What Is the Public Health Issue?
Family history is known to be a risk factor for many
chronic diseases including coronary heart disease, stroke,
cancer, and diabetes. These common diseases result from
the interactions of multiple genes with multiple
environmental factors in complex patterns that, despite
progress in sequencing the human genome, are unlikely to
be understood fully in the near future. In the meantime, a
person’s family health history can be used as a low-cost,
low-tech "genomic tool" with which to capture the
interactions of genetic, environmental, and behavioral
factors in determining that person’s disease risk.
Recognizing the potential of family history for disease
prevention and health promotion, the National Office of
Public Health Genomics at the Centers for Disease Control
and Prevention (CDC) began CDC’s Family History Public
Health Initiative in 2002.
What Has CDC Accomplished?
The purpose of the initiative is to evaluate the
use of family history in assessing people’s risk for
common diseases and in developing more effective early
detection and prevention strategies. At the center of
this effort are a new Web-based family history tool for
determining one’s risk for common chronic diseases, and
research activities to assess the validity and utility
of using family health history as a public health
strategy. The initiative also includes collaborative
campaigns to increase public awareness about the
importance of one’s family health history and to improve
and facilitate the use of family history information by
health professionals.
In FY 2005, major activities have
included the following:
-
Completed development of a web-based
tool, Family Healthware™ that
collects information about health behaviors, screening
tests, and a person’s family history for six diseases ─
coronary heart disease, stroke, diabetes, and
colorectal, breast, and ovarian cancer. One set of
algorithms in the software analyzes users’ family
history data and assesses their familial risk for each
of the six diseases. A second set of algorithms uses the
data on familial risk, health behaviors, and screening
results to generate personalized prevention messages.
- Family Healthware™ is
currently being evaluated by three academic centers
using a network of primary care practices to determine
if personalized prevention messages tailored to familial
risk will motivate people at risk to change lifestyle or
screening behaviors. The study began enrolling patients
in December 2005, and data collection is expected to be
completed by the fall of 2007. To help fill gaps in our
understanding of the role that family history plays in
disease occurrence and prevention, researchers are also
analyzing data from past and ongoing population-based
studies of chronic diseases, including the National
Health and Nutrition Examination Survey and the National
Health Interview Survey.
- CDC collaborated with HHS, on the Surgeon General’s
Family History Initiative, which is a national campaign
that marked Thanksgiving as National Family History Day
and included the development of a web-based tool called
"My Family Health Portrait"— a simplified version of
CDC’s Family Healthware™. CDC
delivered packets of family history resource materials
to chronic disease and genetics experts in health
departments of every U.S. state and territory. These
materials were designed to assist local health
departments in their efforts to educate people about the
importance of collecting their family health history. In
addition, CDC developed a family history website for
the public, at http://www.cdc.gov/genomics/public/famhist.htm,
that includes fact sheets, presentations, case studies,
news articles, relevant links, and other resources.
What Are the Next Steps?
Validating the new, self-administered family history
tools will support the use of family history as a
screening tool for disease prevention and health
promotion. Several federal and professional initiatives
are converging to work synergistically on public health
awareness campaigns and health provider education.
Further research and development will focus on all the
life stages—from children to older adults—where family
history assessment has the potential to prevent disease. |
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