>> I THINK WE CAN START FOR THE ANNOUNCEMENT. WELCOME, EVERYONE TO NIH ROUND TABLE 3 THIS IS THE SESSION FOR HEREDITY AND CULTURE. BEFORE STARTING WE HAVE AN ANNOUNCEMENT. THERE ARE UPCOMING SCHEDULES DECEMBER 4, ROUND TABLE 4 IS COMING, ARTICLES IS ALREADY PUT OBJECT P CAMPUS AND A EMAIL WILL BE SENT OUT LATER THIS WEEK. DECEMBER 6TH ROUND TABLE WITH DR. LISA COOPER FROM JOHNS HOPKINS UNIVERSITY RESCHEDULED BY HURRICANE SANDY SO IT IS OPEN TO ALL MEMBERS. IF YOU KNOW ANYBODY INTERESTED INVITE THEM TO. AND ROOM E 1 AND E-2 DOWNSTAIRS. 4 TO 6:00 P.M., VIDEOCAST. THERE WILL BE A NETWORKING SOCIAL WITH LIGHT REFRESHMENTS FROM 3 TO 4:00 P.M. BEFORE THAT LECTURE. THIS IS QUITE AN OPPORTUNITY TO MEET EACH OTHER TO MAKE A NETWORKING AND WE WILL HAVE A SMALL TABLE TO MAKE A HOLIDAY CARD FOR NIH CHILDREN, THAT WE'LL TALK ABOUT LATER. DECEMBER 11 WILL BE INTRODUCTION TO DIVERSITY. IT IS LONG DAY 1 TO 7:00 P.M., NATCHER BUILDING E-1 AND 2 ROOM WE WILL HEAR FROM DR. MICHAEL SHERIDAN. THIS COURSE IS MANDATORY FOR ALL NIH ACADEMY MEMBERS. DECEMBER 18th WILL BE THE LAST SEMINAR FOR 2012 ROUND TABLE 4 SEMINAR WITH DR. JUDITH (INAUDIBLE) THIS TIME IS CHANGING. 2 TO 4:00 P.M., LOCATION WILL NOT BE DECIDED YET. WE'LL START LECTURE. >> HI, EVERYONE. FIRST NEXT TUESDAY DECEMBER 4 THE GRADUATE COMMITTEE IS TOKING TO DO THE MANNA FOOD BANK, SO THEY'LL BE PACKING BOXES. USUALLY THEY MEET AT 6:30 IN FRONT OF BUILDING 2 VERY, VERY FAST. SO IF YOU WANT TO PARTICIPATE IN THAT, I SENT AN ANNOUNCEMENT IN CAMPUS JUST BEFORE THE -- THIS MEETING. SO JUST EMAIL ERIC TO LET HER KNOW YOU'RE GOING TO PARTICIPATE. DECEMBER 6TH BEFORE DR. COOP EARER'S TALK WE'LL HAVE APPROXIMATE OPPORTUNITY TO MAKE HOLIDAY CARD. THE CHILDREN'S I NORTH CAROLINA HAVE A PROGRAM CALLEDDED THOUGHTFUL TREASURES. SO LIKE ANYTHING TO CHEER THEM UP, YOU ROCK OR HAPPY HOLIDAYS, ANYTHING. COW DONE NEED TO BE LIKE SUPER CROW YEAHTIVE OR CRAFTY. -- CREATIVE OR CRAFTY, JUST AN OPPORTUNITY TO MAKE ENOUGH OF THEM. WE HAVE ALSO DAY SET UP FOR THAT. IT WILL BE DECEMBER THE 12 OR 13, WE STILL HAVEN'T DECIDE FROM 5 TO 6 IN THE CONFERENCE ROOM. ON THE OFFICE OF OIT BUILDING. WE'LL SEND ANNOUNCEMENT SOON ABOUT THAT. THAT'S IT. >> NOW I WOULD LIKE TO INTRODUCE DR. LAURA KOEHLY. SHE IS A SENIOR INVESTIGATOR AND HEAD OF SISTER-IN-LAW NETWORK SECTION IN SOCIAL AND BEHAVIOR RESEARCH BRANCH OF THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE AT NIH. DR. KOEHLY IS QUANTITATIVE PSYCHOLOGIST BY TRAINING, RECEIVING HER DOCK TRAIT FROM UNIVERSITY OF ILL IRVINE CHAMPAGNE, SHE COMPLETED POST-DOCTORAL AT UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER. DR. KOEHLY -- I'M SORRY, DR. KOEHLY, I SHOULD ASK BEFORE. DR. KOEHLY, EXPERTISE IN THE DEVELOPMENT AND APPLICATION OF SOCIAL NETWORK METHODS TO STUDY COMPLEX SOCIAL SYSTEMS SUCH FAMILIES AND COMMUNITIES. DR. KOEHLY HAS CONDUCTEDi INNOVATIVE RESEARCH TO UNDERSTAND FAMILY NETWORK SYSTEM, THE ROLE OF FAMILY SOCIAL TIES IN INDIVIDUAL MEMBERS ENGAGEMENT IN HEALTH BEHAVIORS. OVER THE LAST TEN YEARS HER RESEARCH FOCUS IS TO CONSIDER HOW GENETIC OR GENOMIC RISK INFORMATION CAN BE USED TO ACTIVATE NETWORK PROCESS AND IMPROVE FAMILY HEALTH DECISION MAKING, RISK COMMUNICATION PROCESSES AND SUPPORT FOR AT LEAST FAMILY MEMBERS. THE TITLE OF HER PRESENTATION TODAY IS PROJECT USING FAMILY HEALTH HISTORY TO MOTIVATE MEXICAN ORIGIN FAMILIES TO IMPROVE HEALTH OUTCOMES. PLEASE HELP ME TO WELCOME DR. LAURA KOEHLY. [APPLAUSE] HI. I HOPEIAL HAD A GREAT HOLIDAY. I'M GOING TO VIEW THIS AS INFORMAL AN CASUAL AND LET Y'ALL FEEL FREE TO ASK QUESTIONS SINCE WE'RE MOVING FORWARD. I PLANNED -- I DON'T HAVE THE REMOTE TO SHIFT THINGS SO I HOPE WE'LL NOT HAVE TECHNOLOGICAL ISSUES. I PLAN THE TALK TO FOCUS INITIALLY ON MY PAST TO THE NHGRI, I WAS TOLD YOU ALL MIC LIKE BACKGROUND CAREER TRACK