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1.  On Averages and Peaks: How Do People Integrate Attitudes about Multiple Diseases to Reach a Decision about Multiplex Genetic Testing? 
Background
The aim of the current study was to learn how people integrate attitudes about multiple health conditions to make a decision about genetic testing uptake.
Methods
This study recruited 294 healthy young adults from a parent research project, the Multiplex Initiative, conducted in a large health care system in Detroit, Michigan. All participants were offered a multiplex genetic test that assessed risk for 8 common health conditions (e.g., type 2 diabetes). Data were collected from a baseline survey, a web-based survey, and at the time of testing.
Results
Averaging attitudes across diseases predicted test uptake but did not contribute beyond peak attitudes, the highest attitude toward testing for a single disease in the set. Peak attitudes were found sufficient to predict test uptake.
Limitations
The effects of set size and mode of presentation could not be examined because these factors were constant in the multiplex test offered.
Conclusions
These findings support theories suggesting that people use representative evaluations in attitude formation. The implication of these findings for further developments in genetic testing is that the communication and impact of multiplex testing may need to be considered in the light of a bias toward peak attitudes.
doi:10.1177/0272989X12464432
PMCID: PMC3799841  PMID: 23128581
cognitive psychology; judgment and decision psychology; patient choice modeling; social judgment theory
2.  Risk perceptions and worry about common diseases: A between- and within-subjects examination 
Psychology & health  2012;28(4):434-449.
Objective
To test the relationships between worry and perceptions of likelihood and severity (two indicators of risk perception) across eight common diseases, and to examine contributions of individual and disease variability in worry and risk perceptions.
Methods
Participants were 294 people recruited through the Multiplex Initiative, in which a genetic susceptibility test for 8 common diseases was offered to healthy adults. Participants completed a baseline telephone survey and Web-based surveys measuring the variables for this ancillary study, without a commitment to be tested.
Results
Between- and within-subjects analyses yielded the following findings: 1) worry is more related to likelihood perceptions than to severity perceptions; 2) severity perceptions add significantly to explained worry variances above and beyond likelihood perceptions; 3) the likelihood × severity perception does not add to explained variance in worry above its components; 4) risk perceptions and worries form two identifiable clusters: cancer diseases and cardiovascular-metabolic diseases; 5) there are significant differences in risk perceptions and worry among diseases; 6) there are significant gender differences in risk perceptions and worry about common diseases; 7) variance in risk perception and worry is explained by a combination of between- and within-subjects variances, with the latter being more powerful.
Conclusions
Risk perception research should pay attention to severity perceptions, within-subjects variability and inter-disease differences should not be ignored, gender perspectives on illness perceptions should be acknowledged, and health psychologists must prepare for considering groups of illnesses in addition to single diseases.
doi:10.1080/08870446.2012.737464
PMCID: PMC3566271  PMID: 23121110
risk perception; worry; severity; likelihood; within-subjects
3.  Modeling Decisions to Undergo Genetic Testing for Susceptibility to Common Health Conditions: An Ancillary Study of the Multiplex Initiative 
Psychology & health  2011;27(4):430-444.
New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the Multiplex Genetic Testing Model (MGTM) using structural equation modeling (SEM). The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes toward testing as predictors of intentions and behavior. Participants were 270 healthy insured adults age 25–40 from the Multiplex Initiative conducted within a health care system in Detroit MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β=0.13, p<0.05), which predicted general attitudes toward testing (β=0.24, p<0.01). Consistent with our hypothesized model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β=0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β=0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.
doi:10.1080/08870446.2011.586699
PMCID: PMC3175306  PMID: 21660870
Genetic testing; Multiplex Initiative; health behavior; common disease; structural equation modeling; personalized medicine; U.S.A.
4.  Invasive prenatal testing decisions in pregnancy after infertility† 
Prenatal diagnosis  2010;30(6):575-581.
Objective
This study assessed decisional conflict about invasive prenatal testing among women pregnant after infertility.
Methods
We surveyed 180 pregnant women with a history of infertility using a mixed methods cross-sectional design. Difficulty in deciding whether to have prenatal testing was measured using the Decisional Conflict Scale.
Results
A minority of women (31%) chose to have invasive prenatal testing. Most participants (72%) reported low decisional conflict (score <25; mean = 22.1; standard deviation = 23.2; range: 0–100). Half (53%) of the participants said that infertility made the testing decision easier. Qualitative data suggest that infertility makes the decision easier by clarifying relevant values and priorities. Most infertility characteristics studied were not significantly associated with decisional conflict. Variables associated with higher decisional conflict included infertility distress due to rejection of a childfree lifestyle, disagreement with others about testing, and choosing to have invasive testing after having had treatment for infertility.
Conclusions
For some women, infertility may make the invasive prenatal testing decision easier. Women with the greatest need for decisional support were those who have had treatment and choose invasive testing, who disagree with others about their testing choice, or who are particularly distressed about being childless.
doi:10.1002/pd.2529
PMCID: PMC3096436  PMID: 20509160
prenatal testing; infertility; decisional conflict; decision making; genetic counseling

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