Family Health History Discussions With College Students: Abstract and Introduction
From The Journal of Primary Prevention
Correlates of Family Health History Discussions Between College Students and Physicians
Does Family Cancer History Make a Difference?
Posted: 12/28/2011; J Prim Prev. 2011;32(5-6):311-322. © 2011 Springer
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- Abstract and Introduction
- Methods
- Results
- Discussion
Abstract and Introduction
Abstract
Effective communication between young adults and their healthcare providers can contribute to early detection of risk for developing cancer and establishment of lifelong habits for engagement in healthcare and health promotion behaviors. Our objectives were to examine factors influencing family health history discussions between college students and physicians and factors associated with perceptions about who is responsible for initiating such discussions. Data from an internet-based study of 632 college students were analyzed. Approximately 60% of college student participants reported they had discussed their family health history with a physician. The perception that physicians are responsible for initiating family health history discussions was associated with being non-White and less than completely knowledgeable about cancer. Having a discussion with a physician was associated with being female, having a regular physician, perceiving genetics as a risk for developing cancer, and having a family member diagnosed with cancer. Understanding variation among college students' perceptions about their role in initiating health-history-related discussions and characteristics of those who have or have not discussed family health issues with physicians can inform healthcare practice to foster optimal healthcare interactions in early adulthood.Introduction
Clinical guidelines for cancer screening and prevention are based on known risk factors, such as having a family history of certain cancers (Smith et al. 2009; U.S. Preventive Services Task Force 2005a). The U.S. Preventive Services Task Force guidelines encourage screenings and prevention-related discussions with physicians for those at risk for certain cancers (Berg and U.S. Preventive Services Task Force 2003; U.S. Preventive Services Task Force 2009). Family history is particularly important in prevention and surveillance of colorectal, cervical, and breast cancers. Diagnosis of these cancers in first-degree (i.e., parent, sibling) or second-degree (i.e., grandparent, aunt/uncle) relatives greatly impacts risk assessment; however, the relevant information (i.e., a combination of affected relatives, cancer types, and ages of diagnosis) is not always straightforward. For example, family history of colorectal cancer in a first-degree relative before age 60 or multiple first-degree relatives of any age puts one at highest risk for the same cancer; one first-degree relative diagnosed at age 60 or older or multiple second-degree relatives at any age is also indicative of heightened risk for colorectal cancer (U.S. Preventive Services Task Force 2005b; Wiltz and Nelson 2010).It is important for healthcare consumers to discuss their family health history with physicians, in part because there is great variability in how adults interpret their own family health histories (Kim et al. 2008; Orom et al. 2010; Walter and Emery 2006). Studies have shown that individuals with a family history of a disease tend to underrate their actual risk of developing the same disease (Caruso et al. 2009; Katapodi et al. 2009). For example, Katapodi et al. found (2009) that 89% of women with a high risk for breast cancer underestimated their actual risks and among women with low risk, 9% overestimated their risk. Conversely, Lipkus et al. (1999) found that women with known family histories of breast cancer perceive themselves at higher risk and have more concerns about getting cancer relative to women with no known family history. Furthermore, among the women in this study, having a family history of breast cancer had no association with knowledge of actual breast cancer risk. In fact, many of these women had little awareness of the actual risk factors associated with the disease.
Conversations between young healthcare consumers and their primary care providers allow for development of lifelong prevention and surveillance plans to be matched to relevant family history (Safaee et al. 2010; Taylor et al. 2009; Valdez et al. 2010; Walter and Emery 2006; Wiltz and Nelson 2010). Given that the most prevalent forms of cancer are associated with lifestyle behaviors and that young adulthood is a time during which many lifelong health-related habits are formed (Nelson et al. 2008), it is appropriate for young adults and providers to discuss relevant family history of cancer and associated primary and secondary cancer prevention habits. For it is during these years that young adults form lifelong health-related habits, including patterns of healthcare service utilization.
While there is emerging evidence about how adults of all ages tend to perceive and act upon cancer-related information, relatively little is known about young adults' interactions with healthcare providers. Despite the utility of family history information for healthcare consumers and their providers, it is unclear if young adults discuss their family history with their primary care physicians. When young adults do not discuss family health history with their physicians, screening opportunities could be missed, along with opportunities to establish healthy lifestyle behaviors for long-term prevention and adherence to appropriate screening guidelines. Understanding factors that influence these discussions about family health history among young adult healthcare consumers and physicians is important for understanding how young adults approach interactions with providers about their long-term risk for developing cancer and behaviors to address this risk.