TRAJECTORY AND HOW I GOT HERE. I'M HAPPY TO SPEND MORE TIME ON THAT THAN WHAT I HAVE ALLOCATED SO THAT'S UP TO YOU IF WE WANT TO STOP AND HAVE A CONVERSATION AT THAT POINT. THEN I THOUGHT I WOULD GIVE YOU AN OVERVIEW OF RESEARCH LAB AND WHAT WE FOCUS ON, TO WHY FOCUS ON NETWORKS IN PARTICULAR. THEN TRY TO CONVINCE YOU HOPEFULLY THAT NETWORKS ARE IMPORTANT THAT RELATIONSHIPS MATTER TO HEALTH OUTCOMES. I THINK THE PAPER I SENT TO YOU FOR YOUR JOURNAL CLUB HOPEFULLY GAVE YOU A LITTLE BIT OF TASTE OF WHY I THINK RELATIONSHIPS MATTER TO HEALTH OUTCOMES. AND THEN I WILL END TALKING ABOUT SOME OF THE MAIN OUTCOMES FROM AN INTERVENTION STUDY THAT WE DID IN HOUSTON, TEXAS, WHICH FOCUSEDDED ON MULTI-GENERATIONAL ORIGIN HOUSEHOLD. THEN WE CAN HAVE A CONVERSATION WITHIN OR AFTER, WHATEVER YOU GUYS WANT. SO IT'S YOUR TIME I GUESS IS WHAT I'M SAYING. SO MY PAST NHGRI MY TRAINING, MENTIONED A LITTLE BIT HOW I GOT HERE. MY FIRST ACADEMIC RAINING AS UNDERSTOOD GRADUATE WAS UC DAVIS AND I STARTED IN THE PSYCHOLOGY PROGRAM THINKING THAT I WANTED TO BE A CLINICAL PSYCHOLOGIST WHEN I LEFT THERE. AS I MOVED THROUGH THAT PROGRAM I REALIZED THAT MY CALLING WAS NOT AS A CLINICAL PSYCHOLOGIST BUT RATHER SKILL SET WAS IN QUANTITATIVE METHOD AND STATISTICS. I MADE A SHIFT IN MY TRAINING TO MERGE THOSE TWO DISCIPLINES SO I ENDED UP WITH A BACHELOR'S IN PSYCHOLOGY WITH A MINOR IN STATISTICS AND MATHEMATICS EMPHASIS BUT HAVING FINISHED THAT, THAT'S MY NEXT SLIDE. FROM THERE I WENT TO THE UNIVERSITY OF ILLINOIS TO DO MY DOCTORAL STUDY, GO -- BIG TEN FOR THOSE WHO ARE AT MARYLAND MIGHT BE QUESTIONING WHY MARYLAND IS IN THE BIG TEN BUT ANYWAY, AT THE UNIVERSITY OF ILLINOIS I GOT MY DOCK TRAIT IN QUANTITATIVE SIGH ALCOHOL ALCOHOL AND MASTERS IN -- IN PSYCHOLOGY AND MASTERS IN STATISTICS. FROM THERE I WENT TO MD CANCER CENTER DEPARTMENT OF BEHAVIORAL SCIENCE IN THE DIVISION OF CANCER PREVENTION. ALONG THE ROAD AS I MOVED FROM ONE PLACE TO ANOTHER I HAD A LOT OF QUESTIONS OR DECISIONS TO MAKE IN TERMS OF MY CAREER PATH. SO I JUST THOUGHT I'D MENTION THIS IN THAT AT UC DAVIS I HAD THIS GO THROUGH THIS PROCESS TO FIND WHAT WAS MY DISCIPLINARY HOME. WAS IT PSYCHOLOGY, STATISTICS, I ENDED UP MERGING THOSE TWO DISCIPLINES BUT IT WAS A COGNITIVE PROCESS FOR ME TO FIGURE OUT WHERE I FIT AND THAT'S A THEME AS I TRAVELED THROUGH MY TRAINING AND CAREER AND WHEN I FINISHED MY BACHELOR'S I HAD A QUESTION WHAT DO I DO NEXT. I'M IMAGINING YOU GUYS, A LOT ARE GOING THROUGH THAT PROCESS RIGHT NOW, A LOT OF COLLEAGUES IN MY PSYCHOLOGY DEPARTMENT WERE MOVING TO MANAGEMENT POSITIONS OR ACTUARIAL POSITIONS AT INSURANCE COMPANIES. AND I WAS IN THIS PLACE, WHAT DO I DO NEXT. DO I GO TO GRAD SCHOOL, IF I DO GO TO GRAD SCHOOL WHERE DO I GO. I WAS LUCKY THAT I HAD A DOCTORAL STUDENT AT THE UNIVERSITY OF CALIFORNIA WHO IS TEACHING MY STAT CLASS WHO SUGGESTED TO ME THAT I LOOK INTO QUANTITATIVE PSYCHOLOGY. I NEVER HEARD OF SUCH A THING. HE WAS SO INSTRUMENTAL, HE GOT ALL THE INFORMATION ABOUT THE FIVE OR SO PROGRAMS IN THE UNITED STATES IN THAT AREA. AND REALLY ENCOURAGED ME TO LOOK INTO THAT AS A NEXT PHASE OR NEXT STEP IN TERMS OF MY GRADUATE CAREER. THE UNIVERSITY OF ILLINOIS WAS ONE OF THOSE DEPARTMENTS THAT HAD A QUANTITATIVE PSYCHOLOGY DOCTORATE SO THAT'S WHERE I ENDED UP NEXT IN TERMS OF THOSE DECISION MAKING PROCESSES SO TO SPEAK. WHEN I WAS AT THE UNIVERSITY OF ILLINOIS A LOT OF WORK THAT I DID WAS WHAT I WOULD CALL THEORETICAL IN TERMS OF DEVELOPMENT OF STATISTICAL MODELS FOR SPECIFICALLY FOR SOCIAL NETWORK PROCESSES. AND LIVING IN A WORD WHERE DATA PRETTY. EVERYTHING FOLLOWED SIMILAR DISTRIBUTIONS WE MADE. ALL OUR DATA POINTS WERE INDEPENDENT. SO I HAD THIS DECISION THAT I HAD TO MAKE, WHAT WAS I GOING TO DO NEXT. WAS I GOINGTO APPLY FOR FACULTY POSITIONS IN STATISTICS OR QUANTITATIVE