Advertisement

Familial Risk for Common Diseases in Primary Care

The Family Healthware™ Impact Trial

      Context

      Family history is a risk factor for many common chronic diseases, yet it remains underutilized in primary care practice.

      Background

      Family Healthware™ is a self-administered, web-based tool that assesses familial risk for CHD; stroke; diabetes; and colorectal, breast, and ovarian cancer, and provides a personalized prevention plan based on familial risk. The Family Healthware Impact Trial evaluated the tool.

      Design

      In this cluster RCT, participants completed baseline and 6-month follow-up surveys. The intervention group used Family Healthware directly after the baseline survey. Controls used the tool after completing the follow-up survey.

      Setting/participants

      Patients aged 35–65 years with no known diagnosis of these six diseases were enrolled from 41 primary care practices.

      Main outcome measures

      The prevalence of family-history–based risk for coronary heart disease (CHD); stroke; diabetes; and colorectal, breast, and ovarian cancer was determined in a primary care population.

      Results

      From 2005 to 2007, 3786 participants enrolled. Data analysis was undertaken from September 2007 to March 2008. Participants had a mean age of 50.6 years and were primarily white (91%) women (70%). Of the 3585 participants who completed the risk assessment tool, 82% had a strong or moderate familial risk for at least one of the diseases: CHD (strong=33%, moderate=26%); stroke (strong=15%, moderate=34%); diabetes (strong=11%, moderate=26%); colorectal cancer (strong=3%, moderate=11%); breast cancer (strong=10%, moderate=12%); and ovarian cancer (strong=4%, moderate=6%). Women had a significantly (p<0.04) higher familial risk than men for all diseases except colorectal and ovarian cancer. Overweight participants were significantly (p≤0.02) more likely to have a strong family history for CHD, stroke, and diabetes. Older participants were significantly (p≤0.02) more likely to report a strong family history for CHD and stroke as well as colorectal and breast cancer.

      Conclusions

      This self-administered, online tool delineated a substantial burden of family-history–based risk for these chronic diseases in an adult, primary care population.

      Trial registration

      NCT00164658.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hamilton B.E.
        • Minino A.M.
        • Martin J.A.
        • Kochanek K.D.
        • Strobino D.M.
        • Guyer B.
        Annual summary of vital statistics: 2005.
        Pediatrics. 2007; 119: 345-360
        • Minino A.M.
        • Heron M.P.
        • Murphy S.L.
        • Kochanek K.D.
        Deaths: final data for 2004.
        Natl Vital Stat Rep. 2007; 55: 1-119
        • Colditz G.A.
        • Willett W.C.
        • Hunter D.J.
        • et al.
        Family history, age, and risk of breast cancer.
        JAMA. 1993; 270: 338-343
        • Fuchs C.S.
        • Giovannucci E.L.
        • Colditz G.A.
        • Hunter D.J.
        • Speizer F.E.
        • Willett W.C.
        A prospective study of family history and the risk of colorectal cancer.
        N Engl J Med. 1994; 331: 1669-1674
        • Harrison T.A.
        • Hindorff L.A.
        • Kim H.
        • et al.
        Family history of diabetes as a potential public health tool.
        Am J Prev Med. 2003; 24: 152-159
        • Hunt S.C.
        • Gwinn M.
        • Adams T.D.
        Family history assessment: strategies for prevention of cardiovascular disease.
        Am J Prev Med. 2003; 24: 136-142
        • Amundadottir L.T.
        • Thorvaldsson S.
        • Gudbjartsson D.F.
        • et al.
        Cancer as a complex phenotype: pattern of cancer distribution within and beyond the nuclear family.
        PLoS Med. 2004; 1: e65
        • Jood K.
        • Ladenvall C.
        • Rosengren A.
        • Blomstrand C.
        • Jern C.
        Family history in ischemic stroke before 70 years of age: the Sahlgrenska Academy Study on Ischemic Stroke.
        Stroke. 2005; 36: 1383-1387
        • Colditz G.A.
        • Stampfer M.J.
        • Willett W.C.
        • Rosner B.
        • Speizer F.E.
        • Hennekens C.H.
        A prospective study of parental history of myocardial infarction and coronary heart disease in women.
        Am J Epidemiol. 1986; 123: 48-58
        • Scheuner M.T.
        • Whitworth W.C.
        • McGruder H.
        • Yoon P.W.
        • Khoury M.J.
        Expanding the definition of a positive family history for early-onset coronary heart disease.
        Genet Med. 2006; 8: 491-501
        • Yoon P.W.
        • Scheuner M.T.
        • Khoury M.J.
        Research priorities for evaluating family history in the prevention of common chronic diseases.
        Am J Prev Med. 2003; 24: 128-135
        • Scheuner M.T.
        • Wang S.J.
        • Raffel L.J.
        • Larabell S.K.
        • Rotter J.I.
        Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood.
        Am J Med Genet. 1997; 71: 315-324
        • Acheson L.S.
        • Wiesner G.L.
        • Zyzanski S.J.
        • Goodwin M.A.
        • Stange K.C.
        Family history-taking in community family practice: implications for genetic screening.
        Genet Med. 2000; 2: 180-185
        • Rich E.C.
        • Burke W.
        • Heaton C.J.
        • et al.
        Reconsidering the family history in primary care.
        J Gen Intern Med. 2004; 19: 273-280
        • Acheson L.
        Fostering applications of genetics in primary care: what will it take?.
        Genet Med. 2003; 5: 63-65
        • Emery J.
        • Rose P.
        Expanding the role of the family history in primary care.
        Br J Gen Pract. 1999; 49: 260-261
        • Emery J.
        Evaluation of questionnaire on cancer family history in general practice.
        BMJ. 2000; 320: 186-187
        • Suther S.
        • Goodson P.
        Barriers to the provision of genetic services by primary care physicians: a systematic review of the literature.
        Genet Med. 2003; 5: 70-76
        • Annis A.M.
        • Caulder M.S.
        • Cook M.L.
        • Duquette D.
        Family history, diabetes, and other demographic and risk factors among participants of the National Health and Nutrition Examination Survey 1999–2002.
        Prev Chronic Dis. 2005; 2: A19
        • Johnson N.
        • Lancaster T.
        • Fuller A.
        • Hodgson S.V.
        The prevalence of a family history of cancer in general practice.
        Fam Pract. 1995; 12: 287-289
        • Frezzo T.M.
        • Rubinstein W.S.
        • Dunham D.
        • Ormond K.E.
        The genetic family history as a risk assessment tool in internal medicine.
        Genet Med. 2003; 5: 84-91
        • Yoon P.W.
        • Scheuner M.T.
        • Jorgensen C.
        • Khoury M.J.
        Family Healthware™: developing family healthware, a family history screening tool to prevent common chronic diseases.
        Prev Chronic Dis. 2009; : A33
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
      1. CDC. Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta GA: USDHHS, CDC.

