Perceptions of Family Health History in an East Baltimore Community

Perceptions of Family Health History in an East Baltimore Community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions of Family Health History in an East Baltimore Community Yasheel Pandya, Angela Zhu, Ethan Mondell, Sophia Choi, Gina Kim, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5915151/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 May, 2025 Read the published version in Journal of Community Genetics → Version 1 posted 8 You are reading this latest preprint version Abstract Knowledge and discussion of family health history (FHH) can allow patients, families, and communities to proactively monitor their health and communicate with providers to identify genetic risk factors and inform clinical decision-making. Under-resourced communities may face barriers in collecting, sharing, and using FHH due to competing priorities, health literacy, and medical mistrust. We characterized community opinions about FHH in a public Baltimore market. A paper survey was administered during biweekly health fairs at the Northeast Market. The survey assessed participants’ practices of discussing and collecting FHH, knowledge of genetic testing, perception of FHH, and demographics. One hundred and one surveys were collected. 76% of respondents discussed FHH while only 56% collected FHH (p < .05). Logistic regression found that female gender significantly predicts FHH collection (OR = 2.77, 95% CI [1.15, 6.84]). Additionally, higher income was significantly correlated with discussing (OR = 1.59, 95% CI [1.14, 2.37]), collecting (OR = 1.29, 95% CI [1.01, 1.68]), and valuing transmission of FHH from older to younger people (OR = 1.70, 95% CI [1.22, 2.51]). Participants were found to favor obtaining FHH knowledge through intergenerational exchange compared to medical staff or schoolteachers. These findings indicate that promoting FHH warrants equitable strategies to reach all persons across gender, age, and socioeconomics. Having local advocates trained in the significance of FHH (e.g. community health workers) and supporting intergenerational approaches (e.g. older women with younger relatives) may be a consideration to reach such populations. More insight is needed to gain a comprehensive understanding of how FHH is valued by certain demographics and then begin to foster equitable strategies to educate and inform diverse populations on FHH. family health genetics perceptions Baltimore community Figures Figure 1 Figure 2 Introduction Family health history (FHH) is the history of the health of an individual’s biological relatives of at least three generations, which is used for assessing risk, diagnosing, and managing diseases (Kwong et al. 2020 ). A more comprehensive history also includes social and lifestyle history, medication, race/ethnicity, and religion (Haga and Orlando, 2020 ). Knowing and sharing FHH can empower individuals and families, along with their healthcare providers, to address heritable health conditions (Thompson et al. 2015 ; O’Leary et al. 2011 ; Haga and Orlando, 2020 ). The presence of a genetic illness or chronic disease, such as cardiovascular disease, diabetes, or cancer in a family member(s) is a risk factor for the same or related conditions in other relatives (Kaphingst et al. 2011; Ginsburg et al. 2019 ; Filoche et al. 2021 ). By monitoring these risks in more tailored ways, providers can individualize screening plans for patients based on their unique background and connect them with specialist teams. Early awareness of FHH allows individuals to communicate with their provider and make informed lifestyle decisions, such as healthy exercise and diet, that further reduce the risk of late-development conditions (Ginsburg et al. 2019 ; Li et al. 2021 ). FHH is a crucial component of precision medicine, as it supplies contextual information for diagnoses, treatment, and prevention (Li et al. 2021 ). Given recent advances in preventive screening, guidelines, and genetic testing, which include FHH information, varied understanding of its importance may increase disparities in its utilization (Madhavan et al. 2019 ). People who are assigned male sex at birth, people with racial, ethnic, gender, and sexual minority identities, people with low income, and people with limited education disproportionately face barriers to obtaining FHH and discussing it with a provider (Hull and Natarajan 2022 ). Many racial minority communities also harbor feelings of distrust and hesitation towards the healthcare system due to historical mistreatment and discrimination (Senier et al. 2015 ). Other barriers include stigma, interfamilial relations, personal conflict, or generational gaps in information. While health is often discussed in these families, health information is less often transcribed to a formal FHH record and variably discussed with providers due to privacy and family sensitivities concerns, varied memories and accuracy of health information (Thompson et al. 2015 , Yoon et al. 2002 ). It is therefore necessary to continue exploring the barriers, behaviors, or attitudinal differences responsible for the disparity in importance and collection of FHH. While discussions of FHH are more verbal and colloquial, collecting FHH is variably done via official documentation for patient care. As FHH collection is heavily dependent on patient knowledge, it is crucial for patients to be educated on the importance of FHH and how to effectively collect it. By obtaining incomplete or inaccurate information and lacking awareness of inherited conditions, patients can limit their abilities to get the proper diagnoses or treatment for many early preventable diseases (Haga and Orlando 2020 ). Efforts to streamline educational initiatives to promote FHH are limited – often in the form of worksheets or infographics (Madhavan et al. 2019 ). Enhancing primary care providers' skills in gathering and explaining FHH is limited by time constraint during appointments and standardization. Online FHH collection forms are less constrained by time, but their accessibility to all patients remains an issue - online FHH collection may lack the appropriate depth or relevance to maximize tailored patient care without PCP guidance, making the built-in online algorithms less effective (Ginsburg et al. 2019 ). Computer literacy and privacy concerns pose other issues with online forms (Kwong et al. 2020 ). Public education on FHH through the National Family History Day initiative, the Genetic Alliance organization, and other governmental outreach efforts have increased some willingness to share FHH with relatives and healthcare providers, but do not consider each community’s unique characteristics (Senier et al. 2015 ). A community’s socioeconomic status, willingness and ability to accept FHH innovations, and perception about FHH influences the effectiveness and uptake of initiatives (Allen et al. 2020 ). Given the significance of understanding the population with which to partner, our group developed a FHH education and outreach table in an East Baltimore public market and for use at health fairs (Krumpf et al. 2024). The initiative spreads awareness of FHH, offers tools patrons can use to record it, and distributes informational flyers on the screening, prevention, and treatment accessibility of common genetic conditions. Methods A paper survey was administered at the Northeast Market, a local public market within the East Baltimore neighborhood in Baltimore City. The survey was introduced to patrons who voluntarily engaged with a FHH outreach table during a biweekly health fair hosted at the Northeast Market. The outreach table was staffed by a clinical geneticist and healthcare students who raised awareness of FHH and offered educational materials on chronic health condition screening, prevention, and treatment accessibility. The table was set up with various print outs on the table and a sign with a family tree at various sites within the Northeast Market over the course of the study, most commonly directly adjacent to the entrance of the market and in the middle of the market near the food court. To maintain anonymity, no identifying information was recorded. Survey collection and data analysis spanned from October 2021 to October 2023. Survey questions were generated with input from a clinical geneticist, Baltimore community advisory group, and stakeholder interviews to define research priorities according to the community’s interests and ensure the survey’s accessibility to residents with varying education and socioeconomic status. Participants answered the survey themselves after receiving the paper copy at the table and once