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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (15 November 2019) | Viewed by 30027

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Special Issue Editors

Dr. Colleen M. McBride

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Guest Editor

Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
Interests: Translational research related to genomics; health disparities; and public health; Raising understanding of complexity of genomic influences on health; Population-wide dissemination of genomics-informed health promotion innovation.

Dr. Yue Guan

E-Mail Website
Guest Editor

Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
Interests: communication of genetic information; dissemination of evidence-based genetic screening applications

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue for the International Journal of Environmental Research and Public Health on “Genomic Applications to Promote Public Health in the Context of Health Disparities”. For detailed information on the journal, I refer you to https://www.mdpi.com/journal/ijerph.

The field of public health genomics focuses on the effective translation of emerging genomic knowledge for health promotion and disease prevention. Evidence-based guidelines now support family history-based screening for some inherited conditions (e.g., hereditary breast cancer). However, early translation efforts have had limited reach outside of specialty clinical settings in metropolitan areas and to underrepresented minorities. The concern is that this limited reach will exacerbate existing disparities. To avert this, there are a number of important areas to address:

Intervention research to evaluate approaches to expand the reach of genomic screening programs to minority populations and those living in rural settings.
Communication research to evaluate strategies for conveying genomic risk in a broad array of settings.
Community engagement research to evaluate partnerships to extend access to and uptake of genomic applications
Dissemination and Implementation research to understand the adoption and sustainability of guideline implementation and other genomic applications for public health.

The keywords we have listed below are meant to suggest a few of the many possibilities. Inquiries regarding potential topics are welcome.

Dr. Colleen M. McBride
Dr. Yue Guan
Guest Editors

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Keywords

access to genetic services
common disease genetics
community-based research
ethnic/racial minorities
evaluation of genetic/genomic tools for public health
genetic communication
genetic education
health disparities
rural health
population-based genetic risk screening
public health genetics

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Published Papers (7 papers)

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19 pages, 3399 KiB

Open AccessArticle

Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia

by Joseph Lipscomb, Cam Escoffery, Theresa W. Gillespie, S. Jane Henley, Robert A. Smith, Toni Chociemski, Lyn Almon, Renjian Jiang, Xi Sheng, Michael Goodman and Kevin C. Ward

Int. J. Environ. Res. Public Health 2020, 17(3), 977; https://doi.org/10.3390/ijerph17030977 - 4 Feb 2020

Cited by 8 | Viewed by 4240

Abstract

Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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13 pages, 593 KiB

Open AccessArticle

Autism Spectrum Disorders: Prenatal Genetic Testing and Abortion Decision-Making among Taiwanese Mothers of Affected Children

by Wei-Ju Chen, Shixi Zhao, Tse-Yang Huang, Oi-Man Kwok and Lei-Shih Chen

Int. J. Environ. Res. Public Health 2020, 17(2), 476; https://doi.org/10.3390/ijerph17020476 - 11 Jan 2020

Cited by 5 | Viewed by 7775

Abstract

With the rapid growing rate of autism spectrum disorders (ASDs), prenatal genetic testing (PGT) has been offered to detect various genomic disorders, including ASD, in Taiwan. However, disparities exist in this area, as there is limited research on factors associated with PGT utilization and relevant decision-making that may guide the regulations and ethical guidelines for culturally appropriate PGT services in Taiwan. This study proposed a comprehensively integrated theoretical framework for examining the intention to undergo PGT to detect ASD susceptibility genes and subsequent abortion decision-making among Taiwanese mothers of children affected by ASD. Survey data from 333 mothers of children with ASD in 236 elementary schools with special education services in Taiwan were collected and analyzed using structural equation modeling. Approximately two-thirds of the participants (66.6%) would undergo PGT to detect ASD susceptibility genes; more than half (53.1%) would terminate the hypothetically ASD-affected pregnancy. Abortion intention was associated with age, religion, attitudes toward PGT for detecting ASD susceptibility genes, and willingness to undergo such PGT. This study explores the potential impacts of PGT on Taiwanese society, and the findings are applicable to countries heavily influenced by Chinese culture, areas with Asian immigrants, and Western countries with such PGT services and/or research available. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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8 pages, 391 KiB

Open AccessArticle

Black Women’s Confidence in the Genetic Information Nondiscrimination Act

by Arnethea L. Sutton, Alesha Henderson, Alejandra Hurtado-de-Mendoza, Erin Tanner, Mishaal Khan, John Quillin and Vanessa B. Sheppard

Int. J. Environ. Res. Public Health 2019, 16(24), 5112; https://doi.org/10.3390/ijerph16245112 - 14 Dec 2019