PSYCHOLOGY. AND DO WHAT MY FACULTY HAD BEEN DOING IN TERMS OF DEVELOPING MATHEMATICAL STATISTICAL MODELS, TEACH STATISTICS OR WAS I GOING TO DO SOMETHING A LITTLE BIT DIFFERENT. I THINK WHAT I WAS FINDING A PARTICULAR CHALLENGE IS THAT I FOUND MESSY DATA REALLY INTERESTING. YOU GET MESSY DATA WHEN YOU DO SCIENCE, WHEN YOU'RE IN THE REAL WORLD SO I WANTED TO GET SOME EXPERIENCE IN REAL DATA, REAL DATA ANALYSIS AND DEALING WITH THE PROBLEMS THAT YOU HAVE INHERENTLY WHEN YOU COLLECT DATA. SO WHAT THAT LED ME TO THROUGH SOME THE WORD BE, CIRCUMSTANCES WAS TO FIND MYSELF AT MD ANDERSON CANCER CENTER. SPECIFICALLY THOSE CIRCUMSTANCES WERE THAT I WAS AT A CONFERENCE FOR THE CLASSIFICATION SOCIETY PRESENTING A PAPER AND I RAN INTO AN INDIVIDUAL WHO WAS IN BIOINFORMATICS AT MD ANDERSON CANCER CENTER AND HE SAYS WHY DONE YOU COME HERE AND INTERVIEW AND MAYBE WE HAVE A PLACE FOR YOU. THAT GAVE ME THE EXPERIENCE TO WORK WITH REAL DATA, BE INVOLVEDDED IN WRITING GRANTS, DESIGNING STUDIES, DEAL WITH MESSINESS OF DATA. SO THAT REALLY HELPED ME FORGE WHERE I AM NOW. THE POINT OF THIS SLIDE SOCIAL CONNECTIONS PROVIDE OPPORTUNITY. I WOULD HAVE NEVER KNOWN ABOUT QUANTITATIVE PSYCHOLOGY DEPARTMENT AT UNIVERSITY OF ILLINOIS OR THAT THERE WAS ACTUALLY A DOCTORAL PROGRAM IN QUANTITATIVE PSYCHOLOGY. IF IT WASN'T FOR THIS PROFESSOR OF MINE WHO TOOK AN INTEREST IN ME WHO I ENGAGED WITH IN CONVERSATIONS AND HIM MENTORING ME AND POINTING ME IN THAT DIRECTION. I WOULD HAVE NEVER ENDED UP MD ANDERSON CANCER CENTER IF I HAD NEVER HAD THE CONVERSATION WITH THAT INDIVIDUAL AT THE CLASSIFICATION SOCIETY WHO I HAD NEVER MET BEFORE, BUT HE CREATED AN OPPORTUNITY FOR ME TO COME TO RESEARCH ASSOCIATE POSITION THERE AND GET A SENSE OF WHAT I FOUND INTERESTING AND WHERE I FIT. AND I GUESS THE POINT I WANT TO MAKE IS THAT YOU NEVER KNOW WHERE THOSE SOCIAL CONNECTIONS ARE GOING TO HAPPEN. YOU NEVER KNOW WHO YOU'RE GOING TO TALK TO THAT WILL OPEN THOSE DOORS AND CREATE THAT OPPORTUNITY. SO THE SOCIAL NETWORKING EVENTS THAT YOU HAVE ARE REALLY FUNDAMENTAL CREATING THOSE OPPORTUNITIES AND OPENING THOSE DOORS. AS I MENTIONED I DID HAVE THIS KIND OF RECURRING THEME IN TERMS OF FIGURING OUT WHO I WAS IN TERMS OF A SIGNTIS. SO TRYING DIFFERENT THINGS ON, FINDING OUT WHERE I FIT. THAT BEGAN IN MY UNDERGRADUATE CAREER BUT DIDN'T END WHEN I ENDED UP AT MD ANDERSON. WHEN I LEFT MD ANDERSON I TOOK MY FIRST FACULTY POSITION, IT WAS AT THE UNIVERSITY OF IOWA, ANOTHER BIG TEN SCHOOL. IN EDUCATIONAL MEASUREMENT AND STATISTICS. SO IN THAT POSITION I WAS TRYING ON AM I A STATISTICIAN OR METHODOLOGIST HAT. HOW DID THIS FEEL, WAS THAT WHERE I FELT MOST COMFORTABLE. I DIDN'T FEEL LIKE I FIT THERE. I WASN'T APPLYING WHAT I LEARNED AT MD ANDERSON TO LOOK AT WHAT INTERESTS ME IN TERMS OF TRYING TO HELP THE PUBLIC IMPROVE HEALTH OUTCOMES, DOING SOMETHING THAT I FELT HAD MEANING TO THE PUBLIC AND PUBLIC HEALTH. I'M GOING TO STOP HER AND SEE IF THAT'S SOMETHING THAT NEEDS TO BE DONE. SO I DECIDED TO SEE IF I COULD TAKE A SHIFT AND I ENDED UP GOING TO TEXAS A AND M UNIVERSITY IN THE DEPARTMENT OF PSYCHOLOGY. THAT AT THAT UNIVERSITY I WAS TRYING ON THE PSYCHOLOGIST HAT. AM I A SOCIAL PSYCHOLOGIST. I AT THAT TIME STUDYING FAMILY SYSTEMS AND I COULD THINK OF FAMILIES AS -- THINK OF THE PROCESSES THAT I WAS EXAMINING IN THESE FAMILIES FROM A SOCIAL PSYCHOLOGICAL PERSPECTIVE OR WAS I A TEAM SCIENTIST, ORGANIZATIONS, WE CAN THINK OF US AS A UNIQUE TEAM AND HOW WE CAN TAKE TEAM SCIENCE AND INTEGRATE THAT TO STUDY OF FAMILIES. AGAIN, I WAS HAVING A LITTLE PROBLEM THERE BECAUSE THERE WASN'T A LOT OF FOLKS IN THE PSYCH DEPARTMENT STUDYING HEALTH OUTCOMES. SO I DIDN'T QUITE HAVE A PLACE THAT FELT LIKE HOME. THAT'S WHEN I CAME HERE TO THE NIH TO SOCIAL AND BEHAVIORAL RESEARCH BRANCH. THAT'S ALLOWED ME TO INTEGRATE