Genetic and lifestyle causal beliefs about obesity and associated diseases among ethnically diverse patients: a structured interview study.

BACKGROUND: New genetic associations with obesity are rapidly being discovered. People's causal beliefs about obesity may influence their obesity-related behaviors. Little is known about genetic compared to lifestyle causal beliefs regarding obesity, and obesity-related diseases, among minority populations. This study examined genetic and lifestyle causal beliefs about obesity and 3 obesity-related diseases among a low-income, ethnically diverse patient sample. METHODS: Structured interviews were conducted with patients attending an inner-city hospital outpatient clinic. Participants (n=205) were asked how much they agreed that genetics influence the risk of obesity, type 2 diabetes, heart disease, and cancer. Similar questions were asked regarding lifestyle causal beliefs (overeating, eating certain types of food, chemicals in food, not exercising, smoking). In this study, 48% of participants were non-Hispanic Black, 29% Hispanic and 10% non-Hispanic White. RESULTS: Over two-thirds (69%) of participants believed genetics cause obesity 'some' or 'a lot', compared to 82% for type 2 diabetes, 79% for heart disease and 75% for cancer. Participants who held genetic causal beliefs about obesity held more lifestyle causal beliefs in total than those who did not hold genetic causal beliefs about obesity (4.0 vs. 3.7 lifestyle causal beliefs, respectively, possible range 0-5, p=0.025). There were few associations between causal beliefs and sociodemographic characteristics. CONCLUSIONS: Higher beliefs in genetic causation of obesity and related diseases are not automatically associated with decreased lifestyle beliefs. Future research efforts are needed to determine whether public health messages aimed at reducing obesity and its consequences in racially and ethnically diverse urban communities may benefit from incorporating an acknowledgement of the role of genetics in these conditions.

What can interest tell us about uptake of genetic testing? Intention and behavior amongst smokers related to patients with lung cancer.

BACKGROUND: Much of the research examining psychosocial aspects of genetic testing has used hypothetical scenarios, based on the largely untested assumption that hypothetical genetic testing intentions are good proxies for behavior. We tested whether hypothetical interest predicts uptake of genetic testing and whether factors that predict interest also predict uptake. METHODS: Participants (n = 116) were smokers and related to patients with lung cancer, who completed a telephone survey. Interest in genetic testing for lung cancer risk was indicated by responding 'definitely would' to a Likert-style question. Internet-delivered genetic testing for lung cancer risk was then offered. Uptake was indicated by requesting the test and receiving the result. RESULTS: 63% of participants said they 'definitely would' take the genetic test; uptake was 38%. Participants who said they 'definitely would' take the test were more likely than others to take the offered test (45% vs. 26%, p = 0.035). Interest was associated with attitudes towards genetic testing and motivation to quit smoking. Uptake was associated with motivation, prior awareness of genetic testing, and daily Internet use. CONCLUSION: Hypothetical interest only modestly predicts uptake of genetic testing. Interest in genetic testing likely reflects generally positive attitudes that are not good predictors of the choices individuals subsequently make.

Psychological and behavioral responses to genetic test results indicating increased risk of obesity: does the causal pathway from gene to obesity matter?.

BACKGROUND: Common obesity-associated genetic variants may exert their effects through increasing eating or decreasing metabolism. Such differences might influence individual responses to obesity genetic test results. METHODS: This was an experimental analogue study: 191 participants were asked to imagine they had received a genetic test result indicating high eating-based (n = 37) or high metabolism-based (n = 41) risk of obesity, an enzyme test result indicating high eating-based (n = 35) or high metabolism-based (n = 41) risk of obesity, or no risk information (n = 37). Outcomes included perceived risk, self-efficacy (confidence in ability to eat healthily), response-efficacy (confidence that eating healthily will reduce risk), and intention to eat healthily. RESULTS: The groups receiving increased obesity risk information reported greater perceived risk and intention to eat healthily than the no risk information group (both p < 0.01). There were main effects of test type on perceived risk (genetic vs. enzyme: 3.91 vs. 3.55, p = 0.031) and of causal pathway on worry (eating vs. metabolism: 3.33 vs. 2.86, p = 0.049), but no effects of either manipulation on any other outcomes. CONCLUSION: Personal risk information indicating increased obesity risk may increase motivation to eat healthily, regardless of whether the risk is described as genetic or non-genetic or as acting through an eating-based or metabolism-based causal pathway.