Cited by 7 | Viewed by 3353

Abstract

Black women at-risk for hereditary breast and ovarian cancer (HBOC) continue to underutilize genetic counseling and testing (GCT). One reason for this disparity is a fear of discrimination from insurance companies if identified as high-risk. The Genetic Information Nondiscrimination Act (GINA) was enacted to protect against this type of discrimination; however, Black women’s levels of confidence in this law are unknown. In this descriptive study, we sought to (1) assess Black women’s confidence in the GINA law and (2) identify multilevel factors related to their confidence in GINA. Ninety-four Black women at-risk of HBOC completed surveys that assessed intrapersonal, interpersonal, and structural factors. Multiple regression analysis determined factors associated with confidence in GINA. Most women were ≤50 years of age (66.0%) and about half never had a cancer diagnosis (51.1%). Confidence in GINA was moderate (mean = 10.67; standard deviation = 2.54; range = 5–15). Women who valued GCT reported more confidence in GINA (β = 0.345; CI 0.017 to 0.673; p = 0.040). Lack of confidence in GINA may serve as a barrier to seeking GCT. Efforts to increase the perceived value of GCT among Black women could be benefited by increasing awareness of national efforts towards privacy protections of genetic information. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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16 pages, 688 KiB

Open AccessArticle

Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers

by Maria Cerda Diez, Dharma E. Cortés, Michelle Trevino-Talbot, Candice Bangham, Michael R. Winter, Howard Cabral, Tricia Norkunas Cunningham, Diana M. Toledo, Deborah J. Bowen, Michael K. Paasche-Orlow, Timothy Bickmore and Catharine Wang

Int. J. Environ. Res. Public Health 2019, 16(24), 4979; https://doi.org/10.3390/ijerph16244979 - 7 Dec 2019

Cited by 12 | Viewed by 3667

Abstract

Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke—0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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14 pages, 351 KiB

Open AccessArticle

Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer

by Alejandra Hurtado-de-Mendoza, Kristi D. Graves, Sara Gómez-Trillos, Pilar Carrera, Claudia Campos, Lyndsay Anderson, George Luta, Beth N. Peshkin, Marc D. Schwartz, Ana-Paula Cupertino, Nathaly Gonzalez and Vanessa B. Sheppard

Int. J. Environ. Res. Public Health 2019, 16(23), 4793; https://doi.org/10.3390/ijerph16234793 - 29 Nov 2019

Cited by 19 | Viewed by 4057

Abstract

Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

17 pages, 1364 KiB

Open AccessArticle

Blending Insights from Implementation Science and the Social Sciences to Mitigate Inequities in Screening for Hereditary Cancer Syndromes

by Laura Senier, Colleen M. McBride, Alex T. Ramsey, Vence L. Bonham and David A. Chambers

Int. J. Environ. Res. Public Health 2019, 16(20), 3899; https://doi.org/10.3390/ijerph16203899 - 15 Oct 2019

Cited by 10 | Viewed by 3941

Abstract

Genomic screening to identify people at high risk for adult-onset hereditary conditions has potential to improve population health. However, if not equitably accessible, genomics-informed screening programs will exacerbate existing health inequities or give rise to new ones. To realize the disease prevention potential of these screening tools, we need strategies to broaden their reach. We propose a conceptual framework that merges insights from implementation science and sociological research on health inequities. Our framework does three things: first, it broadens the arenas of action beyond those typically addressed in implementation science frameworks; second, it argues for recruiting more diverse partners to share the work of implementation and dissemination; and third, it shows how implementation activities can be coordinated more effectively among those partners. We use screening for hereditary breast and ovarian cancers (HBOC) as a case to illustrate how this enhanced framework could guide implementation science and distribute the benefits of genomic medicine more equitably. Although our example is specific to genomics, this approach is more broadly applicable to the field of implementation science. Coordinated action among multiple stakeholders could translate a host of new technologies from the bench to the trench without creating new inequities or exacerbating existing ones. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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9 pages, 298 KiB

Open AccessCommentary

Regarding the Yin and Yang of Precision Cancer- Screening and Treatment: Are We Creating a Neglected Majority?

by Colleen M. McBride, Yue Guan and Jennifer L. Hay

Int. J. Environ. Res. Public Health 2019, 16(21), 4168; https://doi.org/10.3390/ijerph16214168 - 29 Oct 2019

Cited by 5 | Viewed by 2536

Abstract

In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of “positive” screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive “negative” results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin–yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a “neglected majority”. This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments. Full article

(This article belongs to the Special Issue Genomic Applications to Promote Public Health in the Context of Health Disparities)

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