ALL OF THESE ASPECTS OF MY TRAINING. I THINK OF MYSELF AS A HEALTH PSYCHOLOGIST WITH A PUBLIC HEALTH AND I'M ABLE TO APPLY UNIQUE INNOVATIVE METHODOLOGIES TO STUDY THOSE SOCIAL PROCESSES. SO REALLY WHAT I FOUND OVER THIS LONG TRAJECTORY OF WHAT WE WOULD SAY ABOUT 15 YEARS THAT I FOUND A PLACE I THINK OF AS HOME AND I HOPE YOU GUYS ARE FEELING THE SAME SENTIMENT WHILE HERE ON YOUR POST BACK. SO I THIS I I WANT TO MENTION HOW I ENDED UP HERE. BECAUSE ITTAIS BACK TO MY DAYS BACK AT M.D. ANDERSON AND MY A HA MOMENT. THIS IS WHERE I HAD THAT MOMENT WHERE I COULD SEE THE APPLICATION OF STATISTICAL TRAINING AND SOCIAL NETWORK ANALYSIS WITH HEALTH AND WITHIN THE CONTEXT OF. FAMILY SYSTEMS. WHAT HAPPENED AT MD ANDERSON WAS THAT I HAD AN OFFICE MATE GENETIC COUNSELOR ON A STUDY INVOLVING FAMILIES AT RISK OF DOMINANTLY INHERITED GENETIC CANCER SUSCEPTIBILITY SYNDROME CALLED HMPCC, ALSO KNOWN AS LYNCH SYNDROME. ONE OF THE UNIQUE ASPECTS OF ONE ISSUE SHE WAS LAMENTING ABOUT CONSTANTLY IN OUR OFFICE WAS THAT FAMILY MEMBERS WHEN THEY IDENTIFY THEY FOUND OUT THEY HAD A FAMILY MUTATION THAT PUT THEM AT RISK, AT ONE OF THE ASSOCIATED CANCERS IN LYNCH SYNDROME, THEY HAD A IN A SENSE A RESPONSIBILITY TO INFORM OTHER FAMILY MEMBERS THAT THEY CARRIED THIS MUTATION. IT'S NOT LIKE A PHYSICIAN CAN CONTACT EVERY FAMILY MEMBER WHO IS AT RISK OF CARRYING THE MUTATION AND LET THEM KNOW THEY'RE AT RISK. THAT RESPONSIBILITY LIES SPECIFICALLY WITHIN THE FAMILY. WHAT SHE WAS FINING WAS THAT SOME FAMILY MEMBERS WERE RELUCTANT TO SHARE THIS INFORMATION WITH AT RISK RELATIVES WHICH MEANT THE T RISK RELATIVES DIDN'T KNOW THEY HAD THIS MUTATION AND DIDN'T KNOW THEY WERE AT SIGNIFICANTLY INCREASED RISK OF CANCER. I THINK I MAY HAVE GONE THROUGH. SO WHEN I WAS LISTENING TO HER I SAID I THINK THIS IS A SOCIAL NETWORK PROBLEM. BECAUSE NOT ALL FAMILY RELATIONSHIPS ARE THE SAME. THERE ARE QUALITATIVELY DIFFERENT. SO IF WE COULD UNDERSTAND WHAT ARE THE ASPECTS OF THOSE FAMILY RELATIONSHIPS THAT FACILITATE THAT PROCESS OF DISCLOSURE, THAT THAT MIGHT HELP US TO IMPROVE DISSEMINATION OF THIS INFORMATION WITHIN THE FAMILY SYSTEM. SO THAT LET ME TO CONDUCT A SUBSTUDY THAT ALLOWED ME TO LOOK AT WHAT ARE THE BARRIERS AND FACILITATORS TO THE DISCLOSE SURE OF THIS INFORMATION WITHIN THE FAMILY. IS IT ABOUT BIOLOGY? IS IT ABOUT WHO ARE YOUR FIRST AND SECOND DEGREE RELATIVES. ARE YOU LIKELY TO SHARE WITH PEOPLE YOU ARE BIOLOGICALLY CLOSE TO OR IS IT 4?w AS SPECIAL, QUALITATIVE DIFFERENCES BETWEEN FAMILY MEMBERS. ARE YOU LIKELY THE CHOOSE ONE SISTER TO SHARE THAT INFORMATION WITH THAN ANOTHER CYST AND WHAT ARE THE FUNDAMENTAL SOCIAL PATHWAYS RELATED TO THAT. SO I ENGAGED IN THIS COLLABORATIVE EFFORT WITH MD ANDERSON, THIS OCCURRED WHEN I WAS AT THE UNIVERSITY OF IOWA, THE STUDY THE DIFFUSION PROCESSES OF HER RED TEAR RISK INFORMATION WITHIN THESE FAMILIES -- USING SOCIAL NETWORK ANALYSIS. USING INNOVATIVE METHODOLOGY. THAT RESULTED IN A PAPER WE PUBLISHED IN 2003. COUNSEL DENTALLY AT THE TIME THIS PAPER CAME OUT, THAT WAS WHEN THEY HAD DEVELOPED -- THAT WAS THE INAUGURAL YEAR OF THE SOCIAL BEHAVIORAL RESEARCH BRANCH AT NHGRI. MY BRANCH CHIEF HAPPENED TO BE READING THIS PAPER AND DECIDED THAT THIS WAS SOMETHING THAT SHE WANTED TO BE A PART OF THE SBRB. THAT BECAME THE POINT WHICH SHE HUNTED ME DOWN AND SAID I WANT YOU TO COME HERE AN INTERVIEW FOR THIS POSITION. SO THAT'S WHEN I WAS GRABBED FROM TEXAS A AND M UNIVERSITY AND CAME HERE TO THE NIH. SO THIS PAPER WOULDN'T HAVE HAPPENED WITHOUT MY RESEARCH EXPERIENCE AT MD ANDERSON AND CONTINUED COLLABORATION WITH THOSE FOLKS WHICH I CONTINUE TODAY WHICH I'LL TALK ABOUT A LITTLE MORE WITH PROJECT RAMA. THAT'S IT IN TERMS OF CAREER TRAJECTORY AND I THOUGHT I MIGHT TAKE A MOMENT AND SEE IF THERE'S QUESTIONS BECAUSE THE REST OF THE TALK IS ABOUT