Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (62 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2022)

Objective: The inaccurate portrayal of health information has contributed to distrust in public health throughout COVID-19 causing reduced compliance with recommended health behaviors putting the health and safety of individuals at risk. The purpose of this study is to assess the relationship between cultural orientation and privacy perspectives on trust in public health officials to better disseminate health information and mitigate the impact of COVID-19. Methods: A secondary qualitative analysis was conducted on survey data collected from 634 participants in a cross-sequential study titled “Thoughts and Feelings about COVID-19.” Horizontal Collectivism describes individuals who value equality over power. In Vertical Collectivism, people are willing to sacrifice personal gains for the common group goals. Vertical Individualism emphasizes personal status. Low Comfort privacy disposition describes one’s willingness to share medical information. Results: Horizontal Collectivism, Vertical Collectivism, Vertical Individual, and Low Comfort privacy disposition were significant predictors of trust in public health officials, regarding COVID-19. There was higher trust in public health officials among high Horizontal Collectivism and high Vertical Collectivism cultural orientation constructs. There was lower trust in public health officials among high Vertical Individualism and Low Comfort privacy disposition. Conclusion: Findings from this study shed light on how cultural patterns and attitudes towards health-related privacy could obscure trust in public health officials within the United States. Moreover, understanding the association between these factors could inform effective communication of information regarding COVID-19 and support efforts to efficiently slow the spread of the Coronavirus and prevent future pandemics.

    Cover page: Effects of Cultural Orientation and Privacy Perspectives on Trust in Public Health Officials During COVID-19
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2023)

    Background: Moving from studying diseases to states of optimal health brings new logistical, ethical, legal, and social implications for Precision Health research. The Wu Tsai Human Performance Alliance seeks to study elite performers in precise detail to understand both human performance and translate these findings to the public on a global scale. To achieve their goals, the Alliance is implementing a biobank, which collects, stores, and shares biological samples and health information for future, unspecified research. To inform the design, conduct, and implementation of their Precision Health research and biobank, this study sought to explore the contextual factors of professional sports in the US that may impact successful research implementation. Potential adaptations to improve the acceptability and, by extension, the generalizability of this research were also identified.

    Methods: Dissemination and Implementation Science (DIS) was adapted from implementing evidence-based interventions for the implementation of Precision Health research interventions. This exploratory study conducted one-hour, semi-structured, key informant interviews of professional athletes (n= 20) and their non-athlete stakeholders (n= 22) using an adapted version of the Practical, Robust, Implementation and Sustainability Model (PRISM). A hybrid qualitative method was used to simultaneously apply deductive structured codes from PRISM and inductive codes based on grounded theory.

    Results: Overall, participants reported interest in the Alliance’s research, but willingness to participate or to encourage athletes to participate was usually conditional. Major themes were vulnerabilities (athletes’ characteristics and risks for discrimination), the impact of the research (potential for negative impacts on sports industry and widening health disparities), desires for direct benefit (e.g., individual results or profit-sharing), and decision-making (desires to control usage of samples and data). Several adaptations to traditional research practices, such as data embargoes and dynamic consent, were identified as likely to increase the perceived acceptability of the research and by examining DIS outcomes were theorized to improve the generalizability of the research.

    Discussion: This study provided evidence for the utility of supplementing ethical, legal, and social implications (ELSI) research with DIS methods for planning early-stage research intervention implementation. This study described the logistical, ethical, legal, and social implications of human performance research (HPR) and biobanking for aspiring and professional athletes, while identifying key decision points and potential impacts on implementation outcomes. This study allows researchers to make data-driven decisions to adapt traditional research practices to make the research more acceptable and accessible to future participants with the ultimate goal improve the study’s ability to recruit a representative sample.

