With the advent of widespread genomic testing for diagnostic indications and disease risk assessment, there is increased need to optimize genetic counseling services to support the scalable delivery of precision medicine. Here, we describe how we operationalized the reciprocal engagement model of genetic counseling practice to develop a framework of counseling components and strategies for the delivery of genomic results. This framework was constructed based upon qualitative research with patients receiving genomic counseling following online receipt of potentially actionable complex disease and pharmacogenomics reports. Consultation with a transdisciplinary group of investigators, including practicing genetic counselors, was sought to ensure broad scope and applicability of these strategies for use with any large-scale genomic testing effort. We preserve the provision of pre-test education and informed consent as established in Mendelian/single-gene disease genetic counseling practice. Following receipt of genomic results, patients are afforded the opportunity to tailor the counseling agenda by selecting the specific test results they wish to discuss, specifying questions for discussion, and indicating their preference for counseling modality. The genetic counselor uses these patient preferences to set the genomic counseling session and to personalize result communication and risk reduction recommendations. Tailored visual aids and result summary reports divide areas of risk (genetic variant, family history, lifestyle) for each disease to facilitate discussion of multiple disease risks. Post-counseling, session summary reports are actively routed to both the patient and their physician team to encourage review and follow-up. Given the breadth of genomic information potentially resulting from genomic testing, this framework is put forth as a starting point to meet the need for scalable genetic counseling services in the delivery of precision medicine.

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Studies indicate that films can influence adolescents' attitudes toward and initiation of substance use. It is therefore important to periodically assess film content to assess the types of imagery adolescents are likely to encounter. This study content analyzed teen characters in top films featuring teenagers from 2007, 2008, and 2009 to assess smoking, drinking, and drug use portrayals. Results indicate a relatively low incidence of smoking and drug use. However, one in five teen characters are shown drinking. Overall, substance use depictions have diminished considerably compared with films released at the earlier end of the decade. However, consequences of substance use were infrequently depicted, and characters seldom refused invitations to drink or do drugs. Given these findings, some potentially counterproductive outcomes are discussed.

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