MY SCIENCE. SO I WANTED TO SEE IF ANYTHING CAME TO YOU THAT YOU WANTED TO ASK ABOUT IN TERMS OF MY PATH TO HERE. IF NOT, THAT'S OKAY, I CAN MOVE FORWARD. SO WHY NETWORK? I WANT TO GIVE YOU BACKGROUND WHY WE DECIDED TO STUDY WHAT WE STUDIED IN PROJECT RAMA. WHAT I WOULD LIKE TO SET THE STAGE HERE IN TERMS OF INTERVENTIONS THAT ARE DESIGNED TO INFLUENCE HEALTH BEHAVIORS. IN LARGE PART THE MAJORITY OF INTERVENTIONS THAT ARE OUT THERE THAT ARE FOCUSED ON BEHAVIOR CHANGE OR PROMOTING HEALTH BEHAVIORS FOCUSED ON INDIVIDUAL LEVEL FACTORS SUCH AS INCREASING MOTIVATION AT AN INDIVIDUAL LEVEL OR KNOWLEDGE ABOUT THE RULE OF CERTAIN BEHAVIORS AND DISEASE YOU COMES. LARGE PART THOSE INTERVENTIONS HAVE BEEN UNSUCCESSFUL ACHIEVING SUSTAINABLE BEHAVIOR CHANGE. I AS WELL AS OTHERS HYPOTHESIZED THIS MAYBE DUE TO THE FACT THAT INDIVIDUALS ARE EMBEDDED WITHIN A WEB OF SOCIAL TIES SO THESE SOCIAL RELATIONSHIPS OR RELATIONAL PATHWAYS MAYBE INFLUENTIAL ON THOSE HEALTH BEHAVIORS AND WE MIGHT CONSIDER THE SOCIAL PATHWAYS WHEN DEVELOPING INTERVENTIONS TO IMPROVE HEALTH OUTCOMES. I HAVE POOKITTED THAT GENETIC RISK INFORMATION WHICH IS PARTICULARLY SALIENT MIGHT BE USED TO LEVERAGED RELATIONAL FACTORS IN THE FAMILY BY INCREASING MOTIVATIONS AMONG FAMILY MEMBERS TO IMPROVE HEALTH OUTCOMES. SO AS I MENTIONED THIS HAD BEEN LIMITED SUCCESS OF INTERVENTIONS THAT HAVE STARTED IN INDIVIDUAL. OUR INTERVENTIONS MIGHT BE MORE SUCCESSFUL IF WE IDENTIFY PATHWAYS THAT MIGHT WE IDENTIFY PATHWAYS FOR TARGETING PARTICULAR FAMILY MEMBERS TO ENGAGE IN INTERVENTION EFFORTS. SO MY WORK HAS REALLY FOCUSED ON PATHWAYS WITHIN HOUSEHOLD SO FAMILY MEMBERS WITHIN HOUSEHOLDS AS WELL AS INCLUDING EXTENDED FAMILY. MY FUTURE WORK IN ARE AIM THE TO MOVE OUTSIDE THE SOCIAL SYSTEMS TO CONSIDER BOTH NEIGHBORHOOD AND COMMUNITY NETWORK SYSTEMS BUT WHAT I HAVE DONE UP TO THIS POINT IS FOCUSED ON FAMILY NETWORK SYSTEMS. THE IDEA IS IF WE IDENTIFY SOCIAL PROCESSES FAMILIES IMPORTANTfZ TO PARTICULAR HEALTH OUTCOMES THAT WE MIGHT LEVERAGE THOSE IN INNOVATIVE WAYS WITHIN OUR INTERVENTIONS IN AN EFFORT TO CONTINUED SUPPORT OVER TIME THAT LEAD TO SUSTAINED BEHAVIOR CHANGE. NOW, I HAVE BEEN DOING THIS IN THE CONTEXT OF THE COMMUNEAL COPING MODEL, THE COMMUNEAL COPING MODEL HAS ESSENTIALLY THREE RELATIONAL PROCESSES THAT DEFINE THAT MODEL. FIRST IS A COMMUNICATION PROCESS. THE IDEA IS THAT FAMILIESWILL COMMUNICATE A SHARED HEALTH THREAT THROUGH THAT COMMUNICATION PROCESS THEY WILL THEN DEVELOP WHAT WE CALL A SHARED APPRAISAL. SO THEY WOULD LOOK AT THE HEALTH THREAT AS A COMMON PROBLEM AMONG ALL FAMILY MEMBERS, NOT JUST AN INDIVIDUAL LEVEL PROBLEM BUT A FAMILY LEVEL PROBLEM. IF THEY VIEW THAT AS FAMILY LEVEL PROBLEM THEY DEVELOP COOPERATIVE STRATEGIES IN ORDER TO ADDRESS THAT PROBLEM. I IN MY WORK I HAVE LOOKED AT THESE COOPERATIVE STRATEGIES TO TWO DIFFERENT CONTEXT. THE FIRST MIGHT BE TO REDUCE DISTRESS ASSOCIATED WITH FINDING OUT YOU'RE AT INCREASED RISK OF DISEASE DUE TO SOME INHERITED FACTOR. IN THAT CONTEXT COOPERATIVE STRATEGIES ARE IN LARGE PART SOCIAL SUPPORT PROCESSES. SO EMOTIONAL SUPPORT, TANGIBLE SUPPORT, ET CETERA. WE CAN ALSO THINK ABOUT COOPERATIVE STRATEGIES THAT ARE AIMED AT DEALING WITH THE PROBLEM THROUGH BEHAVIORAL REMEDIES SO TO SPEAK. SO THAT'S MORE OF A PROBLEM FOCUSED COPING. IF WE THINK ABOUT COLORECTAL CANCER WHICH IS ONE CANCER FAMILIES THAT HAVE LYNCH SYNDROME, SCREENING IS REALLY IMPORTANT, AN IMPORTANT PREVENTATIVE BEHAVIOR GOING FOR COLONOSCOPIES EVERY YEAR STARTING AT AGE 18. SO THAT WOULD BE A MORE PROBLEM-FOCUSED BEHAVIORAL PREVENTION MEASURE. SO WHAT I LOOK AT IN TERMS OF COOPERATIVE STRATEGIES THERE, IS ENCOURAGEMENT, HOW DO FAMILY MEMBERS ENCOURAGE EACH OTHER TO ENGAGE IN RISK REDUCING BEHAVIORS AND TO THOSE ENCOURAGEMENT PROCESSES RELATED TO BEHAVIORAL OUTCOMES. Z GIVEN