This study identified cancer-related variables associated with likelihood of conversations about family history between college students and their physicians. The authors developed a conceptual framework to guide analyses (see Fig. 1). Variables of interest were identified using constructs loosely based on the Health Belief Model (Janz and Becker 1984). As the schematic illustrates, personal characteristics influence the cancer-related perceptions of college students. Those who are knowledgeable about cancer and perceive themselves to be susceptible to developing cancer may view the responsibility of initiating family health history discussions with physicians differently. For example, those with family members who have been diagnosed with cancer may feel it is their responsibility to talk with their physician about their potential risk. Considering all of these factors together (i.e., personal characteristics, cancer-related perceptions, and expectations of discussion initiation) may inevitably influence the actual interactions (or lack thereof) between college students and physicians.
 | Figure 1. Conceptual framework illustrating factors associated with consumer–physician discussions about family health history |
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Figure 1.
Conceptual framework illustrating factors associated with consumer–physician discussions about family health history
The purposes of this study were to (a) describe the personal characteristics, cancer-related perceptions, and reported interactions between college students and physicians about family health history among a sample of college students; (b) examine the factors associated with who college students perceive is responsible for initiating student–physician discussion about family health history; and (c) examine the factors that influence discussions about family history between college students and physicians.
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Table 1. Sample characteristics by perceived responsibility to initiate family health history discussions and having discussions with physicians
| Variable | Total (n = 632) | Responsibility to initiate family health history discussions | Discussed family health history with physician | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Equal responsibility (n = 288) | Student's responsibility (n = 198) | Physician's responsibility (n = 146) | χ2 | p | No (n = 251) | Yes (n = 281) | χ2 | p | ||
| Age |  | | | | 8.84 | 0.356 | | | 15.32 | 0.004 |
| 18 years | 61 (9.7%) | 26 (9.0%) | 15 (7.6%) | 20 (13.7%) | | | 29 (11.6%) | 32 (8.4%) | | |
| 19 years | 128 (20.3%) | 65 (22.6%) | 34 (17.2%) | 29 (19.9%) | | | 65 (25.9%) | 63 (16.5%) | | |
| 20 years | 191 (30.2%) | 88 (30.6%) | 67 (33.8%) | 36 (24.7%) | | | 77 (30.7%) | 114 (29.9%) | | |
| 21–24 years | 228 (36.1%) | 97 (33.7%) | 76 (38.4%) | 55 (37.7%) | | | 74 (29.5%) | 154 (40.4%) | | |
| 25+ years | 24 (3.8%) | 12 (4.2%) | 6 (3.0%) | 6 (4.1%) | | | 6 (2.4%) | 18 (4.7%) | | |
| Sex | | | | | 2.74 | 0.255 | | | 44.83 | <0.001 |
| Male | 237 (37.5%) | 118 (41.0%) | 69 (34.8%) | 50 (34.2%) | | | 134 (53.4%) | 103 (27.0%) | | |
| Female | 395 (62.5%) | 170 (5.09%) | 129 (65.2%) | 96 (65.8%) | | | 117 (46.6%) | 278 (73.0%) | | |
| Race | | | | | 9.88 | 0.007 | | | 10.61 | 0.001 |
| Non-Hispanic white | 458 (72.5%) | 216 (75.0%) | 151 (76.3%) | 91 (62.3%) | | | 164 (65.3%) | 294 (77.2%) | | |