Genetic testing for heart disease susceptibility: potential impact on motivation to quit smoking.

As genetic tests for common gene variants and multifactorial, lifestyle-related conditions become available, it will be increasingly important to determine the psychological and behavioral impact of this emerging class of genetic tests. Our aim was to examine the potential impact of genetic testing for heart disease susceptibility on psychological predictors of smoking cessation. Two hundred and sixty-one smokers were asked to imagine that they had undergone a test for heart disease risk. They were randomly assigned to a genetic test scenario (low- or high-risk result) or an oxidative test scenario (high-risk result). Smokers in the genetic test-high risk group reported greater intention to quit smoking than smokers in the oxidative test-high risk group (p = 0.009); 30% of this was mediated by their holding stronger beliefs that quitting would reduce their heart disease risk (outcome expectations) (p = 0.011). The effect of genetic test-high risk feedback on outcome expectations was greatest amongst smokers with no heart disease family history (p = 0.038). The results suggest that genetic testing for heart disease risk may enhance interventions designed to improve health via increasing smoking cessation rates. Whether the findings hold true in studies that use real rather than hypothetical genetic tests remains to be seen.

Gender specialization in heterodichogamous Grayia brandegei (Chenopodiaceae): evidence for an alternative pathway to dioecy.

We examined components of male and female reproductive success in protogynous and protandrous sexual morphs of the heterodichogamous and largely monoecious chenopod shrub Grayia brandegei. Percentage femaleness of flowering stalks ranged from 0 to 37.6% female ( = 15.5%) for protandrous plants and from 14 to 100% female ( = 55.8%) for protogynous plants. Functional gender estimates based on ovule production at two locations ranged from 23.0 to 31.8% female for the protandrous morph, and from 65.3 to 77.0% female for the protogynous morph. Realized gender estimates based on total seed production ranged in value from 3.6 to 16.8% female for the protandrous morph and from 76.5 to 96.4% for the protogynous morph, depending on location and year. Differences in reproductive success of the two morphs were largely due to a reduction in the female function of protandrous plants. Protogynous plants produced more female flowers per stalk and had a higher percentage of seed-filled fruits than did protandrous plants. Differences between sexual morphs were more pronounced in dry areas or years in which overall seed production was minimal. Differential seed production between morphs likely reflects temporal patchiness in environmental conditions, particularly in water availability. The significance of these findings in support of heterodichogamy as an evolutionary pathway to dioecy is discussed.

Cytogeography and chromosome evolution of subgenus Tridentatae of Artemisia (Asteraceae).

The subgenus Tridentatae of Artemisia (Asteraceae: Anthemideae) is composed of 11 species of various taxonomic and geographic complexities. It is centered on Artemisia tridentata with its three widespread common subspecies and two more geographically confined ones. Meiotic chromosome counts on pollen mother cells and mitotic chromosome counts on root tips were made on 364 populations ( = 3.1 plants per population). These population counts are ∼60% of all Tridentatae counts. Some are first records for taxa. The Tridentatae are a polyploid complex (x = 9) with ploidy levels from 2x to 8x, but mostly 2x (48%) and 4x (46%). Polyploidy occurs in nine of the 11 species and in many subspecies as well. Supernumerary or b chromosomes are present only at a low frequency. In the principal species, A. tridentata, 2x plants are larger than 4x ones, which are adapted to drier conditions, probably in consequence of their slower growth rates. Gigas diploidy is a phenomenon shared by some other woody genera, but is in contrast to the gigas polyploid nature of many herbaceous genera. Polyploidy occurs within populations and is essentially autoploid. Hybridization sometimes occurs at taxa interfaces in stable hybrid zones. Stable Tridentatae hybrid zones coupled with the group's inherent propensity for polyploidization has led to the establishment of a geographically and numerically large and successful complex of species.