completed they returned it to the volunteer. The survey aimed to assess participants' knowledge of their family history, whether they discussed it with other family members or healthcare providers, and if their family has participated in genetic testing. A 5-point Likert scale was used to measure participants' extent of agreement or disagreement with statements regarding the value of FHH in health, the role of genetic testing in understanding health risks, and various methods for promoting the utility of FHH within family, community, and institutional settings (see survey in supplementary materials). Early in the study, 4 participants seemed to have not read the questions in full, evidenced by contradictory responses between the FHH discussion and Likert scale questions. This was adjusted for in the analysis after the format was revised for readability and a more intuitive low-to-high Likert scale. The following sociodemographic characteristics were measured: Hispanic origin, race/ethnicity, gender, marital status, employment status, age, level of completed education, and household income. Descriptive analyses and statistical analyses were conducted using Excel and R Studio. Partially completed surveys were excluded from the analysis if less than 50% of survey questions were answered. Non-responses to questions are indicated by n-values less than 101. Statistical tests including logistic regression, Student’s t-test, Chi-Squared, and Wilcoxon Rank Sum (Mann Whitney U) were performed to establish relationships between response variables. A threshold of p < .05 was used to establish statistical significance. The Johns Hopkins Institutional Review Board determined that the study was exempt research (IRB00226247). Results Demographic Characteristics of Participants We collected and analyzed 101 surveys (Table 1 ). The median participant age was 58 years. Most participants self-reported as Black/African American (77%, n = 76/99), female (65%, n = 63/97), and single (54%, n = 38/71). A plurality of participants self-reported as employed (43%, n = 30/69), with high school as the highest completed education (46%, n = 46/100), and a household income below $ 20,000 (24%, n = 20/82). Table 1 Demographic Characteristics Demographics Categories n = 101 General characteristics, median [IQR] Age 58 [41–63] Race/Ethnicity, n (%) n = 99 White/Caucasian 7 (7.1%) Black/African American 76 (76.8%) Asian/Asian Indian 6 (6.1%) American Indian/Alaskan Native 1 (1%) Other 5 (5.1%) Prefer not to say 4 (4%) Gender, n (%) n = 97 Male 34 (35%) Female 63 (64.9%) Prefer not to answer 0 (0%) Other 0 (0%) Marital Status, n (%) n = 71 Single 38 (53.5%) Married 13 (18.3%) Divorced/Separated 11 (15.5%) Widowed 9 (12.7%) Employment Status, n (%) n = 69 Employed 30 (43.4%) Unemployed 18 (26.1%) Student 6 (8.7%) Retired 15 (21.7%) Education Level, n (%) N = 100 Less Than High School 2 (2%) High School/GED 46 (46%) Some College 26 (26%) 4-Year Degree 11 (11%) Graduate Studies 1 (1%) Prefer not to answer 5 (5%) Household Income, n (%) n = 82 $ 0 - $ 19,999 20 (24.4%) $ 20,000 - $ 44,999 16 (19.5%) $ 45,000 - $ 69,999 10 (12.2%) $ 70,000 - $ 99,999 11 (13.4%) $ 100,000+ 5 (6.1%) Prefer not to answer 20 (24.4%) Familiarity with FHH and Genetic Testing There was a significant difference in the proportion of those who discussed FHH with family (76%) compared to those who collected FHH (56%) (p < .05, chi-squared), as seen in Fig. 1 . The difference was larger between those who collected FHH compared to those who knew of people who received genetic testing (31%) (p < .02, chi-squared). Stratifying these responses by demographic characteristics, 64% of females collected FHH compared to 34% of males (p < 0.05). Logistic regression analysis demonstrated that female gender significantly predicts FHH collection (OR = 2.77, 95% CI [1.15, 6.84], p < .05, AIC = 122.78), but does not significantly predict FHH discussion. Generally, participants with higher education, higher income, employment or retirement status, and non-single marital status discussed and collected FHH at higher rates. Ordinal logistic regression demonstrated having a higher income was significantly correlated with discussing (OR = 1.59, 95% CI [1.14, 2.37], p < .05, AIC = 80.85) and collecting FHH (OR = 1.29, 95% CI [1.01, 1.68], p < .05, AIC = 105.53). Across all socioeconomic groups, there was no difference in participants’ knowledge of someone who received genetic testing. Communication Strategies and Perceptions of Health Utility of FHH 74% (n = 72) of participants strongly favored intergenerational exchange of FHH knowledge from older to younger generations, and 71% (n = 69) of participants strongly agreed that talking with relatives about FHH can help teach about health conditions that can be inherited. 69% (n = 69) of individuals strongly believed that knowing one’s FHH could help them make better health choices and 66% (n = 62) strongly agreed that genetic testing can help with understanding risk factors (Fig. 2 ). Stratified by demographic characteristics, participants with higher education, higher income, employment or retirement status, and non-single marital status placed more value on exchanging information about inherited health conditions with relatives (Fig. 2 ). Having a higher income is also significantly correlated with valuing transmission of FHH from older to younger people (OR = 1.70, 95% CI [1.22, 2.51], p < .05, AIC = 139.30). Broadly, participants believed that knowing FHH and completing genetic testing teaches one about their health risks and informs better health choices. Beliefs Regarding Strategies to Advocate for FHH 63% (n = 58) strongly agreed that medical staff should publicly promote FHH. 62% (n = 60) and 55% (n = 52) of participants strongly believed that having teachers talk about FHH could help show its value and the importance of FHH should be taught in science classes, respectively (Fig. 2 ). Stratified by demographic characteristics, participants with higher education, higher income, employment or retirement status, and non-single marital status placed less value on lessons in science classes compared to intergenerational and inter-relative FHH communication. Discussion This survey aimed to gather perceptions about FHH in an under resourced urban community. The survey sample closely aligned with the tabulation area from the 2020 United States Census for zip code 21205, where the NE Market is located. Most residents are unemployed, do not have a bachelor’s degree or higher, identify as Black or African American, and have a median household income of $ 38,211 (United States Census Bureau). However, with a median age of 32.8 years for the zip code, our survey captured older individuals than the neighborhood at large. While respondents engaged in and valued interfamilial FHH discussions, they less frequently collect this information, which may limit their access to the preventive benefits afforded by actionable FHH. Community FHH awareness interventions could empower recipients with knowledge of the benefits of discussing FHH with relatives, the FHH collection tools needed to take a thorough history, and encouragement to share this information with providers. Our finding that females were more likely to collect FHH validates previous studies of their role as kin keepers of FHH information, despite males and females discussing FHH at similar rates (Kaphingst et al. 2011). To promote formal FHH collection, community-based outreach efforts could focus on educating and motivating females while simultaneously encouraging males to develop the self-efficacy to collect FHH themselves to account for varied family structures. Ongoing medical informatic updates to improve ease of FHH collection could help providers and families. While introducing some inaccuracies, both medical record and survey-based collection strategies can offer more actionable health information (Cronin et al. 2021 ). Economic accessibility remains an important barrier to FHH review and potential actionable medical discussion. Compared to other genetic screening tools like whole genome sequencing (WGS) or exome sequencing (WES) (Haga and Orlando, 2020 ), FHH can have increased affordability and acceptability, and support a coherent picture of shared predispositions for patients and families (Valdez et al. 2010 ). However, details of self-reported FHH in low-income individuals are often insufficient, limiting the ability for genetic screening to address pressing health needs (Hull et al. 2022). Many genetic tests are reimbursed by insurance contingent on a strong FHH, but the direct-to-consumer genetic tests that aim to bridge this gap remain cost-prohibitive for