      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2007)
      Although the impact of the [epsilon]4 allele of the Apolipoprotein E gene (APOE-[epsilon]4) on cognitive functioning in adults has been widely studied, researchers have produced little information regarding the nature of this relationship in children. Broadly, the current studies aimed to explore APOE-related differences in cognitive functioning in early life. Study 1 explored the relationship between APOE genotype and educational attainment in a sample of elderly adults. Results indicated that even after accounting for Alzheimer's disease (AD) diagnostic status and gender, [epsilon]4- positive individuals attained fewer years of education relative to [epsilon]2-positive individuals. Studies 2, 3, 4 and 5 examined APOE-related differences in cognitive and achievement test performances in a sample of school-aged children. Scores on group achievement tests and on a measure of visuospatial functioning were compared between the genotype groups in Study 2, and results indicated significantly worse performance among [epsilon]2-positive children relative to [epsilon]3/3 homozygotes and [epsilon]4-positive children on a test of visuospatial functioning. Notably, an increased prevalence of left- handedness was also observed among [epsilon]2-positive individuals in both Studies 1 and 2. Study 3 examined achievement test data from multiple time points, and results indicated generally stable and equivalent performances over time across APOE genotype. Study 4, which is based on findings of atypical hemispheric asymmetries in normal-functioning young adults, investigated the extent to which the [epsilon]4 allele is associated with cognitive discrepancies in school-aged children. Findings indicated that APOE genotype is associated with cognitive asymmetry in early life, but that gender is a significant moderator of this association. Finally, Study 5, a preliminary study, explored whether APOE genotype interacts with a family history of AD to further impact the development of cognitive reserve. Remarkably, results showed a synergistic effect of APOE-[epsilon]4 status and family history of AD such that children with both risk factors showed the lowest test scores. Taken together, these studies suggest that APOE genotype is associated with early life brain and cognitive functioning. Results are discussed within the context of antagonistic pleiotropy, which suggests that APOE genotype may be associated with different effects at different developmental stages
        Cover page: APOE genotype and cognitive functioning in school-aged children : a risk factor for decreased cognitive reserve or an example of antagonistic pleiotropy?
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2018)
        As next-generation genomic sequencing, including whole-genome sequencing information, becomes more common in research, clinical, and public health contexts, there is a need for comprehensive communication strategies and education approaches to prepare patients and clinicians to manage this information and make informed decisions about its use, and nowhere is that imperative more pronounced than when genomic sequencing is applied to newborns. Unfortunately, in-person counseling is unlikely to be applicable or cost-effective when parents obtain genomic risk information directly via the Internet. As a rule, communication strategies should match how people are accessing health information. Today, many people can obtain health information in a variety of settings, including through direct-to-consumer services, via websites, and through other digital channels or settings. In response to these changes, new communication strategies need to be considered. Adopting a comprehensive communication model means understanding the multiple levels of influence experienced by parents and the clinicians who serve them. In addition, applying communication-science principles can help in addressing some key challenges to effectively communicating genomic information to parents.
          Cover page: A New Era, New Strategies: Education and Communication Strategies to Manage Greater Access to Genomic Information.
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2024)
          BACKGROUND: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. OBJECTIVE: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. METHODS: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. RESULTS: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. CONCLUSIONS: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students.
            Cover page: Attitudes Toward School-Based Surveillance of Adolescents Social Media Activity: Convergent Parallel Mixed Methods Survey.
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2018)
            In the last decade, genomic medicine education initiatives have surfaced across the spectrum of physician training in order to help address a gap in genomic medicine preparedness among physicians. The approaches are diverse and stem from the belief that 21st century physicians must be proficient in genomic medicine applications as they will be leaders in the precision medicine movement. We conducted a review of literature in genomic medicine education and training for medical students, residents, fellows, and practicing physicians with articles published between June 2015 and January 2018 to gain a picture of the current state of genomic medicine education with a focus on the United States. We found evidence of progress in the development of new and innovative educational programs and other resources aimed at increasing physician knowledge and readiness. Three overarching educational approach themes emerged, including immersive and experiential learning; interdisciplinary and interprofessional education; and electronic- and web-based approaches. This review is not exhaustive, nevertheless, it may inform future directions and improvements for genomic medicine education. Important next-steps include: (i) identifying and studying ways to best implement low-cost dissemination of genomic information; (ii) emphasizing genomic medicine education program evaluation and (iii) incorporating interprofessional and interdisciplinary initiatives. Genomic medicine education and training will become more and more relevant in the years to come as physicians increasingly interact with genomic and other precision medicine technologies.
              Cover page: Physician preparedness for big genomic data: a review of genomic medicine education initiatives in the United States.
              • Article
              • Peer Reviewed
              Publications (2018)
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2019)

                Background and objectives

                The availability of whole genome sequencing (WGS) is increasing in clinical care, and WGS is a promising tool in diagnostic odyssey cases. Physicians' ability to effectively communicate genomic information with patients, however, is unclear. In this multiperspective study, we assessed physicians' communication of patient genome sequencing information in a diagnostic odyssey case series.

                Methods

                We evaluated physician communication of genome sequencing results in the context of an ongoing study of the utility of WGS for the diagnosis of rare and idiopathic diseases. A modified version of the Medical Communication Competence Scale was used to compare patients' ratings of their physicians' communication of general medical information to communication of genome sequencing information. Physician self-ratings were also compared with patient ratings.

                Results

                A total of 47 patients, parents, and physicians across 11 diagnostic odyssey cases participated. In 6 of 11 cases (54%), the patient respondent rated the physician's communication of genome sequencing information as worse than that of general medical information. In 9 of 11 cases (82%), physician self-ratings of communication of genome sequencing information were worse than the patient respondent's rating. Identification of a diagnosis via WGS was positively associated with physician self-ratings (P = .021) but was not associated with patient respondent ratings (P = .959).

                Conclusions

                These findings reveal that even in diagnostic odyssey cases, in which genome sequencing may be clinically beneficial, physicians may not be well-equipped to communicate genomic information to patients. Future studies may benefit from multiperspective approaches to assessing and understanding physician-patient communication of genome-sequencing information.
                  Cover page: Physician Communication of Genomic Results in a Diagnostic Odyssey Case Series
                  • Article
                  • Peer Reviewed
                  Publications (2018)
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2022)
                    This investigation examined how dispositional compassion and empathy were associated with prosocial behaviors and attitudes in the SARS-CoV-2 pandemic. Every two weeks from March 22 to June 15, 2020, we fielded a survey to a new cohort of adults in the U.S. Compassion related to whether one stayed home to protect others, more hours spent staying home and distancing from others, and more frequent mask wearing in public, in the past two weeks. Compassion also related to greater perceived ability to help others who were negatively affected. Empathy related to more endorsement of understanding others' fear of COVID-19, and less endorsement of the view that others were overreacting to COVID-19. There was an interaction between empathy and political ideology, suggesting that empathy may matter for understanding others' fear among those with more conservative-leaning beliefs. Empathy also related to greater understanding that sheltering-in-place helps prevent the spread of COVID-19. Findings suggest that messaging and interventions to increase compassion and empathy may promote public health behaviors during a pandemic regardless of political orientation. Targeting empathy may be one way to reach individuals with more conservative political beliefs, and it is important to use an evidence-based approach accounting for political party differences in motivated reasoning.
                      Cover page: Association of compassion and empathy with prosocial health behaviors and attitudes in a pandemic
                      Top