Clinical revenues used to support the academic mission of medical schools, 1992-93.

This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U.S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. A total of 60 medical schools (48%) participated in the study. The results, projected for all 126 U.S. medical schools, indicate that faculty practice plans in 1992-93 provided an estimated $2.4 billion in support for medical school academic programs. (1992-93 was the latest year for which complete financial data were available.) This amount represents 28 cents of every faculty-practice-plan dollar collected that year. The primary way in which faculty practice plans support academic programs is by underwriting clinical faculty time spent in academic activities, but direct transfers of funds, from the practice plan to the school and departments, also play a major role. The major beneficiary of faculty-practice-plan support is research, defined broadly to include a range of scholarly activities, at an estimated level of $816 million for all U.S. schools. This is followed by undergraduate medical education, at $702 million, graduate medical education, at $594 million, and other, largely undifferentiated academic support at $244 million. In addition to faculty practice plan revenues, teaching by volunteer faculty contributed another $545 million in imputed-dollar support of academic programs, bringing the total level of support to nearly $3 billion. Volunteer faculty teaching was divided nearly evenly between undergraduate and graduate medical education. Hospitals may also provide clinical revenues in support of the academic mission by applying hospital funds to academic programs and by absorbing academic-program expenses that are not otherwise reimbursed. However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.

Tenure policies in U.S. and Canadian Medical Schools.

This report presents data on tenure policies in U.S. and Canadian medical schools. The data are drawn from the findings of a larger survey of faculty appointment and tenure policies, which was mailed to each medical school dean in December 1993. The deans were asked to complete the questionnaire themselves or direct it to a staff member knowledgeable about faculty personnel policies. Non-responding institutions were sent a follow-up letter two months later. The response rate for the written survey was 96%: 137 of a possible 142 schools responded, with the remaining five schools participating in an abbreviated telephone survey. Of the 142 U.S. and Canadian medical schools, 136 (96%) have tenure systems, although nine of these schools limit the award of tenure to basic science faculty. Over three-fourths of the schools that have tenure systems define tenure to include some kind of financial guarantee. Rarely does this financial guarantee cover total salary/compensation; typically it is restricted to a "base" or university component of salary. Twenty percent of the schools have fixed pre-tenure probationary periods for clinical faculty that are longer than seven years; another 11% report having either no fixed pre-tenure probationary period or one that is unlimited. In the last five years, 10% of medical schools have terminated a tenured faculty member "for cause." Data are also examined concerning policies governing the extension of the pre-tenure probationary period, the rank at which tenure is usually granted, consequences of a negative tenure decision, caps on tenure positions, vacated tenure positions, and tenure arrangements for VA faculty and PhD faculty in clinical departments.(ABSTRACT TRUNCATED AT 250 WORDS)

GEOGRAPHIC DIFFERENTIATION IN ATRIPLEX CONFERTIFOLIA.

Atriplexconfertifolia (Chenopodiaceae) consists of ploidy races extending from diploid through decaploid and is dissected into many racial groups by cytological and flavonoid relationships. On the basis of morphology, the species can be divided into two major subdivisions, one centered in western Nevada and inhabiting chiefly the Great Basin, and one centered in the Colorado Plateau. Western Nevada plants are distinguished by smaller and narrower leaves, as well as by darker spines and other charactristics. Because western Nevada is situated in the lee of the Sierra Nevada Range, it received reduced amounts of rainfall during Pleistocene and Holocene times. These reduced leaf dimensions of A. confertifolia of the rain shadow zone may thus reflect an evolutionary response to aridity.