      2. CDC. National Health Information Survey. Atlanta GA: USDHHS, CDC.

        • Wang C.
        • O'Neill S.M.
        • Rothrock N.
        • et al.
        Comparison of risk perceptions and beliefs across common chronic diseases.
        Prev Med. 2008; 48: 197-202
        • Witte K.
        • Cameron K.A.
        • McKeon J.K.
        • Berkowitz J.M.
        Predicting risk behaviors: development and validation of a diagnostic scale.
        J Health Commun. 1996; 1: 317-341
        • Prochaska J.O.
        • Velicer W.F.
        • Rossi J.S.
        • et al.
        Stages of change and decisional balance for 12 problem behaviors.
        Health Psychol. 1994; 13: 39-46
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48
        • Weinstein N.D.
        Perceived probability, perceived severity, and health-protective behavior.
        Health Psychol. 2000; 19: 65-74
        • Ramsey S.D.
        • Yoon P.
        • Moonesinghe R.
        • Khoury M.J.
        Population-based study of the prevalence of family history of cancer: implications for cancer screening and prevention.
        Genet Med. 2006; 8: 571-575
        • Scheuner M.T.
        • Whitworth W.C.
        • McGruder H.
        • Yoon P.W.
        • Khoury M.J.
        Familial risk assessment for early-onset coronary heart disease.
        Genet Med. 2006; 8: 525-531
        • Valdez R.
        • Yoon P.W.
        • Liu T.
        • Khoury M.J.
        Family history and prevalence of diabetes in the U.S. population: the 6-year results from the National Health and Nutrition Examination Survey (1999–2004).
        Diabetes Care. 2007; 30: 2517-2522
        • Bensen J.T.
        • Liese A.D.
        • Rushing J.T.
        • et al.
        Accuracy of proband reported family history: the NHLBI Family Heart Study (FHS).
        Genet Epidemiol. 1999; 17: 141-150
        • Kahn L.B.
        • Marshall J.A.
        • Baxter J.
        • Shetterly S.M.
        • Hamman R.F.
        Accuracy of reported family history of diabetes mellitus.
        Diabetes Care. 1990; 13: 796-798
        • Kee F.
        • Tiret L.
        • Robo J.Y.
        • et al.
        Reliability of reported family history of myocardial infarction.
        BMJ. 1993; 307: 1528-1530
        • Qureshi N.
        • Wilson B.
        • Santaguida P.
        Collection and use of cancer family history in primary care.
        Agency for Healthcare Research and Quality, Rockville MD2007
        • Kerber R.A.
        • Slattery M.L.
        Comparison of self-reported and database-linked family history of cancer data in a case-control study.
        Am J Epidemiol. 1997; 146: 244-248
        • Mitchell R.J.
        • Brewster D.
        • Campbell H.
        • et al.
        Accuracy of reporting of family history of colorectal cancer.
        Gut. 2004; 53: 291-295
        • Aitken J.
        • Bain C.
        • Ward M.
        • Siskind V.
        • MacLennan R.
        How accurate is self-reported family history of colorectal cancer?.
        Am J Epidemiol. 1995; 141: 863-871
        • Sijmons R.H.
        • Boonstra A.E.
        • Reefhuis J.
        • et al.
        Accuracy of family history of cancer: clinical genetic implications.
        Eur J Hum Genet. 2000; 8: 181-186
        • Kupfer S.S.
        • McCaffrey S.
        • Kim K.E.
        Racial and gender disparities in hereditary colorectal cancer risk assessment: the role of family history.
