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Journal of Genetic Counseling

, Volume 21, Issue 3, pp 440–447 | Cite as

Racial and Ethnic Differences in Direct-to-Consumer Genetic Tests Awareness in HINTS 2007: Sociodemographic and Numeracy Correlates

  • Aisha T. Langford
  • Ken Resnicow
  • J. Scott Roberts
  • Brian J. Zikmund-Fisher
Original Research

Abstract

To examine the association of 1) race/ethnicity and 2) numeracy with awareness of DTC genetic tests. Secondary analysis of 6,754 Hispanic, black, and white adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). Logistic regression was used to examine sociodemographic predictors of DTC genetic tests awareness including race/ethnicity, income, education, and gender. Next, two numeracy variables were added to the model. After controlling for sociodemographic variables, black respondents were significantly less likely to have heard of DTC genetic tests compared to white respondents (OR = 0.79; CI: 0.65–0.97). When numeracy variables were added to the model, the effect of black race was no longer significant (OR = 0.84; CI: 0.69–1.04). Hispanic respondents did not significantly differ from white respondents in awareness of DTC genetic tests. Other significant correlates of DTC genetic tests awareness in the full model included education, income, age, and numeracy variables including degree to which people use medical statistics and numbers to make health decisions, and preference for words or numbers when discussing “the chance of something happening.” Although black respondents were generally less aware of DTC genetic tests than white respondents, this relationship appears to be partially mediated by numeracy.

Keywords

Direct-to-consumer genetic tests Genetic testing Health disparities Numeracy African American Hispanic 