THAT I'M A NETWORK SCIENTIST I ALSO ADD OTHER COMPONENTS TO THIS MODEL. ONE IS THESE IDEA OF RELATIONAL CONSTRUCTS OR RELATIONAL PATHWAYS THAT HAVE BEEN ESTABLISHED WITHIN THE FAMILY SYSTEM THAT MIGHT BE IMPORTANT IN TERMS OF HOW INFORMATION FLOWS WITHIN THAT SYSTEM. SO AS I WAS MENTIONED EARLIER THERE ARE SOME RELATIONAL ASPECTS THAT MIGHT BE PARTICULARLY IMPORTANT IN WHO WE CHOOSE TO SHARE RISK INFORMATION WITH. I HAVE ONE SISTER I'M VERY CLOSE WITH, I SHARE EVERYTHING WITH HER. I HAVE ANOTHER SISTER I'M NOT SO CLOSE WITH, I DON'T TELL HER ANYTHING AND I ASSUME IN A WAY THAT MY MOTHER IS GOING TO TELL HER STUFF. SO THERE ARE QUALITATIVE DIFFERENCES IN WHO I MIGHT SHARE THAT WITH, AND SO I ASSUMED OR HYPOTHESIZED THAT THERE ARE THESE SORT OF SOCIAL RELATIONAL FAMILY SYSTEMS CHARACTERISTICS THAT REALLY ARE THE INFRASTRUCTURE OR ROAD THROUGH WHICH FAMILY COMMUNICATION AND COOPERATIVE STRATEGIES MIGHT FLOW. I ASSUME THERE ARE INDIVIDUAL LEVEL ATTRIBUTES OF THE FAMILY MEMBERS THEMSELVES THAT MIGHT BE RELATED TO RISK COMMUNICATION AN ENCOURAGEMENT OR SOCIAL SUPPORT. SO FOR EXAMPLE, WE KNOW WOMEN ARE PARTICULARLY IMPORTANT IN HOLDING INFORMATION WITH REALLY -- WHICH IS RELATED TO FAMILY HISTORY. SO GENERALLER IS AN IMPORTANT ATTRIBUTE TO CONSIDER. AS WELL AS OTHER RELATED ATTRIBUTE SUCH AS MUTATION STATUS IN LYNCH SYNDROME FAMILIES OR WHETHER SOMEONE IS AFFECTED BY DISEASE IN SOME OTHER STUDIES THAT WE HAVE LOOKED AT. SO WE LOOKED AT THIS COMMUNEAL COPING MODEL IN THE CONTEXT OF A LOT OF DIFFERENT DISEASES. WE HAVE BEEN DOING WORK IN CONTEXT OF SINGLE GENE DISORDERS SO DOMINANTLY INHERITED, CANCER SUSCEPTIBILITY SYNDROMES SUCH AS FAMILIES WITH BRAC-1 AND 2 MUTATIONS AS WELL AS HMPCC AND LYNCH SYNDROME FAMILIES AND ALSO LOOKING AT THIS IN CONTEXT OF MORE COMMON COMPLEX DISEASES SUCH AS DIABETES, HEART DISEASE, AND OTHER CANCERS. WHERE FAMILY HISTORY IS THE GENETIC RISK INFORMATION THAT WE'RE PROVIDING TO FAMILIES TO SEE IF IT SHIFTS THESE RELATIONAL PATHWAYS OF INTEREST. WHY FOCUS ON RELATIONSHIPS IN RELATIONSHIPS MATTER TO HEALTH OUTCOMES. FEW EXAMPLES FROM OUR OWN WORK. ONE OF WHICH YOU READ DURING JOURNAL CLUB. FIRST I'LL TALK ABOUT FAMILY HEALTH HISTORY AND I'M GOING THE TALK ABOUT THIS IN THE CONTEXT OF DATA THATÖ9n WE COLLECTED AT BASELINE WITHIN PROJECT RAMA. I'M GOING TO DEFER THE DESIGN PROJECT UNTIL LATER IN THE TALK BUT JUST TO GIVE YOU A LITTLE BIT PRECURSOR TO THAT, THIS WAS A COMMUNITY SAMPLE OF MULTI-GENERATIONAL MEXICAN ORIGIN HOUSEHOLDS IN THE HOUSTON, TEXAS AREA. BY MULTI-GENERATIONAL WHAT WE HAD WERE IN LARGE PART 80% HOUSEHOLDS WITH SPOUSE PARTNERS WITH THE ADULT CHILD LIVING AT HOME. WE ASKED THE INDIVIDUALS IN OUR STUDY TO EACH SEPARATELY PROVIDE A DETAILED FAMILY HEALTH HISTORY. SO EVERY ONE OF OUR PARTICIPANTS INDICATED OR ENUMERATED THEIR FIRST AND SECOND DEGREE RELATIVES AND THEN FOR EACH OF THOSE RELATIVES THEY INDICATED WHETHER OR NOT THEY HAD BEEN DIAGNOSED WITH DIABETES AND/OR HEART DISEASE AND PROVIDED THEM AN OPTION SAYING I DON'T KNOW SO THEY INDICATED YES, THEY WERE DIAGNOSED, NO, THEY WERE NOT DIAGNOSED ORION IF THEY WERE DIAGNOSED. WHAT I WOULD BE INTERESTED IN LOOKING AT FIRST WAS THIS PROPORTION OF THEIR FAMILY HEALTH HISTORY THAT THEY DID NOT KNOW. WHAT WE FOUND -- LET ME ORIENT YOU TO THE SLIDE, WHAT WE DID IS WE DEVELOPED AGE STRATUS BASED ON ESSENTIALLY DECAYED OF PARTICIPANTS AND PROPORTION OR PERCENTAGE OF THE FIRST AND SECOND DEGREE RELATIVES THEY'RE NUMERATED THAT THEY DID NOT KNOW SOMETHING ABOUT THEIR DIAGNOSIS DIABETES OR HEART DISEASE. WHAT WE FOUND IS YOUNG INDIVIDUALS 18 TO 29 ALMOST MORE THAN 30% OF HEALTH HISTORY. SO A THIRD OF HEALTH INFORMATION THEY DID NOT KNOW. THIS WAS IN CONTRAST TO 15% IN OUR OLDER GENERATIONS. WHAT WE FOUND OR OLDER PARTICIPANTS. AND WHAT WE FOUND IS THIS IS