these under-resourced groups (Hull et al. 2022). Participants with low household incomes face greater difficulty in affording regular care visits, trusting their providers considering historical injustices towards minority groups, and maintaining health literacy of inherited conditions and genetic testing options. Our results further highlighted the urgent need to consider under-resourced communities in accessing and utilizing FHH. Increasing awareness through health education and advocacy initiatives such as our Family Health Initiative at the NE Market served as a start, however, the numerous hindrances to clinic access requires a deeper longitudinal investment in building trust with and understanding the perspectives of these communities. By assessing attitudes towards FHH outreach, our survey revealed the role of elder, respected community members in overcoming barriers to FHH knowledge, which can inform future screening and outreach interventions. Nearly two-thirds of respondents deemed intergenerational FHH communication and talking about FHH with relatives to be very important. As such, outreach interventions should encourage FHH discussion and collection between elders and future generations in the private family setting. With less agreement that FHH should be publicly advocated for by medical professionals and teachers and even less agreement with teachers educating students about FHH in classes, the community more highly values trust between families rather than with public medical and educational systems. Taken together, our findings suggest that efforts to promote FHH should empower families to advocate among themselves, primarily with more elders documenting and sharing their life and experiences with subsequent generations. The private nature of these conversations would also increase the reliability of FHH, as a take-home survey gives individuals the chance to openly discuss with family without interference from provider judgement at an on-site interview (Yoon et al. 2002 , Cronin et al. 2021 ). Furthermore, more intent, detailed, and secure discussion of FHH can improve accuracy as some people may be unaware of or have distorted recollections of the health of their relatives or have hesitancies in communicating about sensitive illnesses such as cancer, sexual dysfunction, mental illness (Thompson et al. 2015 ; Yoon et al. 2002 ). The interfamilial preference also underscored the need for continued trust-building between medical institutions and their patients. Since the FHH must be disclosed with providers for the appropriate recommendations, these community interventions must be performed alongside longitudinal efforts to increase healthcare accessibility and build a positive relationship with the healthcare system. As a limitation, our study primarily recruited participants who had interacted with students under supervision at the FHH table, possibly introducing selection bias for participants with favorable FHH perceptions. In addition, the sample size of 101 taken over 30 months and the reduced response rate to the marital status, employment, and income questions somewhat limits the generalizability of the sample to all market patrons and East Baltimore residents more broadly. Our initiative could be strengthened by administering additional surveys at the NE Market and to other local community landmarks, including libraries, recreation centers, and at health fairs in neighboring areas. In the future, our work will explore curriculum development to promote FHH and genetic testing resources to females and the elderly. With strong preferences for intergenerational communication between relatives, a FHH advocacy curriculum should be administered by community members themselves. A target community member for interventions could be community health workers, enabling them to deliver basic preventive education related to risk assessment, lifestyle recommendations, and genetic evaluation, improving knowledge of screening and shifting attitudes in favor of screening (Allen et al.; Chen et al. 2021 ). An essential component of the curriculum would be to provide participants (individuals or families) with the confidence to initiate private, thorough discussions about FHH between relatives or family constructs, empowering them to share with providers and make informed lifestyle choices. Our study corroborated the impact of systemic disparities on genetic illness knowledge and management, but the attitudes and preferences can serve as a benchmark to maximize the efficacy of future interventions in promoting FHH to under-resourced communities. Declarations Author Contribution Y.P. and A.Z. were equal first authors of this manuscript. A.Z. is the corresponding author. F.P., A.Z., E.M., G.K., and V.V. performed data collection. A.Z. and F.P wrote the main manuscript text. A.Z. and S.C. wrote the introduction. F.P., G.K., and V.V. wrote the methodology. E.M. performed the data analysis. E.M., F.P., and A.Z. wrote the results. Y.P. and A.Z. wrote the discussion section. Y.P. and A.Z. created the figures. A.Z., F.P., E.M., and S.V. reviewed and edited the manuscript. All authors read and approved the final manuscript. Acknowledgement Nathnael Woldehana Email: [email protected] Bates-Hopkins Email: [email protected] Compliance with Ethics Guidelines Yasheel Pandya BS, Angela Zhu, Ethan Mondell BS, Sophia Choi, Gina Kim BS, Valentina Vanos, Siddharth Venkatraman BS, Panagis Galiatsatos MD MHS, Joann Bodurtha MD MPH All procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (JHM IRB IRB00226247) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. References Allen CG, Bethea BJ, McKinney LP, Escoffery C, Akintobi TH, McCray GG, McBride CM (2022) Exploring the role of community health workers in improving the collection of family health history: A pilot study. Health Promot Pract 23:504–517. https://doi.org/10.1177/15248399211019980 Allen CG, Duquette D, Guan Y, McBride CM (2020) Applying theory to characterize impediments to dissemination of community-facing family health history tools: A review of the literature. J Community Genet 11:147–159. https://doi.org/10.1007/s12687-019-00424-9 Awareness of Family Health History as a Risk Factor for Disease—United States, 2004 (2004) CDC. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5344a5.htm Chen W-J, Zhao S, Stelzig D, Nimmons KM, Dhar SU, Eble TN, Martinez D, Yeh Y-L, Chen L-S (2021) Family Health History–Based Cancer Prevention Training for Community Health Workers. Am J Prev Med 60:e159–e167. https://doi.org/10.1016/j.amepre.2020.09.019 Ciesielski TH, Sirugo G, Iyengar SK, Williams SM (2024) Characterizing the pathogenicity of genetic variants: The consequences of context. Npj Genomic Med 9:3. https://doi.org/10.1038/s41525-023-00386-5 Cronin RM, Halvorson AE, Springer C, Feng X, Sulieman L, Loperena-Cortes R, Mayo K, Carroll RJ, Chen Q, Ahmedani BK, Karnes J, Korf B, O’Donnell CJ, Qian J, Ramirez AH (2021) Comparison of family health history in surveys vs electronic health record data mapped to the observational medical outcomes partnership data model in the All of Us Research Program. J Am Med Inform Assoc 28:695–703. https://doi.org/10.1093/jamia/ocaa315 Filoche S, Stubbe MH, Grainger R, Robson B, Paringatai K, Wilcox P, Jefferies R, Dowell A (2021) How is family health history discussed in routine primary healthcare? A qualitative study of archived family doctor consultations. BMJ Open 11:e049058. https://doi.org/10.1136/bmjopen-2021-049058 Ginsburg GS, Wu RR, Orlando LA (2019) Family health history: Underused for actionable risk assessment. Lancet 394:596–603. https://doi.org/10.1016/S0140-6736(19)31275-9 Haga SB, Orlando LA (2020) The Enduring Importance of Family Health History in the Era of Genomic Medicine and Risk Assessment. Pers Med 17:229–239. https://doi.org/10.2217/pme-2019-0091 Hull LE, Natarajan P (2022) Self-rated family health history knowledge among All of Us program participants. Genet Med 24:955–961. https://doi.org/10.1016/j.gim.2021.12.006 Kaphingst KA, Goodman M, Pandya C, Garg P, Stafford J, Lachance C (2012) Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population. Patient Educ Couns 88:291–297. https://doi.org/10.1016/j.pec.2011.11.013 Kumpf E, Thamilselvan V, Wang E, Barger P, Gentry J, Bash C, Young D, Byiringiro S, Bodurtha J, Brown A, Guo M, Carter A, Price L, Smith P, Lacanienta C, Himmelfarb C, Wu AW (2024) Community-driven partnerships with Community-Engaged Research teams bring resources and reliable information to Baltimore residents. J Clin Transl Sci 8:e205. https://doi.org/10.1017/cts.2024.606 Kwong L, Bodurtha J, Busch DW (2020) An Integrative Review of Family Health History in