References

  1. 110th Congress (2008). H.R.493. http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.r.00493. Accessed 5 June 2011.
  2. 23andMe (2011). Core values. https://www.23andme.com/about/values/. Accessed 18 Sept 2011.
  3. Akl, E. A., Oxman, A. D., Herrin, J., Vist, G. E., Terrenato, I., Sperati, F., et al. (2011). Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database of Systematic Review (3), CD006776. doi: 10.1002/14651858.CD006776.pub2.
  4. Ameer, B., & Krivoy, N. (2009). Direct-to-consumer/patient advertising of genetic testing: A position statement of the American College of Clinical Pharmacology. Journal of Clinical Pharmacology, 49(8), 886–888. doi: 10.1177/0091270009335948.PubMedCrossRefGoogle Scholar
  5. American College of Medical Genetics (2008). ACMG statement on direct-to-consumer genetic testing. http://www.acmg.net/AM/Template.cfm?Section=Policy_Statements&Template=/CM/ContentDisplay.cfm&ContentID=2975. Accessed 18 Sept 2011.
  6. American Society of Human Genetics (2007). ASHG statement on direct-to-consumer genetic testing in the United States. http://ashg.org/pdf/dtc_statement.pdf. Accessed Sept 2011.
  7. Armstrong, K., Micco, E., Carney, A., Stopfer, J., & Putt, M. (2005). Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer. Journal of the American Medical Association, 293(14), 1729–1736. doi: 10.1001/jama.293.14.1729.PubMedCrossRefGoogle Scholar
  8. CDC (2008). Adding power to our voices: A framing guide for communicating about injury. http://wwwn.cdc.gov/NCIPC-SuccessStory/files/Adding%20Power%20to%20Our%20Voices%20Injury%20Framing%20Guide.pdf. Accessed 22 Sept 2011.
  9. Center for Health Improvement (2004). Using data strategically: Social math. http://www.chipolicy.org/pdf/TA5.pdf. Accessed 23 Sept 2011.
  10. Fagerlin, A., Zikmund-Fisher, B. J., Ubel, P. A., Jankovic, A., Derry, H. A., & Smith, D. M. (2007). Measuring numeracy without a math test: Development of the subjective numeracy scale. Medical Decision Making, 27(5), 672–680. doi: 10.1177/0272989x07304449.PubMedCrossRefGoogle Scholar
  11. Fischhoff, B., Brewer, N., & Downs, J. (2011). Communicating risks and benefits: An evidence-based user’s guide http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM268069.pdf. Accessed 22 Sept 2011.
  12. Garcia-Retamero, R., & Galesic, M. (2010). Who profits from visual aids: Overcoming challenges in people’s understanding of risks [corrected]. Social Science & Medicine, 70(7), 1019–1025. doi: 10.1016/j.socscimed.2009.11.031.CrossRefGoogle Scholar
  13. Genetic Alliance (2011). Genetic alliance resources and services. http://www.geneticalliance.org/resources#engage. Accessed 20 Sept 2011.
  14. Genetics Home Reference (2011). What is direct-to-consumer genetic testing? http://ghr.nlm.nih.gov/handbook/testing/directtoconsumer. Accessed 5 Feb 2011.
  15. GenoCommunity Think Tank (2011). Knowledge modules. http://genocommunity.org/index.php?note=Events. Accessed 5 June 2011.
  16. Ginde, A. A., Clark, S., Goldstein, J. N., & Camargo, C. A., Jr. (2008). Demographic disparities in numeracy among emergency department patients: Evidence from two multicenter studies. Patient Education and Counseling, 72(2), 350–356. doi: 10.1016/j.pec.2008.03.012.PubMedCrossRefGoogle Scholar
  17. Goddard, K. A., Duquette, D., Zlot, A., Johnson, J., Annis-Emeott, A., Lee, P. W., et al. (2009). Public awareness and use of direct-to-consumer genetic tests: Results from 3 state population-based surveys, 2006. American Journal of Public Health, 99(3), 442–445. doi: 10.2105/AJPH.2007.131631.PubMedCrossRefGoogle Scholar
  18. Gollust, S. E., Hull, S. C., & Wilfond, B. S. (2002). Limitations of direct-to-consumer advertising for clinical genetic testing. Journal of the American Medical Association, 288(14), 1762–1767.PubMedCrossRefGoogle Scholar
  19. Hamilton, A. (2008). Best inventions of 2008. http://www.time.com/time/specials/packages/article/0,28804,1852747_1854493,00.html. Accessed 5 June 2011.
  20. Hipps, Y. G., Roberts, J. S., Farrer, L. A., & Green, R. C. (2003). Differences between African Americans and Whites in their attitudes toward genetic testing for Alzheimer’s disease. Genetic Testing, 7(1), 39–44. doi: 10.1089/109065703321560921.PubMedCrossRefGoogle Scholar
  21. Hogarth, S., Javitt, G., & Melzer, D. (2008). The current landscape for direct-to-consumer genetic testing: Legal, ethical, and policy issues. Annual Review of Genomics and Human Genetics, 9, 161–182. doi: 10.1146/annurev.genom.9.081307.164319.PubMedCrossRefGoogle Scholar
  22. Kaplan, J. B., & Bennett, T. (2003). Use of race and ethnicity in biomedical publication. JAMA: The Journal of the American Medical Association, 289(20), 2709–2716. doi: 10.1001/jama.289.20.2709.CrossRefGoogle Scholar
  23. Kreuter, M. W., Strecher, V. J., & Glassman, B. (1999). One size does not fit all: The case for tailoring print materials. Annals of Behavioral Medicine, 21(4), 276–283.PubMedCrossRefGoogle Scholar
  24. Kutz, G. (2010). Direct-to-consumer genetic tests: Misleading test results are further complicated by deceptive marketing and other questionable practices (p. 33). Washington: U.S. Government Accountability Office.Google Scholar
  25. Langford, A., Resnicow, K., & An, L. (2010). Clinical trial awareness among racial/ethnic minorities in HINTS 2007: Sociodemographic, attitudinal, and knowledge correlates. Journal of Health Communication, 15(Suppl 3), 92–101. doi: 10.1080/10810730.2010.525296.PubMedCrossRefGoogle Scholar
