Social Patterning of Screening Uptake and the Impact of Facilitating Informed Choices: Psychological and Ethical Analyses

Screening for unsuspected disease has both possible benefits and harms for those who participate. Historically the benefits of participation have been emphasized to maximize uptake reflecting a public health approach to policy; currently policy is moving towards an informed choice approach involving giving information about both benefits and harms of participation. However, no research has been conducted to evaluate the impact on health of an informed choice policy. Using psychological models, the first aim of this study was to describe an explanatory framework for variation in screening uptake and to apply this framework to assess the impact of informed choices in screening. The second aim was to evaluate ethically that impact. Data from a general population survey (n = 300) of beliefs and attitudes towards participation in diabetes screening indicated that greater orientation to the present is associated with greater social deprivation and lower expectation of participation in screening. The results inform an explanatory framework of social patterning of screening in which greater orientation to the present focuses attention on the disadvantages of screening, which tend to be immediate, thereby reducing participation. This framework suggests that an informed choice policy, by increasing the salience of possible harms of screening, might reduce uptake of screening more in those who are more deprived and orientated to the present. This possibility gives rise to an apparent dilemma where an ethical decision must be made between greater choice and avoiding health inequality. Philosophical perspectives on choice and inequality are used to point to some of the complexities in assessing whether there really is such a dilemma and if so how it should be resolved. The paper concludes with a discussion of the ethics of paternalism

Time Perspectives and Subjective Well-Being: A Dual-Pathway Framework

In this chapter, we review the literature on the relations between time perspective and well-being. Time perspective is shown to be a stronger influence on individuals’ happiness than personality. The evidence we review suggests that time perspectives influence well-being through both direct and indirect pathways. The past time perspectives exert a direct influence on how people assess their satisfaction in life, while a future orientation impacts happiness through its influence on how people assess their prospects for the future. In contrast, the present time dimensions appear to impact people’s well-being indirectly, by influencing the behaviors that determine life circumstances, which in turn influence well-being. In addition, the future time dimension also exerts an indirect influence on well-being. People who are more future oriented are found to take actions that establish congenial life circumstances that are more likely to lead to a higher sense of well-being

Romantic Ideation, Partner-Seeking, and HIV Risk Among Young Gay and Bisexual Men

Structural changes in the acceptability of same-sex relationships may provide young gay and bisexual men (YGBM) with opportunities to develop expectations about their ideal future relationships. Expectations about the future may act as a promotive factor in youths' lives and reduce HIV risk-taking behaviors; however, few studies have examined the relationship between ideation of a future relationship and sexual behaviors of YGBM. In this study, we examined the relationship between romantic ideation (i.e., intimacy, passion, and commitment) and number of sexual partners in a sample of young men (N = 431; M age = 21.49 years; 88% self-identified as gay) who reported using the Internet to meet other men. Using multivariate Poisson regressions, we found a negative association between commitment and number of partners for unprotected sex, both receptive and insertive, in the past two months. We found similar results when we examined the association between relationship exclusivity and number of partners. These associations persisted after accounting for age, race/ethnicity, sexual identity, and hours spent seeking casual and romantic partners online. We found no significant association between number of partners and ideation of an intimate or passionate relationship, respectively. We discuss the implications of our findings and conclude that there is a need to consider and include YGBM's expectations about the future in on-going HIV prevention programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91266/1/Bauermeister2012_ASEB.pd