| Racial/ethnic minority | 174 (27.5%) | 72 (25.0%) | 47 (23.7%) | 55 (37.7%) | | | 87 (34.7%) | 87 (22.8%) | | |
| Has a regular physician | | | | | 4.06 | 0.131 | | | 12.90 | < 0.001 |
| No | 179 (28.3%) | 91 (31.6%) | 46 (23.2%) | 42 (28.8%) | | | 91 (36.3%) | 88 (23.1%) | | |
| Yes | 453 (71.7%) | 197 (68.4%) | 152 (76.8%) | 104 (71.2%) | | | 160 (63.7%) | 293 (76.9%) | | |
| Perceived cancer knowledge | | | | | 7.51 | 0.111 | | | 10.13 | 0.006 |
| No/low knowledge | 100 (15.8%) | 49 (17.0%) | 23 (11.6%) | 28 (19.2%) | | | 54 (21.5%) | 46 (12.1%) | | |
| Somewhat knowledgeable | 411 (65.0%) | 190 (6.06%) | 127 (64.1%) | 94 (64.4%) | | | 152 (60.6%) | 259 (68.0%) | | |
| Completely knowledgeable | 121 (19.1%) | 49 (17.0%) | 48 (24.2%) | 24 (16.4%) | | | 45 (17.9%) | 76 (19.9%) | | |
| Believe genetics influence cancer | | | | | 2.59 | 0.274 | | | 16.09 | <0.001 |
| No | 160 (25.3%) | 81 (28.1%) | 43 (21.7%) | 36 (24.7%) | | | 85 (33.9%) | 75 (19.7%) | | |
| Yes | 472 (74.7%) | 207 (71.9%) | 155 (78.3%) | 110 (75.3%) | | | 166 (66.1%) | 306 (80.3%) | | |
| Self-risk of developing cancer 10 years | | | | | 3.63 | 0.459 | | | 2.07 | 0.354 |
| None/unlikely | 383 (61.2%) | 182 (63.9%) | 117 (59.1%) | 84 (58.7%) | | | 158 (63.7%) | 225 (59.5%) | | |
| Moderate | 207 (33.1%) | 89 (31.2%) | 71 (35.9%) | 47 (32.9%) | | | 74 (29.8%) | 133 (35.2%) | | |
| Likely/certain | 36 (5.8%) | 14 (4.9%) | 10 (5.1%) | 12 (8.4%) | | | 16 (6.5%) | 20 (5.3%) | | |
| Self-risk of developing cancer lifetime | | | | | 8.40 | 0.078 | | | 12.72 | 0.002 |
| None/unlikely | 147 (23.5%) | 68 (23.9%) | 37 (18.7%) | 42 (29.4%) | | | 76 (30.6%) | 71 (18.8%) | | |
| Moderate | 306 (48.9%) | 145 (50.9%) | 104 (52.5%) | 57 (39.9%) | | | 115 (46.4%) | 191 (50.5%) | | |
| Likely/certain | 173 (27.6%) | 72 (25.3%) | 57 (28.8%) | 44 (30.8%) | | | 57 (23.0%) | 116 (30.7%) | | |
| Family members diagnosed with cancer | | | | | 2.78 | 0.596 | | | 13.32 | 0.001 |
| None | 247 (39.1%) | 116 (40.3%) | 71 (35.9%) | 60 (41.1%) | | | 120 (47.8%) | 127 (33.3%) | | |
| 1 Family member | 264 (41.8%) | 118 (41.0%) | 83 (41.9%) | 63 (43.2%) | | | 90 (35.9%) | 174 (45.7%) | | |
| 2+ Family members | 121 (19.1%) | 54 (18.8%) | 44 (22.2%) | 23 (15.8%) | | | 41 (16.3%) | 80 (21.0%) | | |
| Perceived responsibility to initiate discussions | | | | | – | – | | | 7.42 | 0.025 |
| Equal responsibility | 288 (45.6%) | – | – | – | | | 131 (52.2%) | 157 (41.2%) | | |
| Student's responsibility | 198 (31.3%) | – | – | – | | | 68 (27.1%) | 130 (34.1%) | | |
| Physician's responsibility | 146 (23.1%) | – | – | – | | | 52 (20.7%) | 94 (24.7%) | | |
| Have discussed family history with physician | | | | | 7.42 | 0.025 | | | – | – |
| No | 251 (39.7%) | 131 (45.5%) | 68 (34.3%) | 52 (35.6%) | | | – | – | | |
| Yes | 381 (60.3%) | 157 (54.5%) | 130 (65.7%) | 94 (64.4%) | | | – | – | | |
| Who initiated family history discussionsa | | | | | 21.58 | 0.001 | | | – | – |
| Neither | 152 (39.9%) | 68 (43.3%) | 49 (37.7%) | 35 (37.2%) | | | | | – | – |
| College student | 32 (8.4%) | 21 (13.4%) | 8 (6.2%) | 3 (3.2%) | | | – | – | | |
| Physician | 52 (13.6%) | 11 (7.0%) | 19 (14.6%) | 22 (23.4%) | | | – | – | | |
| Both | 145 (38.1%) | 57 (36.3%) | 54 (41.5%) | 34 (36.2%) | | | – | – | | |