INDEED A SIGNIFICANT DIFFERENCE. IF YOU RECALL WE HAVE THESE MULTI-GENERATIONAL HOUSEHOLDS. SO WHAT I WAS ABLE TO DO IS TAKE THESE INDIVIDUALS WHO DIDN'T KNOW 30% FAMILY HEALTH HISTORY AND FILL IN THOSE BLANKS WITH THE INFORMATION THEIR PARENTS PROVIDED US. I COULD LOOK AT HOW THAT IMPACTED THEIR RISK EVALUATION WHAT WE FOUND FOR THESE YOUNG HEALTHY INDIVIDUALS WAS THAT 17% OF THOSE INDIVIDUALS SHIFTED FROM AN P AVERAGE POPULATION BASED RISK TO INCREASE RISK OF DIABETES. THAT WASH THEM FOR BLOOD GLUCOSE TESTING STARTING AT AN EARLIER AGE AND TESTING MORE FREQUENTLY. WE FOUND A SIMILAR BUT LARGER SHIP IN TERMS OF HEART DISEASE. 27% OF INDIVIDUALS WHO SHIFTED FROM AVERAGE POPULATION BASED RISK TO INCREASE RISK THAT WOULD WARRANT MORE SURVEILLANCE IN TERMS OF THEIR DISEASE STATUS. I THINK THIS PICKS TO IMPORTANCE OF FAMILIES SHARING INFORMATION WITH EACH OTHER. IF THE PARENTS SHARED THAT INFORMATION WITH THEIR CHILDREN THEY WOULD HAVE POTENTIALLY MORE ACCURATE KNOWLEDGE OF WHAT THEIR FAMILY HEALTH HISTORY IS AND RISK OF THESE COMMON COMPLEX DISEASES. S FROM ASSOCIATED WITH SHIFTS OR CHANGES IN SCREENING REGIMENS WITH A LOT OF DISEASES HAVE BEEN LOOKING AT. WHAT THIS SPEAKS TO IS TO DEVELOP APPROACHES THAT IMPROVE ACCURACY OF FAMILY RISK INFORMATION, PARTICULARLY AMONG THE YOUNGER GENERATION INDIVIDUALS WHERE WE CAN FOCUS ON PREVENTATIVE BEHAVIORS T. THE SAME CONTEXT OF DISEASE RISK. THE DISEASE CONSTELLATION WITHIN THE FAMILY LIE WITNESS THE FAMILY ITSELF. WE NEED TO DEVELOP APPROACHES THAT WILL IMPROVE THE DISSEMINATION OF THAT INFORMATION. WHAT WE FOUND IN RESEARCH IS THERE IS LIMITED REACH OF THIS INFORMATION. SO WE LIKE TO EXTHE TEND THE REACH OF DISCUSSIONS OF FAMILY RISK INFORMATION BEYOND FIRST DEGREE RELATIVES TO INCLUDE SECOND DEGREE RELATIVES BECAUSE SECOND DEGREE RELATIVES DISEASE DIAGNOSIS ARE JUST AS IMPORTANT TO YOUR RISK ASSESSMENT AS FIRST DEGREE RELATIVES. SO OUR WORK HAS FOCUSED ON IDENTIFYING FAMILY BASED APPROACHES THAT PROMOTE THE CUSHION ABOUT FAMILY RISK WE HAVE ALSO FOUND RELATIONAL FACTORS ARE IMPORTANT IN TERMS OF HEALTH BEHAVIORS. TO ENGAGE IN RISK REDUCING BEHAVIORS HAS BEEN -- WE HAVE SHOWN THAT'S ASSOCIATED WITH INCREASED INTENTIONS TO ENGAGE IN SCREENING BEHAVIORS AND IMPROVE DIET AND PHYSICAL ACTIVITY. WE HAVE ALSO FOUND WHILE WE KNOW INTENTIONS DON'T ALWAYS TRANSLATE TO ACTUAL BEHAVIOR IN OUR LYNCH SYNDROME FAMILIES WE FOUND THAT NOT ONLY FAMILY ENCOURAGEMENT BUT ALSO FAMILY RISK ARE ASSOCIATED WITH FREQUENT COLONOSCOPY SCREENING IN THESE AT RISK FAMILIES SO WE FOUND THESE RELATIONAL PATHWAYS ARE IMPORTANT IN TERMS OF ENGAGEMENT IN RISK REDUCING BEHAVIORS. SO WHAT THIS MEANS, IF WE THINK ABOUT THE FACT FAMILY MEMBERS SHARE RISK OF DISEASE, BECAUSE THEY HAVE SHARED BIOLOGY, THERE IS A AGGREGATION OF DISEASE RISK WITHIN THE FAMILY, WHAT THAT IMPLIES IS THERE WOULD ALSO BE SHARED RECOMMENDATIONS WITH RISK -- RESPECT TO RISK REDUCING BEHAVIORS WITHIN THESE FAMILIES. SO IF WE CAN DEVELOP APPROACHES THAT WILL INCREASE COOPERATIVE STRATEGIES WHETHER IT WITH BEHAVIORAL ENCOURAGEMENT WITHIN FAMILYS WE MIGHT BE ABLE TO INCH CREASE SCREENING ADHERENCE AMONG INDIVIDUALS AS WELL AS ADOPTION OF HEALTHFUL BEHAVIORS. SO THAT'S THE FOCUS OF WHAT WE HAVE BEEN DOING IS HOW TO DEVELOP OR IDENTIFY FAMILY BASED STRATEGIES THAT ENCOURAGE ENGAGEMENT PREVENTATIVE HEALTH BEHAVIORS IN HOPES OF IMPROVING HEALTH OUTCOMES. WHAT THIS LEADS US TO IS CAN WE IN FACT USE GENETIC OR GENOMIC RISK INFORMATION TO ACTIVATE FAMILY RELATIONSHIPS THAT WE FOUND TO BE IMPORTANT IN TERMS OF PREVENTATIVE HEALTH BEHAVIORS. THAT LEADS ME TO PROJECT RAMA WHICH STAND FOR RISK ASSESSMENT FOR MEXICAN AMERICANS, FOR THOSE WHO KNOW SPANISH YOU MIGHT SEE RAMA ALSO MEANS TREE LIMB SO WE WERE TRYING TO ATTACH THE NAME OF OUR PROJECT TO THE IDEA OF FAMILY HISTORY