        J Cancer Educ. 2006; 21: S32-S36
        • Ziogas A.
        • Anton-Culver H.
        Validation of family history data in cancer family registries.
        Am J Prev Med. 2003; 24: 190-198
        • Glanz K.
        • Grove J.
        • Le M.L.
        • Gotay C.
        Underreporting of family history of colon cancer: correlates and implications.
        Cancer Epidemiol Biomarkers Prev. 1999; 8: 635-639
        • Murff H.J.
        • Peterson N.B.
        • Greevy R.
        • Zheng W.
        Impact of patient age on family cancer history.
        Genet Med. 2006; 8: 438-442
        • Tang W.
        • Hong Y.
        • Province M.A.
        • et al.
        Familial clustering for features of the metabolic syndrome: the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study.
        Diabetes Care. 2006; 29: 631-636
        • Hariri S.
        • Yoon P.W.
        • Qureshi N.
        • Valdez R.
        • Scheuner M.T.
        • Khoury M.J.
        Family history of type 2 diabetes: a population-based screening tool for prevention?.
        Genet Med. 2006; 8: 102-108
        • CDC
        Awareness of family health history as a risk factor for disease—U.S., 2004.
        MMWR Morb Mortal Wkly Rep. 2004; 53: 1044-1047
        • Gail M.H.
        • Brinton L.A.
        • Byar D.P.
        • et al.
        Projecting individualized probabilities of developing breast cancer for white females who are being examined annually.
        J Natl Cancer Inst. 1989; 81: 1879-1886
        • Audrain-McGovern J.
        • Hughes C.
        • Patterson F.
        Effecting behavior change: awareness of family history.
        Am J Prev Med. 2003; 24: 183-189
        • Baptiste-Roberts K.
        • Gary T.L.
        • Beckles G.L.
        • et al.
        Family history of diabetes, awareness of risk factors, and health behaviors among African Americans.
        Am J Public Health. 2007; 97: 907-912
        • Qureshi N.
        • Kai J.
        Informing patients of familial diabetes mellitus risk: how do they respond?.
        BMC Health Serv Res. 2008; 8: 37
        • Sweet K.M.
        • Bradley T.L.
        • Westman J.A.
        Identification and referral of families at high risk for cancer susceptibility.
        J Clin Oncol. 2002; 20: 528-537
        • Skinner C.S.
        • Rawl S.M.
        • Moser B.K.
        • et al.
        Impact of the Cancer Risk Intake System on patient–clinician discussions of tamoxifen, genetic counseling, and colonoscopy.
        J Gen Intern Med. 2005; 20: 360-365
        • Jones J.L.
        • Hughes K.S.
        • Kopans D.B.
        • et al.
        Evaluation of hereditary risk in a mammography population.
        Clin Breast Cancer. 2005; 6: 38-44
        • Hampton T.
        Family health history.
        JAMA. 2005; 294: 3075
        • Emery J.
        The GRAIDS Trial: the development and evaluation of computer decision support for cancer genetic risk assessment in primary care.
        Ann Hum Biol. 2005; 32: 218-227
        • O'Neill S.M.
        Communicating familial risk—my generations.
        2005 (Nov 17–18; Atlanta GA)
        • Acheson L.S.
        • Zyzanski S.J.
        • Stange K.C.
        • Deptowicz A.
        • Wiesner G.L.
        Validation of a self-administered, computerized tool for collecting and displaying the family history of cancer.
        J Clin Oncol. 2006; 24: 5395-5402