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Table 2. Correlates of perceived responsiblilty to initiate family health history discussions
| Variable | Responsibility to initiate: college student | Responsibility to initiate: physician | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| β | SE | p | OR | Lower | Upper | β | SE | p | OR | Lower | Upper | |
| 25+ years | 0.23 | 0.61 | .704 | 1.26 | 0.38 | 4.17 | −0.60 | 0.72 | .406 | 0.55 | 0.14 | 2.25 |
| 21–24 years | −0.36 | 0.37 | .325 | 0.70 | 0.34 | 1.43 | −0.61 | 0.40 | .122 | 0.54 | 0.25 | 1.18 |
| 20 years | −0.29 | 0.37 | .434 | 0.75 | 0.36 | 1.55 | −0.92 | 0.41 | .024 | 0.40 | 0.18 | 0.89 |
| 19 years | 0.07 | 0.40 | .861 | 1.07 | 0.50 | 2.32 | −0.47 | 0.44 | .286 | 0.63 | 0.27 | 1.48 |
| 18 years | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Female | −0.10 | 0.20 | .615 | 0.90 | 0.61 | 1.34 | 0.29 | 0.25 | .244 | 1.33 | 0.82 | 2.16 |
| Male | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Racial/ethnic minority | −0.07 | 0.23 | .755 | 0.93 | 0.60 | 1.45 | 0.60 | 0.25 | .018 | 1.82 | 1.11 | 2.99 |
| Non-Hispanic white | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Has physician | −0.42 | 0.22 | .056 | 0.66 | 0.43 | 1.01 | −0.24 | 0.26 | .360 | 0.79 | 0.47 | 1.32 |
| Has no physician | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Cancer knowledge: completely | −0.60 | 0.33 | .072 | 0.55 | 0.29 | 1.06 | −0.82 | 0.39 | .036 | 0.44 | 0.21 | 0.95 |
| Cancer knowledge: somewhat | −0.26 | 0.29 | .367 | 0.77 | 0.44 | 1.35 | −0.47 | 0.33 | .153 | 0.63 | 0.33 | 1.19 |
| Cancer knowledge: no/low | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Genetics as cancer risk: yes | −0.24 | 0.23 | .280 | 0.78 | 0.50 | 1.22 | 0.02 | 0.27 | .948 | 1.02 | 0.60 | 1.74 |
| Genetics as cancer risk: no | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Cancer risk 10 years: likely/certain | −0.10 | 0.44 | .817 | 0.90 | 0.38 | 2.15 | 0.69 | 0.47 | .142 | 1.99 | 0.80 | 4.96 |
| Cancer risk 10 years: moderate | −0.11 | 0.21 | .604 | 0.90 | 0.60 | 1.34 | −0.03 | 0.25 | .920 | 0.98 | 0.60 | 1.58 |
| Cancer risk 10 years: none/unlikely | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | – |
| Family members diagnosed: 2+ | −0.16 | 0.27 | .546 | 0.85 | 0.51 | 1.43 | −0.35 | 0.33 | .294 | 0.71 | 0.37 | 1.35 |
| Family members diagnosed: 1 | −0.04 | 0.22 | .837 | 0.96 | 0.63 | 1.46 | −0.02 | 0.26 | .952 | 0.99 | 0.60 | 1.63 |
| Family members diagnosed: 0 | 1.00 | – | – | – | – | – | 1.00 | – | – | – | – | |
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Table 3. Correlates of perceived responsibililty to initiate family health history discussions
| Variable | Responsibility to initiate: college student | |||||
|---|---|---|---|---|---|---|
| | | | | 95% CI | ||
| β | SE | p | OR | Lower | Upper | |
| 18 years | 1.00 | – | – | – | – | – |
| 19 years | 0.52 | 0.38 | .175 | 1.68 | 0.79 | 3.57 |
| 20 years | 0.62 | 0.37 | .095 | 1.85 | 0.90 | 3.82 |
| 21–24 years | 0.27 | 0.35 | .448 | 1.31 | 0.65 | 2.62 |
| 25+ years | 0.95 | 0.64 | .136 | 2.58 | 0.74 | 8.96 |
| Male | 1.00 | – | – | – | – | – |
| Female | −0.37 | 0.23 | .108 | 0.69 | 0.44 | 1.08 |
| Non-Hispanic white | 1.00 | – | – | – | – | – |
| Racial/ethnic minority | −0.66 | 0.24 | .005 | 0.52 | 0.32 | 0.82 |
| Has no physician | 1.00 | – | – | – | – | – |
| Has physician | −0.19 | 0.24 | .423 | 0.83 | 0.52 | 1.31 |
| Cancer knowledge: no/low | 1.00 | – | – | – | – | – |
