-Criticism Scale and Beck Depression Inventory-II, participants were randomly assigned to receive either a six-session compassion meditation (CM) group (Grady Compassion and Meditation Program) or a six-session support group. As predicted, path analysis results showed that treatment condition led to changes in self-criticism from pre- to posttreatment, with those receiving CM showing greater reductions in levels of self-criticism than those randomized to the support group. Path analyses also revealed that changes in self-criticism fully mediated the link between condition and changes in depressive symptoms. These findings highlight the importance and value of targeting levels of self-criticism in compassion-based interventions to reduce the depressive symptoms of suicidal African Americans.

Impact of violence research on participants over time: Helpful, harmful, or neither?

OBJECTIVE: To investigate the impact of answering survey questions about experiences of stressful, stigmatizing, potentially traumatic and sexually violating events on well being, defined as reactions to research, anxiety, and positive and negative affect over two weeks. METHOD: With an ethnically diverse sample of 559 higher education students, we employed a mixed experimental design (with between and within-subjects components) to evaluate changes in positive and negative affect, anxiety, traumatic stress symptoms, and reactions to research. We used multilevel regression models and planned contrasts to determine which, if any, specific characteristics of the survey questions caused changes in well being by comparing the effects of answering a randomly assigned set of survey questions about stressful, stigmatizing, potentially traumatic, or sexually violating life events across a two-week period. RESULTS: Controlling for baseline post-traumatic stress symptoms and levels of the outcome, we identified few statistically significant effects between conditions or across time. Significant effects included a small decrease in positive affect immediately after responding to questions about sexually violating events, which diminished at two weeks; these same participants perceived fewer drawbacks to research participation. Participants who responded to questions about stressful life events reported greater perceptions of benefits. CONCLUSIONS: Our data support the safety of survey research on sexual assault or other stressful, stigmatizing, or potentially traumatic events.

Body image flexibility moderates the association between disordered eating cognition and disordered eating behavior in a non-clinical sample of women: a cross-sectional investigation.

Body image flexibility, a regulation process of openly and freely experiencing disordered eating thoughts and body dissatisfaction, has been found to be a buffering factor against disordered eating symptomatology. The present cross-sectional study investigates whether body image flexibility accounts for disordered eating behavior above and beyond disordered eating cognition, mindfulness, and psychological inflexibility in a sample of nonclinical women, and whether body image flexibility moderates the associations between these correlates and disordered eating behavior. Participants were 421 women, age 21±5.3 years old on average, who completed a web-based survey that included the self-report measures of interest. Results demonstrate the incremental effects of body image flexibility on disordered eating behavior above and beyond disordered eating cognition, mindfulness, and psychological inflexibility. Women with greater body image flexibility endorse disordered eating behavior less so than those with lower body image flexibility. Body image flexibility moderates the association between disordered eating cognition and disordered eating behavior; for women with greater body image flexibility, disordered eating cognition is not positively associated with disordered eating behavior.