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Download This Article As A VOLUME 7: NO. 1, A07 JANUARY 2010 ORIGINAL RESEARCH Familial Risk for Chronic Disease and Intent to Share Family History With a Health Care Provider Among Urban Appalachian Women, Southwestern Ohio, 2007 Margaret G. Au, MBE, MS; Sandra J. Cornett, RN, PhD; Todd G. Nick, PhD; Jody Wallace, MS; Yu Wang, MS; Nancy S. Warren, MS; Melanie F. Myers, MS, PhD Suggested citation for this article: Au MG, Cornett SJ, Nick Health Portrait had lower odds of high familial risk for TG, Wallace J, Wang Y, Warren NS, et al. Familial risk for diabetes, heart disease, and stroke. Most participants (n = chronic disease and intent to share family history with a 62, 77%) reported that they intended to share their fam- health care provider among urban Appalachian women, ily history with a health care provider. Factors associated southwestern Ohio, 2007. Prev Chronic Dis 2010;7(1): with intent to share family history included younger age, A07. http://www.cdc.gov/pcd/issues/2010/jan/08_0221.htm. use of the electronic family history tool, and high familial Accessed [date]. risk of heart disease. PEER REVIEWED Conclusion The large proportion of women who intended to share family history with a health care provider may reflect the Abstract success of the educational component. Since familial risk for chronic disease is high among these urban Appalachian Introduction women, the need to share family history should continue Family history of certain chronic diseases is a risk factor to be promoted. for those diseases. We assessed demographic characteris- tics associated with familial risk for common diseases and whether familial risk was associated with intent to share Introduction family history with a health care provider among urban Appalachian women. Many people from rural Appalachia migrated to cities outside Appalachia after World War II, includ- Methods ing Cincinnati and Dayton, Ohio (1). The prevalence Urban Appalachian women (N = 88) with less than a of many chronic diseases and risk factors is higher college education participated in education sessions about in Appalachians than in others in this region (2), so family history in health promotion in southwest Ohio. Appalachians would benefit from knowing their famil- Participants used My Family Health Portrait, electroni- ial risk for these diseases and sharing this information cally or on paper, to document their level of familial risk. with their health care providers. Awareness of familial Evaluations completed after each session gauged intent to risk for a disease may motivate people to be screened share family history with a health care provider. (3-5). Appalachian women in West Virginia recognized that a family history of cancer is an indication for more Results frequent cancer screenings (6). In addition, a family Participants who used the paper version of My Family history of colon cancer was strongly associated with The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. www.cdc.gov/pcd/issues/2010/jan/08_0221.htm • Centers for Disease Control and Prevention VOLUME 7: NO. 1 JANUARY 2010 having had a colonoscopy among Appalachians in the which was defined by the community organizations, was Ohio Valley (7). met if the participant, a parent, or a grandparent was born in 1 of the 410 counties designated by the Appalachian Familial risk for heart disease, diabetes, stroke, breast Regional Commission (15) or if the participant self- cancer, ovarian cancer, and colon cancer has been described identified as Appalachian. From July through October in the general population in the United States (5,8-11) but 2007, we held 13 initial and 12 follow-up sessions (2 follow- not in the urban Appalachian population. Also not well up sessions were combined) at the 4 community organiza- studied is the relationship between having a family his- tions that had computers with Internet access. tory of a disease and intent to share this information with a health care provider. Understanding factors associated Education sessions focused on family history as a risk with familial risk and intent to share family history can factor for common diseases and how to collect and docu- inform promotional efforts on the use of family history in ment family history by using My Family Health Portrait urban Appalachian and other communities. The goal of (16) electronically or on paper (participant’s choice). this study was to determine whether demographic char- Participants recorded and updated family histories during acteristics were associated with familial risk and whether both education sessions. Between sessions — approxi- familial risk of common diseases predicted intent to share mately 2 weeks — participants were asked to speak with family history with a health care provider among urban family members and update their histories. Appalachian women in southwestern Ohio. After the follow-up sessions, participants completed a sur- vey to assess their intent to share their family history with Methods a health care provider. We also interviewed participants on the telephone (10- to 15-minute interviews) approximately This study was part of the Family History Demonstration 4 weeks after they attended the last education session. We Project, details of which have been reported elsewhere asked questions such as “Have you talked to a health care (12). Briefly, 6 participating community organizations that provider about your family history since our last meeting?” serve urban Appalachian populations in Cincinnati, Ohio and “If no, do you intend to talk to a health care provider (2 organizations), Dayton, Ohio (3 organizations), and about your family history in the future?” We made up to 5 Newport, Kentucky (1 organization) (northern Kentucky attempts to contact participants by telephone. is a part of the Greater Cincinnati metropolitan statistical area), recruited participants. A representative from each We used family histories and a general familial risk organization invited potential participants to attend initial stratification guideline (Figure) (8) to calculate familial and follow-up educational sessions about the use of family risks for heart disease, diabetes, stroke, breast cancer, history in health care. The community organizations are ovarian cancer, and colon cancer among 88 participants nonprofit social service agencies that provide resources who met the Appalachian criterion. We classified par- such as career training, social services, and child care. ticipants as having high, moderate, and average familial None serves only Appalachians, but all are in neighbor- risk. If a participant had a given condition, we calculated hoods where many Appalachians live. The Cincinnati familial risk twice: including the affected participant as an Children’s Hospital institutional review board deemed additional first-degree relative with the condition (17) and the Family History Demonstration Project exempt from not including the affected participant. review because it was an educational project, not research on human participants. After we assessed familial risk for all 6 conditions, breast, ovarian, and colon cancer were omitted from further anal- We recruited women because of their influential role yses because of lack of variance in the risk categories (all in family health (13) and because women are more likely >80% “average” risk). Correlations between familial risks than men to record their family history (14). One of our for heart disease, diabetes, and stroke were calculated by goals, reported elsewhere (12), was to create educational using a Spearman correlation coefficient (rs). tools for urban Appalachians of limited literacy. As a proxy for literacy, a requirement for participation was less than We used the proportional odds model (18) to conduct a college education. The Appalachian heritage criterion, unadjusted (crude) and adjusted ordinal logistic regres- The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. 2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2010/jan/08_0221.htm VOLUME 7: NO. 1 JANUARY 2010 sion analyses that used familial risks for heart disease, diabetes, and stroke as outcome vari- ables. Predictor variables included education, age, community organization where the par- ticipant attended sessions, family history tool used (electronic or paper), and race. Education was measured as the highest grade completed and collapsed into 3 categories: 6th through 8th grade, 9th through 11th grade, and 12th grade or higher or General Educational Development certification. We used χ2 tests to assess the relationships between familial risk of heart disease, dia- betes, and stroke and intent to share family history with a health care provider. Simple Figure. General familial risk stratification guideline. Adapted from Scheuner et al (8). and multiple binary logistic regression analy- Reprinted with permission of John Wiley & Sons, Inc. ses were carried
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