| Cancer knowledge: somewhat | 0.21 | 0.29 | .462 | 1.24 | 0.70 | 2.17 |
| Cancer knowledge: completely | 0.26 | 0.36 | .464 | 1.30 | 0.64 | 2.64 |
| Genetics as cancer risk: no | 1.00 | – | – | – | – | – |
| Genetics as cancer risk: yes | −0.33 | 0.26 | .203 | 0.72 | 0.44 | 1.19 |
| Cancer risk 10 years: none/unlikely | 1.00 | – | – | – | – | – |
| Cancer risk 10 years: moderate | −0.10 | 0.23 | .676 | 0.91 | 0.58 | 1.43 |
| Cancer risk 10 years: likely/certain | −0.77 | 0.43 | .076 | 0.47 | 0.20 | 1.08 |
| Family members diagnosed: 0 | 1.00 | – | – | – | – | – |
| Family members diagnosed: 1 | −0.02 | 0.24 | .947 | 0.98 | 0.62 | 1.57 |
| Family members diagnosed: 2+ | 0.23 | 0.32 | .474 | 1.25 | 0.68 | 2.33 |
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Table 4. Correlates of having discussed family health history with a physician
| Variable | β | SE | p | OR | 95% CI | |
|---|---|---|---|---|---|---|
| Lower | Upper | |||||
| 18 years | 1.00 | – | – | – | – | – |
| 19 years | −0.03 | 0.34 | .927 | 0.97 | 0.50 | 1.89 |
| 20 years | 0.37 | 0.33 | .260 | 1.44 | 0.76 | 2.73 |
| 21–24 years | 0.79 | 0.32 | .014 | 2.21 | 1.17 | 4.17 |
| 25+ years | 1.07 | 0.58 | .065 | 2.91 | 0.93 | 9.03 |
| Male | 1.00 | – | – | – | – | – |
| Female | 0.92 | 0.18 | <.001 | 2.50 | 1.75 | 3.58 |
| Non-Hispanic white | 1.00 | – | – | – | – | – |
| Racial/ethnic minority | −0.37 | 0.20 | .069 | 0.69 | 0.47 | 1.03 |
| Has no physician | 1.00 | – | – | – | – | – |
| Has physician | 0.57 | 0.20 | .004 | 1.77 | 1.20 | 2.62 |
| Responsibility to initiate: equal | 1.00 | – | – | – | – | – |
| Responsibility to initiate: college student | −0.32 | 0.21 | .119 | 0.73 | 0.49 | 1.09 |
| Responsibility to initiate: physician | 0.10 | 0.25 | .691 | 1.11 | 0.68 | 1.81 |
| Cancer knowledge: no/low | 1.00 | – | – | – | – | – |
| Cancer knowledge: somewhat | 0.42 | 0.25 | .100 | 1.52 | 0.92 | 2.48 |
| Cancer knowledge: completely | 0.28 | 0.30 | .358 | 1.32 | 0.73 | 2.40 |
| Genetics as cancer risk: no | 1.00 | – | – | – | – | – |
| Genetics as cancer risk: yes | 0.42 | 0.21 | .040 | 1.53 | 1.02 | 2.28 |
| Cancer risk 10 years: none/unlikely | 1.00 | – | – | – | – | – |
| Cancer risk 10 years: moderate | 0.00 | 0.20 | .986 | 1.00 | 0.68 | 1.46 |
| Cancer risk 10 years: likely/certain | −0.17 | 0.39 | .667 | 0.84 | 0.39 | 1.83 |
| Family members diagnosed: 0 | 1.00 | – | – | – | – | – |
| Family members diagnosed: 1 | 0.40 | 0.20 | .046 | 1.49 | 1.01 | 2.20 |
| Family members diagnosed: 2+ | 0.32 | 0.25 | .214 | 1.37 | 0.83 | 2.2 |
Authors and Disclosures
Matthew Lee Smith1,2, Erica T. Sosa3, Angela K. Hochhalter2,4, Julie Covin5, Marcia G. Ory2 and E. Lisako J. McKyer61Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 330 River Road, 315 Ramsey Center, Athens, GA 30602, USA
2Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M, Health Science Center, College Station, TX, USA
3Department of Health and Kinesiology, University of Texas at San Antonio, San Antonio, TX, USA
4Department of Internal Medicine, Scott & White Healthcare and Texas A&M Health Science Center, Temple, TX, USA
5Department of Occupational Therapy, University of Texas Health Science Center, San Antonio, TX, USA
6Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
Matthew Lee Smith
Email: health@uga.edu; matthew.smith@srph.tamhsc.edu
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