Pediatrics. Clin Pediatr 59:1282–1287. https://doi.org/10.1177/0009922820943474 Li M, Zhao S, Young CM, Foster M, Huei-yu Wang J, Tseng T-S, Kwok O-M, Chen L-S (2021) Family Health History–Based Interventions: A Systematic Review of the Literature. Am J Prev Med 61:445–454. https://doi.org/10.1016/j.amepre.2021.03.022 Madhavan S, Bullis E, Myers R, Zhou CJ, Cai EM, Sharma A, Bhatia S, Orlando LA, Haga SB (2019) Awareness of family health history in a predominantly young adult population. PLOS ONE 14:e0224283. https://doi.org/10.1371/journal.pone.0224283 O’Leary J, Edelson V, Gardner N, Gepp A, Kyler P, Moore P, Petruccio C, Williams M, Terry S, Bowen D (2011) Community-Centered Family Health History: A Customized Approach to Increased Health Communication and Awareness. Prog Community Health Partnersh 5:113–122. https://doi.org/10.1353/cpr.2011.0016 Sanghavi K, Moses I, Moses D, Gordon A, Chyr L, Bodurtha J (2019) Family health history and genetic services—The East Baltimore community stakeholder interview project. J Community Genet 10:219–227. https://doi.org/10.1007/s12687-018-0379-z Senier L, Shields M, Lee R, Nicoll L, Falzon D, Wiecek E (2015) Community-Based Family Health History Education: The Role of State Health Agencies in Engaging Medically Underserved Populations in Understanding Genomics and Risk of Chronic Disease. Healthcare 3:995–1017. https://doi.org/10.3390/healthcare3040995 Thompson T, Seo J, Griffith J, Baxter M, James A, Kaphingst KA (2015) The Context of Collecting Family Health History: Examining Definitions of Family and Family Communication about Health among African American Women. J Health Commun 20:416–423. https://doi.org/10.1080/10810730.2014.977466 United States Census Bureau (n.d.) ZIP Code Tabulation Area ZCTA5 21205. https://data.census.gov/profile/ZCTA5_21205?g=860XX00US21205 Valdez R, Yoon PW, Qureshi N, Green RF, Khoury MJ (2010) Family History in Public Health Practice: A Genomic Tool for Disease Prevention and Health Promotion. Annu Rev Public Health 31:69–87. https://doi.org/10.1146/annurev.publhealth.012809.103621 Wildin RS, Messersmith DJ, Houwink EJF (2021) Modernizing family health history: Achievable strategies to reduce implementation gaps. J Community Genet 12:493–496. https://doi.org/10.1007/s12687-021-00531-6 Yoon PW, Scheuner MT, Peterson-Oehlke KL, Gwinn M, Faucett A, Khoury MJ (2002) Can family history be used as a tool for public health and preventive medicine? Genet Med 4:304–310. https://doi.org/10.1097/00125817-200207000-00009 Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformationsFigures.pdf Cite Share Download PDF Status: Published Journal Publication published 31 May, 2025 Read the published version in Journal of Community Genetics → Version 1 posted Editorial decision: Revision requested 09 May, 2025 Reviews received at journal 13 Mar, 2025 Reviewers agreed at journal 21 Feb, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviewers invited by journal 15 Feb, 2025 Editor assigned by journal 04 Feb, 2025 Submission checks completed at journal 04 Feb, 2025 First submitted to journal 27 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5915151","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":410943646,"identity":"7c420100-b88e-455f-a896-8bb38665e9f7","order_by":0,"name":"Yasheel Pandya","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Yasheel","middleName":"","lastName":"Pandya","suffix":""},{"id":410943647,"identity":"2bf1d168-02a5-4602-8be1-1c65ac65d075","order_by":1,"name":"Angela Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYFACHgaGj39smA2ATAmitTDObEgjUQszb8NhBuK18PefPSbBu+M8uzkD88HbPMRokThwLk1C8sxtZssGtmRrorQwHOwxkzBgu81scIDHTJooLfKHecwkEtjOAbXwfyNOi8ExoJaDbQdAtrARp8XwDI+xZcOZZGaDw2zGlnOI0SJ3/ozh7T8VdskGx5sf3nhDjBYYSGZgJkU5CNiRqmEUjIJRMApGEAAAzo0s9D0sfI4AAAAASUVORK5CYII=","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":true,"prefix":"","firstName":"Angela","middleName":"","lastName":"Zhu","suffix":""},{"id":410943648,"identity":"32253476-6222-4041-9b5a-3e5ec303ff90","order_by":2,"name":"Ethan Mondell","email":"","orcid":"","institution":"Johns Hopkins Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ethan","middleName":"","lastName":"Mondell","suffix":""},{"id":410943649,"identity":"2c8a0829-cf77-4d07-8b6f-85666a5bf5b3","order_by":3,"name":"Sophia Choi","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Sophia","middleName":"","lastName":"Choi","suffix":""},{"id":410943650,"identity":"efbdd246-329f-4c95-9049-d7a6f7d60af1","order_by":4,"name":"Gina Kim","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Gina","middleName":"","lastName":"Kim","suffix":""},{"id":410943651,"identity":"998f3119-8b81-4454-97c4-ddfcbc58227b","order_by":5,"name":"Valentina Vanos","email":"","orcid":"","institution":"Johns Hopkins Bloomberg School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Valentina","middleName":"","lastName":"Vanos","suffix":""},{"id":410943653,"identity":"399aabe5-82c9-4f1b-9281-4de286ef5067","order_by":6,"name":"Siddharth Venkatraman","email":"","orcid":"","institution":"Johns Hopkins Medicine","correspondingAuthor":false,"prefix":"","firstName":"Siddharth","middleName":"","lastName":"Venkatraman","suffix":""},{"id":410943656,"identity":"28286c44-1637-446f-a4b0-35b99cd67bd2","order_by":7,"name":"Panagis Galiatsatos","email":"","orcid":"","institution":"Johns Hopkins Medicine","correspondingAuthor":false,"prefix":"","firstName":"Panagis","middleName":"","lastName":"Galiatsatos","suffix":""},{"id":410943657,"identity":"ea1f5ec9-ce43-4522-9d82-c24cb5e9a9ab","order_by":8,"name":"Joann Bodurtha","email":"","orcid":"","institution":"Johns Hopkins Medicine","correspondingAuthor":false,"prefix":"","firstName":"Joann","middleName":"","lastName":"Bodurtha","suffix":""}],"badges":[],"createdAt":"2025-01-27 22:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5915151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5915151/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12687-025-00804-4","type":"published","date":"2025-05-31T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75591780,"identity":"b04eb5a8-9a0c-4905-bd11-b87be13deafc","added_by":"auto","created_at":"2025-02-06 07:13:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":123449,"visible":true,"origin":"","legend":"\u003cp\u003eHistory of FHH discussion, collection, and knowledge of genetic testing in social networks. Values are percentages of participants (n=97, n=96, n=95). There are significant differences ( *= p\u0026lt;.05, chi-squared) between the proportion of those answering yes to discussing FHH and answering yes to collecting or knowing of genetic testing\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5915151/v1/a6ff35f1efbc5b36c3e9bfa2.png"},{"id":75592368,"identity":"f6895ab8-eeec-4352-9e7e-f077d8313710","added_by":"auto","created_at":"2025-02-06 07:21:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":198982,"visible":true,"origin":"","legend":"\u003cp\u003eAttitudes towards FHH and its advocacy. Values are percentage of participants (n=101) based on their Likert scale answer\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5915151/v1/8c19d0dfc0323b4b2429b918.png"},{"id":83782992,"identity":"609eaec9-dcea-437d-980c-4ee8c7cf776a","added_by":"auto","created_at":"2025-06-02 16:09:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":743766,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5915151/v1/eb95fde6-9c54-4ea2-8150-aae5a9f35f69.pdf"},{"id":75591783,"identity":"8fefadf4-603c-4b5b-9c55-40d491b67f57","added_by":"auto","created_at":"2025-02-06 07:13:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":834823,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformationsFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5915151/v1/46305fae401b042d2078b373.