Acting Surgeon General Encourages Americans to Know Health History

Acting Surgeon General Steven K. Galson, M.D., M.P.H., encourages everyone to identify and make a record of health problems that seem to run in the family. The Office of the Surgeon General has an updated Web tool to help create that health history.

"Talking about and sharing your own family health history is something you can do right now in order to gain an understanding of your health and the health of family members," says Galson. "It's a starting point for taking fuller charge of your own health future.

"Tracing the illnesses your grandparents, parents, and additional blood relatives have suffered from can help your health care provider predict diseases and disorders from which you could be at risk," Galson said.

Families can use the Web-based tool "My Family Health Portrait." This tool provides consumers with a free and easily-to-use way to assemble their family health information. Launched in 2004 in partnership with several other agencies of the U.S. Department of Health and Human Services, the Surgeon General's Family History Initiative encourages all American families to learn more about their family health history.

Thanksgiving Day is Family Health History Day

“Knowing your family health history is an important way to understand your risk factors and the preventive steps you can take to keep you and your family healthy,” stated DPH Commissioner J. Robert Galvin, M.D., M.P.H., M.B.A.

The goal of the Family Health Initiative is to provide an accessible method for easily obtaining an accurate family health history and, importantly, to use that information in health promotion and disease prevention. Such information is important because, although it is estimated that in a few years sophisticated genetic testing and other related advances will dramatically change how health care is practiced, genetic information can already be used today to improve health.

HHS Launches New Family Health History Initiative

U.S. Surgeon General Richard H. Carmona declared Thanksgiving Day, when American families traditionally gather to celebrate and give thanks, to be the first annual National Family History Day. Americans are encouraged to use their family gatherings as a time to collect important family health history information that can benefit all family members.

To help gather family history information, HHS released a new, free computer program that organizes important health information into a printout that can be taken to a health care professional to help determine whether a patient is at higher risk for disease. The printout can also be placed in a patient's medical record. The new computerized tool, called "My Family Health Portrait,"

The Agency for Healthcare Research and Quality (AHRQ) operates a national database of medical practice guidelines, developed by independent medical and professional organizations, that can help individuals and their health care professionals to customize prevention programs. Family health history is one of the criteria for many of the practice guidelines, which frequently recommend specific medical testing to detect an illness early. The guidelines can be found at the National Guideline Clearinghouse. AHRQ is part of the U.S. Department of Health and Human Services.

The "My Family Health Portrait" software can be downloaded from the Internet and installed on computers using the Windows operating system with the .NET framework installed.
All personal information entered into the program is maintained on the user's computer only; no information is available to the federal government or any other agency. The software will be available in both English and Spanish.

In addition to the software tool, a print version of "My Family Health Portrait" will be available in English and Spanish ( this is so exciting, we will also have this in Spanish!!) through the Federal Citizen Information Center and at consolidated health centers nationwide. Consolidated health centers provide care to patients regardless of their ability to pay. HHS' Health Resources and Services Administration funds the national network of more than 3,600 community health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers.

Self Reported Impact of FHH Modules:

“We need more education about good habits and life style--try, try, try, no quit!”

“I went to the doctor and he said I am fat. Now I exercise and eat more vegetables.”

“People is motivated by activities and we can learn much better.”

In this pilot study we learned the following:

1. FHH is viewed as a risk factor for chronic disease among Utah Hispanics.
2. FHH creates communication that builds family support for maintaining positive lifestyle changes.
   
3. Changes survey format to meet cultural needs were needed.
   
4. Misconceptions exist about heredity among Hispanics. We had to reinforce that disease, allergies, and conditions have a genetic component.
5. Genetic variance exists among family members:

· Perception of risk vary

· Variety of incentives needed!

The impact of our pilot study was determined through a pretest and a posttest survey administered to both groups. The survey was a 32-item paper and pencil questionnaire that assessed beliefs regarding the contribution of family history to the development of common chronic diseases in our participants were included. Our results are summarized in the table below.

Percent Change in FHH Attitudes, Knowledge and Behavior

ATTITUDE/BEHAVIOR	Percent Change
Felt motivated to make changes after participating	64%
Felt motivated to learn more	68%
Reported having talked to a family member about their FHH	64%
Reported changing their diet	55%
Reported visiting a medical professional	23%

Hispanic ESL class participants were self-selected and each class assigned as comparison (n=50) and experimental groups (n=50). Only the experimental group received instruction on the following FHH modules:

• Family Traits Trivia -This FHH teaching module encourages participants to observe the shared traits of family members, as well as the combination of traits that makes them unique.

• Pick the Risk: The Polygenic Pedigree Challenge -- Participants are challenged to track and record the passage of colored candies (representing genes) through generations of a family using a pedigree.

• Risk Continuum - A whole-class kinesthetic demonstration of what it means to be in a "risk group" for developing heart disease based on family history/genetics.

The Genetic Science Learning Center at the University of Utah has developed many FHH teaching modules originally designed for high school students. Elsie Lopez and I have adapted these module for the adult Hispanic population in Utah. We carried out an FHH pilot study intervention in the community last year. The purpose of this study was to determine the extent to which FHH education had an impact on attitudes and health care seeking behaviors regarding chronic disease risk and FHH collection among participants.

