Improving Prevention with a Gene-Environment Focused Family History Assessment

Family history tools should ideally assess the complex interplay of shared genetic, environmental, and behavioral factors that impact health outcomes for individuals and families. In practice, however, family health history assessments rarely incorporate social and environmental exposures, even though these factors are widely recognized as major contributors to chronic diseases. This presentation will discuss how “place or neighborhood factors” could be meaningfully incorporated into family health history assessments to enhance patient-clinician interactions and promote tailored public health prevention strategies. Additionally, it will explore how a family history assessment that incorporates multiple determinants of health may improve our ability to assess and address health disparities through an increased understanding of gene-environment interactions within public health prevention programs in communities. Finally, this presentation will also report on findings from a recent study that assessed beliefs about neighborhood influences on chronic disease risk among racially and ethnically diverse individuals in low-income communities in Cleveland, Ohio. Findings from this study suggest that integrating social and environmental factors into family health history assessments would better reflect lay perceptions of disease causation. Our findings also suggest that integrating “place” into genetic risk assessments may improve patient-clinician communication as well as disease prevention and management strategies. Drawing from these data, we will explore how a re-conceptualization of family history to address multiple determinants could help ensure that environmental factors are appropriately accounted for in the “genomic” era, and ultimately improve efforts to predict, prevent, and manage chronic diseases in clinical and public health settings.