  26. Laskey, S. L., Williams, J., Pierre-Louis, J., O’Riordan, M., Matthews, A., & Robin, N. H. (2003). Attitudes of African American premedical students toward genetic testing and screening. Genetics in Medicine, 5(1), 49–54. doi: 10.1097/01.GIM.0000046360.61376.EB.PubMedCrossRefGoogle Scholar
  27. Leighton, J. W., Valverde, K., & Bernhardt, B. A. (2011). The general public’s understanding and perception of direct-to-consumer genetic test results. Public Health Genomics. doi: 10.1159/000327159.
  28. Lipkus, I. M. (2007). Numeric, verbal, and visual formats of conveying health risks: Suggested best practices and future recommendations. Medical Decision Making, 27(5), 696–713. doi: 10.1177/0272989x07307271.PubMedCrossRefGoogle Scholar
  29. Matloff, E., & Caplan, A. (2008). Direct to confusion: Lessons learned from marketing BRCA testing. The American Journal of Bioethics, 8(6), 5–8. doi: 10.1080/15265160802248179.PubMedCrossRefGoogle Scholar
  30. McBride, C. M., Wade, C. H., & Kaphingst, K. A. (2010). Consumers’ views of direct-to-consumer genetic information. Annual Review of Genomics and Human Genetics, 11, 427–446. doi: 10.1146/annurev-genom-082509-141604.PubMedCrossRefGoogle Scholar
  31. McGuire, A. L., & Burke, W. (2008). An unwelcome side effect of direct-to-consumer personal genome testing: Raiding the medical commons. Journal of the American Medical Association, 300(22), 2669–2671. doi: 10.1001/jama.2008.803.PubMedCrossRefGoogle Scholar
  32. National Cancer Institute (2009a). Health Information National Trends Survey (HINTS) 2007: Final report. http://hints.cancer.gov/docs/HINTS2007FinalReport.pdf. Accessed 7 May 2011.
  33. National Cancer Institute (2009b). HINTS survey instruments. http://hints.cancer.gov/instrument.aspx. Accessed 7 May 2011.
  34. National Human Genome Research Institute (2010a). Direct to consumer marketing of genetic tests. http://www.genome.gov/12010659. Accessed 5 Feb 2011.
  35. National Human Genome Research Institute (2010b). Frequently asked questions about genetic testing. http://www.genome.gov/19516567#al-5. Accessed 7 Feb 2011.
  36. National Society of Genetic Counselors (2007). Position statements: Direct to consumer genetic testing. http://www.nsgc.org/Media/PositionStatements/tabid/330/Default.aspx#DTC. Accessed 18 Sept 2011.
  37. Ortiz, A. P., Lopez, M., Flores, L. T., Soto-Salgado, M., Finney Rutten, L. J., Serrano-Rodriguez, R. A., et al. (2011). Awareness of direct-to-consumer genetic tests and use of genetic tests among Puerto Rican adults, 2009. Preventing Chronic Disease, 8(5), A110.PubMedGoogle Scholar
  38. Osborn, C. Y., Cavanaugh, K., Wallston, K. A., White, R. O., & Rothman, R. L. (2009). Diabetes numeracy: An overlooked factor in understanding racial disparities in glycemic control. Diabetes Care, 32(9), 1614–1619. doi: 10.2337/dc09-0425.PubMedCrossRefGoogle Scholar
  39. Peters, E., Hibbard, J., Slovic, P., & Dieckmann, N. (2007). Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Affairs (Millwood), 26(3), 741–748. doi: 10.1377/hlthaff.26.3.741.CrossRefGoogle Scholar
  40. Powers, B. J., Trinh, J. V., & Bosworth, H. B. (2010). Can this patient read and understand written health information? Journal of the American Medical Association, 304(1), 76–84. doi: 10.1001/jama.2010.896.PubMedCrossRefGoogle Scholar
  41. Genetics and Public Policy Center (2006). Public health at risk: Failures in oversight of genetic testing laboratories. http://www.dnapolicy.org/images/reportpdfs/PublicHealthAtRiskFinalWithCover.pdf. Accessed 5 May 2011.
  42. Ramirez, A. G., Aparicio-Ting, F. E., de Majors, S. S., & Miller, A. R. (2006). Interest, awareness, and perceptions of genetic testing among Hispanic family members of breast cancer survivors. Ethnicity & Disease, 16(2), 398–403.Google Scholar
  43. Reyna, V. F., Nelson, W. L., Han, P. K., & Dieckmann, N. F. (2009). How numeracy influences risk comprehension and medical decision making. Psychological Bulletin, 135(6), 943–973. doi: 10.1037/a0017327.PubMedCrossRefGoogle Scholar
  44. Singer, E., Antonucci, T., & Van Hoewyk, J. (2004). Racial and ethnic variations in knowledge and attitudes about genetic testing. Genetic Testing, 8(1), 31–43. doi: 10.1089/109065704323016012.PubMedCrossRefGoogle Scholar
  45. Suther, S., & Kiros, G. E. (2009). Barriers to the use of genetic testing: A study of racial and ethnic disparities. Genetics in Medicine, 11(9), 655–662. doi: 10.1097/GIM.0b013e3181ab22aa.PubMedCrossRefGoogle Scholar
  46. Waldrop-Valverde, D., Osborn, C. Y., Rodriguez, A., Rothman, R. L., Kumar, M., & Jones, D. L. (2010). Numeracy skills explain racial differences in HIV medication management. AIDS and Behavior, 14(4), 799–806. doi: 10.1007/s10461-009-9604-4.PubMedCrossRefGoogle Scholar
  47. Woloshin, S., Schwartz, L. M., & Welch, H. G. (2005). Patients and medical statistics. Interest, confidence, and ability. Journal of General Internal Medicine, 20(11), 996–1000. doi: 10.1111/j.1525-1497.2005.00179.x.PubMedCrossRefGoogle Scholar
  48. Zikmund-Fisher, B. J., Fagerlin, A., & Ubel, P. A. (2010). A demonstration of “less can be more” in risk graphics. Medical Decision Making, 30(6), 661–671. doi: 10.1177/0272989x10364244.PubMedCrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2012

Authors and Affiliations

  • Aisha T. Langford
    • 1
  • Ken Resnicow
    • 1
  • J. Scott Roberts
    • 1
  • Brian J. Zikmund-Fisher
    • 1
  1. 1.Department of Health Behavior & Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA

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