Research findings in the field of genomics conclude that chronic conditions arise from the complex interaction between multiple genes, environmental factors, and personal behaviors. However, genetics alone will not determine the extent of development of chronic disease. Implementation of health and nutritional principles are needed in order to establish healthy lifestyles that will help reduce the risk factor for disease. Family health history offers evidence for multiple gene, behavior, and environmental interactions and is also recognized as an independent predictor and important risk factor for disease

Family health history (FHH) is recognized as an important risk factor for chronic disease. Researchers have demonstrated that individuals who have family members with a particular chronic disease are at greater risk of developing the disease themselves compared to the general population. The extent to which people view FHH as a risk factor has implications for whether or not FHH data is collected by individuals and utilized for disease prevention. While research has recently been conducted among Caucasian audiences throughout Utah, little is known about the impact of FHH on immigrants or others who lack community connections to traditional health resources.

Chronic diseases such as heart disease, cancer, stroke, and lower respiratory diseases collectively remain the leading cause of death among populations living in the United States. As Utah health indicator data suggests, Hispanics are not immune from chronic disease conditions and suffer in disproportionate numbers. The Hispanic population in Utah represents the largest racial/ethnic group in the State. A total of 268,234 Hispanics reside in Utah, which accounts for11% of total population. Of the 443,738 individuals living in Utah County, 37,420 or 8% are of hispanic origin.
Based on the health indicators for the State of Utah, Hispanics experience health disparities in several important chronic disease risk factors. These risk factors include lack of health insurance, lack of medical home, lack of early prenatal care, lack of colorectal and prostate cancer screening, obesity, lack of vegetable consumption, and lack of physical activity. More specifically, from 1999 to 2004, 64% of Hispanic adults were found to be overweight or obese, a percentage significantly higher than the overall State average of 55.6%.3 Similarly, the percentage of Hispanic adults with no physical activity (28.0%) was significantly higher than the State average.

Frequently Asked Questions

Q: A:	What is family history? Family history refers to health information about you and your close relatives. Family history is one of the most important risk factors for health problems like heart disease, stroke, diabetes and cancer. (A risk factor is anything that increases your chance of getting a disease.)
Q: A:	Why is knowing my family history important? Family members share their genes, as well as their environment, lifestyles and habits. A family history helps identify people at increased risk for disease because it reflects both a person’s genes and these other shared risk factors.
Q:	My mother had breast cancer. Does this mean I will get cancer, too? Having a family member with a disease suggests that you may have a higher chance of developing that disease than someone without a similar family history. It does not mean that you will definitely develop the disease. Genes are only one of many factors that contribute to disease. Other factors to consider include lifestyle habits, such as diet and physical activity. If you are at risk for breast cancer, consider following national guidelines for a healthy diet and regular exercise. It is also important to talk with your physician about your risk and follow recommendations for screening tests (such as mammograms) that may help to detect disease early, when it is most treatable.
Q: A:	Because both of my parents had heart disease, I know I have “bad” genes. Is there anything I can do to protect myself? First of all, there are no “good” or “bad” genes. Most human diseases, especially common diseases such as heart disease, result from the interaction of genes with environmental and behavioral risk factors that can be changed. The best disease prevention strategy for anyone, especially for someone with a family history, includes reducing risky behaviors (such as smoking) and increasing healthy behaviors (such as regular exercise).
Q: A:	How can knowing my family history help lower my risk of disease? You can’t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity and poor eating habits. People with a family history of chronic disease may have the most to gain from making lifestyle changes . In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to participate in screening tests, such as mammograms and colorectal cancer screening, for early detection of disease. People who have a family history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run.
Q: A:	How can I learn about my family history? The best way to learn about your family history is to ask questions, talk at family gatherings, draw a family tree and record health information. If possible, look at death certificates and family medical records.
Q: A:	How do I learn about my family history if I'm adopted? Learning about your family health history may be hard if you are adopted. Some adoption agencies collect medical information on birth relatives. This is becoming more common but is not routine. Laws concerning collection of information vary by state. Contact the health and social service agency in your state for information about how to access medical or legal records. The National Adoption Clearinghouse offers information on adoption and could be helpful if you decide to search for your birth parents. To learn more, visit http://www.childwelfare.gov/.
Q: A:	What should I do with the information? First, write down the information you collect about your family history and share it with your doctor. Second, remember to keep your information updated and share it with your siblings and children. Third, pass it on to your children, so that they too will have a family history record.
Q: A:	What will my doctor do with the information? Your doctor may assess your risk of disease based on your family history and other risk factors. Your doctor may also recommend things you can do to help prevent disease, such as exercising more, changing your diet, or using screening tests to detect disease early.
Q: A:	If I don’t have a family history of disease, does that mean I am not at risk? Even if you don’t have a history of a particular health problem in your family, you could still be at risk. This is because you may be unaware of disease in some family members, or you could have family members who died young, before they had a chance to develop chronic conditions. Your risk of developing a chronic disease is also influenced by many other factors, including your habits and personal health history.