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions of Family Health History in an East Baltimore Community","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFamily health history (FHH) is the history of the health of an individual\u0026rsquo;s biological relatives of at least three generations, which is used for assessing risk, diagnosing, and managing diseases (Kwong et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A more comprehensive history also includes social and lifestyle history, medication, race/ethnicity, and religion (Haga and Orlando, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Knowing and sharing FHH can empower individuals and families, along with their healthcare providers, to address heritable health conditions (Thompson et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; O\u0026rsquo;Leary et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Haga and Orlando, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The presence of a genetic illness or chronic disease, such as cardiovascular disease, diabetes, or cancer in a family member(s) is a risk factor for the same or related conditions in other relatives (Kaphingst et al. 2011; Ginsburg et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Filoche et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). By monitoring these risks in more tailored ways, providers can individualize screening plans for patients based on their unique background and connect them with specialist teams. Early awareness of FHH allows individuals to communicate with their provider and make informed lifestyle decisions, such as healthy exercise and diet, that further reduce the risk of late-development conditions (Ginsburg et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Li et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). FHH is a crucial component of precision medicine, as it supplies contextual information for diagnoses, treatment, and prevention (Li et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Given recent advances in preventive screening, guidelines, and genetic testing, which include FHH information, varied understanding of its importance may increase disparities in its utilization (Madhavan et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePeople who are assigned male sex at birth, people with racial, ethnic, gender, and sexual minority identities, people with low income, and people with limited education disproportionately face barriers to obtaining FHH and discussing it with a provider (Hull and Natarajan \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Many racial minority communities also harbor feelings of distrust and hesitation towards the healthcare system due to historical mistreatment and discrimination (Senier et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Other barriers include stigma, interfamilial relations, personal conflict, or generational gaps in information. While health is often discussed in these families, health information is less often transcribed to a formal FHH record and variably discussed with providers due to privacy and family sensitivities concerns, varied memories and accuracy of health information (Thompson et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, Yoon et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). It is therefore necessary to continue exploring the barriers, behaviors, or attitudinal differences responsible for the disparity in importance and collection of FHH.\u003c/p\u003e \u003cp\u003eWhile discussions of FHH are more verbal and colloquial, collecting FHH is variably done via official documentation for patient care. As FHH collection is heavily dependent on patient knowledge, it is crucial for patients to be educated on the importance of FHH and how to effectively collect it. By obtaining incomplete or inaccurate information and lacking awareness of inherited conditions, patients can limit their abilities to get the proper diagnoses or treatment for many early preventable diseases (Haga and Orlando \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Efforts to streamline educational initiatives to promote FHH are limited \u0026ndash; often in the form of worksheets or infographics (Madhavan et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Enhancing primary care providers' skills in gathering and explaining FHH is limited by time constraint during appointments and standardization. Online FHH collection forms are less constrained by time, but their accessibility to all patients remains an issue - online FHH collection may lack the appropriate depth or relevance to maximize tailored patient care without PCP guidance, making the built-in online algorithms less effective (Ginsburg et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Computer literacy and privacy concerns pose other issues with online forms (Kwong et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Public education on FHH through the National Family History Day initiative, the Genetic Alliance organization, and other governmental outreach efforts have increased some willingness to share FHH with relatives and healthcare providers, but do not consider each community\u0026rsquo;s unique characteristics (Senier et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). A community\u0026rsquo;s socioeconomic status, willingness and ability to accept FHH innovations, and perception about FHH influences the effectiveness and uptake of initiatives (Allen et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Given the significance of understanding the population with which to partner, our group developed a FHH education and outreach table in an East Baltimore public market and for use at health fairs (Krumpf et al. 2024). The initiative spreads awareness of FHH, offers tools patrons can use to record it, and distributes informational flyers on the screening, prevention, and treatment accessibility of common genetic conditions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA paper survey was administered at the Northeast Market, a local public market within the East Baltimore neighborhood in Baltimore City. The survey was introduced to patrons who voluntarily engaged with a FHH outreach table during a biweekly health fair hosted at the Northeast Market. The outreach table was staffed by a clinical geneticist and healthcare students who raised awareness of FHH and offered educational materials on chronic health condition screening, prevention, and treatment accessibility. The table was set up with various print outs on the table and a sign with a family tree at various sites within the Northeast Market over the course of the study, most commonly directly adjacent to the entrance of the market and in the middle of the market near the food court. To maintain anonymity, no identifying information was recorded. Survey collection and data analysis spanned from October 2021 to October 2023.\u003c/p\u003e \u003cp\u003eSurvey questions were generated with input from a clinical geneticist, Baltimore community advisory group, and stakeholder interviews to define research priorities according to the community\u0026rsquo;s interests and ensure the survey\u0026rsquo;s accessibility to residents with varying education and socioeconomic status. Participants answered the survey themselves after receiving the paper copy at the table and once completed they returned it to the volunteer. The survey aimed to assess participants' knowledge of their family history, whether they discussed it with other family members or healthcare providers, and if their family has participated in genetic testing. A 5-point Likert scale was used to measure participants' extent of agreement or disagreement with statements regarding the value of FHH in health, the role of genetic testing in understanding health risks, and various methods for promoting the utility of FHH within family, community, and institutional settings (see survey in supplementary materials). Early in the study, 4 participants seemed to have not read the questions in full, evidenced by contradictory responses between the FHH discussion and Likert scale questions. This was adjusted for in the analysis after the format was revised for readability and a more intuitive low-to-high Likert scale. The following sociodemographic characteristics were measured: Hispanic origin, race/ethnicity, gender, marital status, employment status, age, level of completed education, and household income.\u003c/p\u003e \u003cp\u003eDescriptive analyses and statistical analyses were conducted using Excel and R Studio. Partially completed surveys were excluded from the analysis if less than 50% of survey questions were answered. Non-responses to questions are indicated by n-values less than 101. Statistical tests including logistic regression, Student\u0026rsquo;s t-test, Chi-Squared, and Wilcoxon Rank Sum (Mann Whitney U) were performed to establish relationships between response variables. A threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;.05 was used to establish statistical significance. The Johns Hopkins Institutional Review Board determined that the study was exempt research (IRB00226247).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics of Participants\u003c/h2\u003e \u003cp\u003eWe collected and analyzed 101 surveys (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The median participant age was 58 years. Most participants self-reported as Black/African American (77%, n\u0026thinsp;=\u0026thinsp;76/99), female (65%, n\u0026thinsp;=\u0026thinsp;63/97), and single (54%, n\u0026thinsp;=\u0026thinsp;38/71). A plurality of participants self-reported as employed (43%, n\u0026thinsp;=\u0026thinsp;30/69), with high school as the highest completed education (46%, n\u0026thinsp;=\u0026thinsp;46/100), and a household income below \u003cspan\u003e$\u003c/span\u003e20,000 (24%, n\u0026thinsp;=\u0026thinsp;20/82).