Utilizing Family Health History to Assess Objective Risk for Chronic Disease among African Americans: Building a Culturally Tailored, Community-Based Intervention

Background: African Americans (AA) experience a disproportionate burden of morbidity and mortality from preventable chronic diseases. Family health history (FHH) is a critical risk factor for type 2 diabetes (DIAB), cardiovascular disease (CVD), and hypertension (HTN). According to an NIH, "family history has an important role in the practice of medicine and may motivate positive lifestyle changes, enhance individual empowerment, and influence clinical interventions." However, no consensus exists on how FHH information is best obtained from racial/ethnic minority populations. Limited studies exist that examine the use of FHH to influence AA risk perceptions. This study examined the influence of a community-based FHH intervention on AA risk perceptions for DIAB, CVD, and HTN. Methods: The intervention used a pre/post design with one follow-up session. Participants completed a pre-survey followed by a FHH interview, immediately followed by a post-survey. Survey collected data on socio-demographics, behavioral risk factors, trust in research, and risk perception. Participants were contacted 30 days later for follow-up. Data analysis 1) summarized distribution of participants' objective risk (average, moderate, or high), based on Scheuner's objective risk stratification, 2) compared accuracy of risk perception pre- and post-FHH using marginal homogeneity tests, and 3) examined predictors of accuracy of risk perception post-FHH using multinomial logistic regression. Results: 799 AA completed the intervention. Majority were female (84%), ≥51 years of age (58%), and 25% had an annual income of ≤ $20,000. A majority of individuals (52%) reported being diagnosed with either DIAB (19%), CVD (9%), or HTN (45%). A higher percentage of individuals were classified as having high risk for DIAB (47%), CVD (41%), and HTN (72%). Preliminary results demonstrate accuracy was significantly different pre- and post-family health history (p<0.05). In addition, predictors of accuracy post-FHH included age, income, education, perceived risk pre- and post-FHH, and objective risk (p<0.05). Conclusions: The family health history is a promising public health tool that can be culturally tailored to meet the needs of minority populations. Participants identified as "high risk" would benefit greatly from targeted prevention strategies. This intervention has the potential to motivate positive lifestyle changes, thus decreasing racial and ethnic health disparities.