Using Family Health History for Chronic Disease Prevention in the Age of Genomics: Translation to Health Education Practice
Hanson, Carl, Novilla, Lelinneth, Barnes, Michael, De La Cruz, Natalie, Meacham, Aaron, American Journal of Health Education
Advances in the field of human genomics have important implications for the prevention of chronic disease. In response to these advancements, public health professionals--including health educators--must become competent in the principles underlying the interface between genomics and the use of family health history. Family health history captures the familial nature and incidence of chronic diseases and provides valuable insights on the risk for chronic diseases within the context of shared genes, environments, and behavior. The purpose of this article is to review family health history research as an important tool for assessing chronic disease risk; to provide information regarding its use in health education practice as a potential preventive tool; and to discuss the ethical, legal, and social implications of such use.
Advances in the field of human genomics and their associated health implications call for an increased understanding and capacity among public health professionals to integrate this knowledge into existing and future health programs and prevention strategies. Unlike genetics, which is viewed as the study of single genes, genomics is the study of functions and interactions of all genes with each other and the environment. (1) In April 2003, the sequencing of the human genome--the detailed mapping of the chemical building blocks of DNA--was announced. (2) This achievement instilled hope among many that individualized information will ultimately lead to the design of "new effective therapeutic and preventive strategies." (3(p69)) The Centers for Disease Control and Prevention (CDC) have responded to this scientific progress by encouraging awareness among health educators and practicing public health professionals, as well as competency in facilitating the education of agency staff, administrators, volunteers, community groups, and other interested personnel in the effective use of genomics in health education and public health. (2,3) To ensure competency, the CDC has developed web-based training tools on the importance and relevance of genomic advancements to the practice of public health. (4)
Personalized genomics, or the sequencing of one's own genome for determining individual risk for disease, is presently limited by cost and is subject to further research. (5) As such, it may not be an affordable option for most individuals until years from now. (5) Although genetic tests for certain cancers and diseases are available and may be covered at varying degrees by health insurance, not all possible genetic changes that mark the risk for developing cancer and certain chronic diseases have been discovered, nor are all these detected by current laboratory methods. In the meantime, family health history, or the health background of individuals sharing a common ancestry, can serve as a "genomic tool," (6) providing information on potential disease susceptibility within the context of shared genes, environment, and behaviors. (7,8) Although additional studies are needed to establish the effectiveness of family health history as an intervention tool for changing modifiable risk factors, (9,10) a growing body of research suggests that risk communication based on family health history information can influence the adoption of a healthy lifestyle, particularly among at-risk groups. By encouraging the use of the family health history, health educators can help individuals and families take an active role in managing their own health by moderating risks for such chronic conditions as heart disease, diabetes, stroke, and cancer.
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The purpose of this article is to (1) review evidence of family health history as an important tool for assessing chronic disease risk and for motivating behavior change, (2) review ethical and legal implications for using family health history in health education practice, and (3) provide recommendations for the application of family health history in health education practice. …