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;101\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral characteristics, median [IQR]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 [41\u0026ndash;63]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eRace/Ethnicity, n (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite/Caucasian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack/African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (76.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian/Asian Indian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmerican Indian/Alaskan Native\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (64.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital Status, n (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEmployment Status, n (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (43.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEducation Level, n (%)\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess Than High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School/GED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4-Year Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate Studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eHousehold Income, n (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0 - \u003cspan\u003e$\u003c/span\u003e19,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e20,000 - \u003cspan\u003e$\u003c/span\u003e44,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e45,000 - \u003cspan\u003e$\u003c/span\u003e69,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e70,000 - \u003cspan\u003e$\u003c/span\u003e99,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100,000+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFamiliarity with FHH and Genetic Testing\u003c/h3\u003e\n\u003cp\u003eThere was a significant difference in the proportion of those who discussed FHH with family (76%) compared to those who collected FHH (56%) (p\u0026thinsp;\u0026lt;\u0026thinsp;.05, chi-squared), as seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The difference was larger between those who collected FHH compared to those who knew of people who received genetic testing (31%) (p\u0026thinsp;\u0026lt;\u0026thinsp;.02, chi-squared).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStratifying these responses by demographic characteristics, 64% of females collected FHH compared to 34% of males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Logistic regression analysis demonstrated that female gender significantly predicts FHH collection (OR\u0026thinsp;=\u0026thinsp;2.77, 95% CI [1.15, 6.84], p\u0026thinsp;\u0026lt;\u0026thinsp;.05, AIC\u0026thinsp;=\u0026thinsp;122.78), but does not significantly predict FHH discussion. Generally, participants with higher education, higher income, employment or retirement status, and non-single marital status discussed and collected FHH at higher rates. Ordinal logistic regression demonstrated having a higher income was significantly correlated with discussing (OR\u0026thinsp;=\u0026thinsp;1.59, 95% CI [1.14, 2.37], p\u0026thinsp;\u0026lt;\u0026thinsp;.05, AIC\u0026thinsp;=\u0026thinsp;80.85) and collecting FHH (OR\u0026thinsp;=\u0026thinsp;1.29, 95% CI [1.01, 1.68], p\u0026thinsp;\u0026lt;\u0026thinsp;.05, AIC\u0026thinsp;=\u0026thinsp;105.53). Across all socioeconomic groups, there was no difference in participants\u0026rsquo; knowledge of someone who received genetic testing.\u003c/p\u003e\n\u003ch3\u003eCommunication Strategies and Perceptions of Health Utility of FHH\u003c/h3\u003e\n\u003cp\u003e74% (n\u0026thinsp;=\u0026thinsp;72) of participants strongly favored intergenerational exchange of FHH knowledge from older to younger generations, and 71% (n\u0026thinsp;=\u0026thinsp;69) of participants strongly agreed that talking with relatives about FHH can help teach about health conditions that can be inherited. 69% (n\u0026thinsp;=\u0026thinsp;69) of individuals strongly believed that knowing one\u0026rsquo;s FHH could help them make better health choices and 66% (n\u0026thinsp;=\u0026thinsp;62) strongly agreed that genetic testing can help with understanding risk factors (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStratified by demographic characteristics, participants with higher education, higher income, employment or retirement status, and non-single marital status placed more value on exchanging information about inherited health conditions with relatives (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Having a higher income is also significantly correlated with valuing transmission of FHH from older to younger people (OR\u0026thinsp;=\u0026thinsp;1.70, 95% CI [1.22, 2.51], p\u0026thinsp;\u0026lt;\u0026thinsp;.05, AIC\u0026thinsp;=\u0026thinsp;139.30). Broadly, participants believed that knowing FHH and completing genetic testing teaches one about their health risks and informs better health choices.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eBeliefs Regarding Strategies to Advocate for FHH\u003c/h3\u003e\n\u003cp\u003e63% (n\u0026thinsp;=\u0026thinsp;58) strongly agreed that medical staff should publicly promote FHH. 62% (n\u0026thinsp;=\u0026thinsp;60) and 55% (n\u0026thinsp;=\u0026thinsp;52) of participants strongly believed that having teachers talk about FHH could help show its value and the importance of FHH should be taught in science classes, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Stratified by demographic characteristics, participants with higher education, higher income, employment or retirement status, and non-single marital status placed less value on lessons in science classes compared to intergenerational and inter-relative FHH communication.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis survey aimed to gather perceptions about FHH in an under resourced urban community. The survey sample closely aligned with the tabulation area from the 2020 United States Census for zip code 21205, where the NE Market is located. Most residents are unemployed, do not have a bachelor\u0026rsquo;s degree or higher, identify as Black or African American, and have a median household income of \u003cspan\u003e$\u003c/span\u003e38,211 (United States Census Bureau). However, with a median age of 32.8 years for the zip code, our survey captured older individuals than the neighborhood at large. While respondents engaged in and valued interfamilial FHH discussions, they less frequently collect this information, which may limit their access to the preventive benefits afforded by actionable FHH. Community FHH awareness interventions could empower recipients with knowledge of the benefits of discussing FHH with relatives, the FHH collection tools needed to take a thorough history, and encouragement to share this information with providers.\u003c/p\u003e \u003cp\u003eOur finding that females were more likely to collect FHH validates previous studies of their role as kin keepers of FHH information, despite males and females discussing FHH at similar rates (Kaphingst et al. 2011). To promote formal FHH collection, community-based outreach efforts could focus on educating and motivating females while simultaneously encouraging males to develop the self-efficacy to collect FHH themselves to account for varied family structures. Ongoing medical informatic updates to improve ease of FHH collection could help providers and families. While introducing some inaccuracies, both medical record and survey-based collection strategies can offer more actionable health information (Cronin et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEconomic accessibility remains an important barrier to FHH review and potential actionable medical discussion. Compared to other genetic screening tools like whole genome sequencing (WGS) or exome sequencing (WES) (Haga and Orlando, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), FHH can have increased affordability and acceptability, and support a coherent picture of shared predispositions for patients and families (Valdez et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). However, details of self-reported FHH in low-income individuals are often insufficient, limiting the ability for genetic screening to address pressing health needs (Hull et al. 2022). Many genetic tests are reimbursed by insurance contingent on a strong FHH, but the direct-to-consumer genetic tests that aim to bridge this gap remain cost-prohibitive for these under-resourced groups (Hull et al. 2022). Participants with low household incomes face greater difficulty in affording regular care visits, trusting their providers considering historical injustices towards minority groups, and maintaining health literacy of inherited conditions and genetic testing options. Our results further highlighted the urgent need to consider under-resourced communities in accessing and utilizing FHH. Increasing awareness through health education and advocacy initiatives such as our Family Health Initiative at the NE Market served as a start, however, the numerous hindrances to clinic access requires a deeper longitudinal investment in building trust with and understanding the perspectives of these communities.\u003c/p\u003e \u003cp\u003eBy assessing attitudes towards FHH outreach, our survey revealed the role of elder, respected community members in overcoming barriers to FHH knowledge, which can inform future screening and outreach interventions. Nearly two-thirds of respondents deemed intergenerational FHH communication and talking about FHH with relatives to be very important. As such, outreach interventions should encourage FHH discussion and collection between elders and future generations in the private family setting. With less agreement that FHH should be publicly advocated for by medical professionals and teachers and even less agreement with teachers educating students about FHH in classes, the community more highly values trust between families rather than with public medical and educational systems. Taken together, our findings suggest that efforts to promote FHH should empower families to advocate among themselves, primarily with more elders documenting and sharing their life and experiences with subsequent generations. The private nature of these conversations would also increase the reliability of FHH, as a take-home survey gives individuals the chance to openly discuss with family without interference from provider judgement at an on-site interview (Yoon et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2002\u003c/span\u003e, Cronin et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, more intent, detailed, and secure discussion of FHH can improve accuracy as some people may be unaware of or have distorted recollections of the health of their relatives or have hesitancies in communicating about sensitive illnesses such as cancer, sexual dysfunction, mental illness (Thompson et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Yoon et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). The interfamilial preference also underscored the need for continued trust-building between medical institutions and their patients. Since the FHH must be disclosed with providers for the appropriate recommendations, these community interventions must be performed alongside longitudinal efforts to increase healthcare accessibility and build a positive relationship with the healthcare system.\u003c/p\u003e \u003cp\u003eAs a limitation, our study primarily recruited participants who had interacted with students under supervision at the FHH table, possibly introducing selection bias for participants with favorable FHH perceptions. In addition, the sample size of 101 taken over 30 months and the reduced response rate to the marital status, employment, and income questions somewhat limits the generalizability of the sample to all market patrons and East Baltimore residents more broadly.\u003c/p\u003e \u003cp\u003eOur initiative could be strengthened by administering additional surveys at the NE Market and to other local community landmarks, including libraries, recreation centers, and at health fairs in neighboring areas. In the future, our work will explore curriculum development to promote FHH and genetic testing resources to females and the elderly. With strong preferences for intergenerational communication between relatives, a FHH advocacy curriculum should be administered by community members themselves. A target community member for interventions could be community health workers, enabling them to deliver basic preventive education related to risk assessment, lifestyle recommendations, and genetic evaluation, improving knowledge of screening and shifting attitudes in favor of screening (Allen et al.; Chen et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). An essential component of the curriculum would be to provide participants (individuals or families) with the confidence to initiate private, thorough discussions about FHH between relatives or family constructs, empowering them to share with providers and make informed lifestyle choices. Our study corroborated the impact of systemic disparities on genetic illness knowledge and management, but the attitudes and preferences can serve as a benchmark to maximize the efficacy of future interventions in promoting FHH to under-resourced communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.P. and A.Z. were equal first authors of this manuscript. A.Z. is the corresponding author. F.P., A.Z., E.M., G.K., and V.V. performed data collection. A.Z. and F.P wrote the main manuscript text. A.Z. and S.C. wrote the introduction. F.P., G.K., and V.V. wrote the methodology. E.M. performed the data analysis. E.M., F.P., and A.Z. wrote the results. Y.P. and A.Z. wrote the discussion section. Y.P. and A.Z. created the figures. A.Z., F.P., E.M., and S.V. reviewed and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eNathnael Woldehana Email: [email protected] Bates-Hopkins Email: [email protected]\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompliance with Ethics Guidelines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYasheel Pandya BS, Angela Zhu, Ethan Mondell BS, Sophia Choi, Gina Kim BS, Valentina Vanos, Siddharth Venkatraman BS, Panagis Galiatsatos MD MHS, Joann Bodurtha MD MPH\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (JHM IRB IRB00226247) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.\u003c/p\u003e\n\u003cp\u003eIf doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAllen CG, Bethea BJ, McKinney LP, Escoffery C, Akintobi TH, McCray GG, McBride CM (2022) Exploring the role of community health workers in improving the collection of family health history: A pilot study. Health Promot Pract 23:504\u0026ndash;517. https://doi.org/10.1177/15248399211019980\u003c/li\u003e\n\u003cli\u003eAllen CG, Duquette D, Guan Y, McBride CM (2020) Applying theory to characterize impediments to dissemination of community-facing family health history tools: A review of the literature. J Community Genet 11:147\u0026ndash;159. https://doi.org/10.1007/s12687-019-00424-9\u003c/li\u003e\n\u003cli\u003eAwareness of Family Health History as a Risk Factor for Disease\u0026mdash;United States, 2004 (2004) CDC. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5344a5.htm\u003c/li\u003e\n\u003cli\u003eChen W-J, Zhao S, Stelzig D, Nimmons KM, Dhar SU, Eble TN, Martinez D, Yeh Y-L, Chen L-S (2021) Family Health History\u0026ndash;Based Cancer Prevention Training for Community Health Workers. Am J Prev Med 60:e159\u0026ndash;e167. https://doi.org/10.1016/j.amepre.2020.09.019\u003c/li\u003e\n\u003cli\u003eCiesielski TH, Sirugo G, Iyengar SK, Williams SM (2024) Characterizing the pathogenicity of genetic variants: The consequences of context. Npj Genomic Med 9:3. https://doi.org/10.1038/s41525-023-00386-5\u003c/li\u003e\n\u003cli\u003eCronin RM, Halvorson AE, Springer C, Feng X, Sulieman L, Loperena-Cortes R, Mayo K, Carroll RJ, Chen Q, Ahmedani BK, Karnes J, Korf B, O\u0026rsquo;Donnell CJ, Qian J, Ramirez AH (2021) Comparison of family health history in surveys vs electronic health record data mapped to the observational medical outcomes partnership data model in the All of Us Research Program. J Am Med Inform Assoc 28:695\u0026ndash;703. https://doi.org/10.1093/jamia/ocaa315\u003c/li\u003e\n\u003cli\u003eFiloche S, Stubbe MH, Grainger R, Robson B, Paringatai K, Wilcox P, Jefferies R, Dowell A (2021) How is family health history discussed in routine primary healthcare? A qualitative study of archived family doctor consultations. BMJ Open 11:e049058. https://doi.org/10.1136/bmjopen-2021-049058\u003c/li\u003e\n\u003cli\u003eGinsburg GS, Wu RR, Orlando LA (2019) Family health history: Underused for actionable risk assessment. Lancet 394:596\u0026ndash;603. https://doi.org/10.1016/S0140-6736(19)31275-9\u003c/li\u003e\n\u003cli\u003eHaga SB, Orlando LA (2020) The Enduring Importance of Family Health History in the Era of Genomic Medicine and Risk Assessment. Pers Med 17:229\u0026ndash;239. https://doi.org/10.2217/pme-2019-0091\u003c/li\u003e\n\u003cli\u003eHull LE, Natarajan P (2022) Self-rated family health history knowledge among All of Us program participants. Genet Med 24:955\u0026ndash;961. https://doi.org/10.1016/j.gim.2021.12.006\u003c/li\u003e\n\u003cli\u003eKaphingst KA, Goodman M, Pandya C, Garg P, Stafford J, Lachance C (2012) Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population. Patient Educ Couns 88:291\u0026ndash;297. https://doi.org/10.1016/j.pec.2011.11.013\u003c/li\u003e\n\u003cli\u003eKumpf E, Thamilselvan V, Wang E, Barger P, Gentry J, Bash C, Young D, Byiringiro S, Bodurtha J, Brown A, Guo M, Carter A, Price L, Smith P, Lacanienta C, Himmelfarb C, Wu AW (2024) Community-driven partnerships with Community-Engaged Research teams bring resources and reliable information to Baltimore residents. J Clin Transl Sci 8:e205. https://doi.org/10.1017/cts.2024.606\u003c/li\u003e\n\u003cli\u003eKwong L, Bodurtha J, Busch DW (2020) An Integrative Review of Family Health History in Pediatrics. Clin Pediatr 59:1282\u0026ndash;1287. https://doi.org/10.1177/0009922820943474\u003c/li\u003e\n\u003cli\u003eLi M, Zhao S, Young CM, Foster M, Huei-yu Wang J, Tseng T-S, Kwok O-M, Chen L-S (2021) Family Health History\u0026ndash;Based Interventions: A Systematic Review of the Literature. Am J Prev Med 61:445\u0026ndash;454. https://doi.org/10.1016/j.amepre.2021.03.022\u003c/li\u003e\n\u003cli\u003eMadhavan S, Bullis E, Myers R, Zhou CJ, Cai EM, Sharma A, Bhatia S, Orlando LA, Haga SB (2019) Awareness of family health history in a predominantly young adult population. PLOS ONE 14:e0224283. https://doi.org/10.1371/journal.pone.0224283\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Leary J, Edelson V, Gardner N, Gepp A, Kyler P, Moore P, Petruccio C, Williams M, Terry S, Bowen D (2011) Community-Centered Family Health History: A Customized Approach to Increased Health Communication and Awareness. Prog Community Health Partnersh 5:113\u0026ndash;122. https://doi.org/10.1353/cpr.2011.0016\u003c/li\u003e\n\u003cli\u003eSanghavi K, Moses I, Moses D, Gordon A, Chyr L, Bodurtha J (2019) Family health history and genetic services\u0026mdash;The East Baltimore community stakeholder interview project. J Community Genet 10:219\u0026ndash;227. https://doi.org/10.1007/s12687-018-0379-z\u003c/li\u003e\n\u003cli\u003eSenier L, Shields M, Lee R, Nicoll L, Falzon D, Wiecek E (2015) Community-Based Family Health History Education: The Role of State Health Agencies in Engaging Medically Underserved Populations in Understanding Genomics and Risk of Chronic Disease. Healthcare 3:995\u0026ndash;1017. https://doi.org/10.3390/healthcare3040995\u003c/li\u003e\n\u003cli\u003eThompson T, Seo J, Griffith J, Baxter M, James A, Kaphingst KA (2015) The Context of Collecting Family Health History: Examining Definitions of Family and Family Communication about Health among African American Women. J Health Commun 20:416\u0026ndash;423. https://doi.org/10.1080/10810730.2014.977466\u003c/li\u003e\n\u003cli\u003eUnited States Census Bureau (n.d.) ZIP Code Tabulation Area ZCTA5 21205. https://data.census.gov/profile/ZCTA5_21205?g=860XX00US21205\u003c/li\u003e\n\u003cli\u003eValdez R, Yoon PW, Qureshi N, Green RF, Khoury MJ (2010) Family History in Public Health Practice: A Genomic Tool for Disease Prevention and Health Promotion. Annu Rev Public Health 31:69\u0026ndash;87. https://doi.org/10.1146/annurev.publhealth.012809.103621\u003c/li\u003e\n\u003cli\u003eWildin RS, Messersmith DJ, Houwink EJF (2021) Modernizing family health history: Achievable strategies to reduce implementation gaps. J Community Genet 12:493\u0026ndash;496. https://doi.org/10.1007/s12687-021-00531-6\u003c/li\u003e\n\u003cli\u003eYoon PW, Scheuner MT, Peterson-Oehlke KL, Gwinn M, Faucett A, Khoury MJ (2002) Can family history be used as a tool for public health and preventive medicine? Genet Med 4:304\u0026ndash;310. https://doi.org/10.1097/00125817-200207000-00009\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-community-genetics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocg","sideBox":"Learn more about [Journal of Community Genetics](http://link.springer.com/journal/12685)","snPcode":"12687","submissionUrl":"https://submission.nature.com/new-submission/12687/3","title":"Journal of Community Genetics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"family health, genetics, perceptions, Baltimore, community","lastPublishedDoi":"10.21203/rs.3.rs-5915151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5915151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eKnowledge and discussion of family health history (FHH) can allow patients, families, and communities to proactively monitor their health and communicate with providers to identify genetic risk factors and inform clinical decision-making. Under-resourced communities may face barriers in collecting, sharing, and using FHH due to competing priorities, health literacy, and medical mistrust. We characterized community opinions about FHH in a public Baltimore market.\u003c/p\u003e \u003cp\u003eA paper survey was administered during biweekly health fairs at the Northeast Market. The survey assessed participants\u0026rsquo; practices of discussing and collecting FHH, knowledge of genetic testing, perception of FHH, and demographics.\u003c/p\u003e \u003cp\u003eOne hundred and one surveys were collected. 76% of respondents discussed FHH while only 56% collected FHH (p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Logistic regression found that female gender significantly predicts FHH collection (OR\u0026thinsp;=\u0026thinsp;2.77, 95% CI [1.15, 6.84]). Additionally, higher income was significantly correlated with discussing (OR\u0026thinsp;=\u0026thinsp;1.59, 95% CI [1.14, 2.37]), collecting (OR\u0026thinsp;=\u0026thinsp;1.29, 95% CI [1.01, 1.68]), and valuing transmission of FHH from older to younger people (OR\u0026thinsp;=\u0026thinsp;1.70, 95% CI [1.22, 2.51]). Participants were found to favor obtaining FHH knowledge through intergenerational exchange compared to medical staff or schoolteachers.\u003c/p\u003e \u003cp\u003eThese findings indicate that promoting FHH warrants equitable strategies to reach all persons across gender, age, and socioeconomics. Having local advocates trained in the significance of FHH (e.g. community health workers) and supporting intergenerational approaches (e.g. older women with younger relatives) may be a consideration to reach such populations. More insight is needed to gain a comprehensive understanding of how FHH is valued by certain demographics and then begin to foster equitable strategies to educate and inform diverse populations on FHH.\u003c/p\u003e","manuscriptTitle":"Perceptions of Family Health History in an East Baltimore Community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 07:13:26","doi":"10.21203/rs.3.rs-5915151/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-09T12:14:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-13T20:55:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245638350034394796677188651125430229066","date":"2025-02-21T14:15:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336481378335198761483343529450352698676","date":"2025-02-17T10:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-15T14:50:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-04T08:54:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-04T08:50:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Community Genetics","date":"2025-01-27T21:55:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-community-genetics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocg","sideBox":"Learn more about [Journal of Community Genetics](http://link.springer.com/journal/12685)","snPcode":"12687","submissionUrl":"https://submission.nature.com/new-submission/12687/3","title":"Journal of Community Genetics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b75fb9f9-01c1-4223-a34a-0ca6ebbab9d6","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:03:54+00:00","versionOfRecord":{"articleIdentity":"rs-5915151","link":"https://doi.org/10.1007/s12687-025-00804-4","journal":{"identity":"journal-of-community-genetics","isVorOnly":false,"title":"Journal of Community Genetics"},"publishedOn":"2025-05-31 15:57:58","publishedOnDateReadable":"May 31st, 2025"},"versionCreatedAt":"2025-02-06 07:13:26","video":"","vorDoi":"10.1007/s12687-025-00804-4","vorDoiUrl":"https://doi.org/10.1007/s12687-025-00804-4","workflowStages":[]},"version":"v1","identity":"rs-5915151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5915151","identity":"rs-5915151","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}