AND FAMILY TREE THIS WAS FAMILY HISTORY BASED FEEDBACK INTERVENTION THAT TARGETED MEXICAN AMERICAN FAMILIES WHICH ARE MEXICAN AMERICANS ARE ONE OF FASTEST GROWING POPULATIONS IN THE UNITED STATES. THEY ARE AT INCREASED RISK OF COMMON COMPLEX DISEASES SUCH AS DIABETES AND HEART DISEASE. SO IF WE CAN DEVELOP AN INTERVENTION THAT WILL IMPROVE ADHERENCE TO PREVENTATIVE SCREENING BEHAVIORS AS WELL AS IMPROVED LIFESTYLE FACTORS, WE HAVE WE HAVE POTENTIAL THE TO MAKE A HUGE PUBLIC HEALTH IMPACT WITHIN THIS LARGELY UNDERSERVED COMMUNITY. I WAS FORTUNATE ENOUGH TO PARTNER WITH THE COHORT, A LARGE. LATION BASED COOR ESTABLISHD BY MY COLLEAGUE AT THE DEPARTMENT OF EPIDEMIOLOGY AT MD ANDERSON CANCER CENTER. SO HERE IS AN EXAMPLE OF A CONNECTION OR RELATIONSHIP BEGAN IN THE LATE 1990s THAT I'M ABLE TO STILL I GUESS MAINTAIN AND INTEGRATE TO MY SCIENCE WHILE HERE AT THE NIH. JUST TO GIVE YOU A SENSE OF THE COHORT, AT THE TIME OF WHEN WE BEGAN THIS STUDY, THEY HAD IDENTIFIED MEXICAN AMERICAN HOUSEHOLDS THROUGH STANDARD EPIDEMIOLOGICAL SAMPLING METHODS SUCH AS RANDOM DIGIT DIALING AND BLOCK WALKING, AND AT THAT TIME WE HAD IDENTIFIED OVER 14,000 MEXICAN ORIGIN HOUSEHOLDS IN THE HOUSTON, TEXAS AREA. AT THE MOMENT THE COHORT I THINK CONSISTS OF ABOUT 21, 22,000 MEXICAN ORIGIN HOUSEHOLDS IN HOUSTON. WHAT WAS REALLY GREAT FOR ME IS THAT THEY COLLECTED A LOT OF INFORMATION ABOUT THE COMPOSITION OF THESE HOUSEHOLDS, SO WE WERE ABLE TO IDENTIFY 1900 HOUSEHOLDS THAT MET OUR ELIGIBILITY CRITERIA IN THAT THEY WERE MULTI-GENERATIONAL HOUSEHOLDS SO ELIGIBILITY REQUIREMENT WAS THAT WE HAD TO HAVE TWO ADULTS IN THE HOUSEHOLD SOCIALLY TIED TO EACH OTHER AND IN LARGE PART THIS WAS FOLKS SPOUSE PARTNERS WITH EACH OTHER AND THEN WE HAD TO HAVE AT LEAST TWO INDIVIDUALS BIOLOGICALLY TIED TO EACH OTHER BUT THAT HAD TO REPRESENT TWO DIFFERENT GENERATIONS. IN LARGE PART WHAT THIS WAS WAS A PARENT AND ADULT CHILD AND I MENTIONED EARLIER ABOUT 80% OF THOSE HOUSEHOLDS WERE SPOUSE PARTNERS WITH THEIR ADULT CHILD LIVING THERE. THE REMAINING WERE SPOUSE PARTNERS WITH ONE OF THE PARENTS SO PARENT AND INLAW LIVING IN THE HOUSEHOLD. AND WE WERE ABLE TO RECRUIT 162 OF THESE HOUSEHOLDS WITH THREE ADULT PARTICIPANTS FOR OUR STUDY. SO JUST TO BRIEFLY -- THE STUDY DESIGN WE DID A BASELINE ASSESSMENT IN OUR PARTICIPANTS' HOMES SO ALL THREE INDIVIDUALS PARTICIPATING INDIVIDUALS HAD TO BE AVAILABLE IN THE HOME ON THE SAME DAY AT THE SAME TIME, WE SEPARATED THEM INTO SEPARATE SPACES AND THEY COMPLETED A COMPUTERIZED SURVEY WHICH THEY DID THEIR FAMILY HEALTH HISTORY ASSESSMENT. WE DIDN'T WANT ANYONE ASKING ANYONE ABOUT WHAT DOES UNCLE JOE -- HAVE THEY BEEN DIAGNOSED WITH DIABETES AND SO WE REALLY WANTED TO KEEP THEM SEPARATE IN TERMS OF MAKING THAT ASSESSMENT. WE THEN RANDOMIZED HOUSEHOLDS TO ONE OF FOUR FEEDBACK CONDITIONS. CHARACTERIZED BY THE FOLLOWING RANDOMIZED DESIGN. THE FIRST FACTOR INDICATED WHETHER OR NOT ALL FAMILY MEMBERS RECEIVED A SUPPLEMENTAL PERSONALIZED RISK EVALUATION BASED ON FAMILY HEALTH HISTORY. THIS WAS IN CONTRAST TO WHETHER OR NOT A SINGLE FAMILY MEMBER RECEIVED THOSE SUPPLEMENTAL RISK ASSESSMENTS. SO WHAT WE WERE TRYING TO CAPTURE HERE WAS HOW WOULD A FAMILY BASED APPROACH CONTRAST WITH WHAT WE WERE THINK OF AS THE CURRENT STANDARD OF CARE WHICH IS WHEN A SINGLE INDIVIDUAL MIGHT GO INTO A HEALTH PROVIDER'S OFFICE AND BE GIVEN PERSONALIZED RISK INFORMATION VERSUS WHETHER WE DID THAT IN A COLLECTIVE WITH THE GROUP OF FAMILY MEMBERS. THE SECOND FACTOR IS WHETHER OR NOT SUPPLEMENTAL RISK ASSESSMENTS ALSO INCLUDED PERSONALIZED BEHAVIORAL RECOMMENDATIONS ON NOW THEY CAN ADJUST THEIR HEALTH BEHAVIOR IN SUCH A WAY TO IMPROVE HEALTH OUTCOMES. SO HALF THE HOUSEHOLDS RECEIVED THE RECOMMENDATIONS AND THE OTHER HOUSEHOLDS RECEIVED A PERSONALIZED RISK ASSESSMENT. THIS WAS TO GET A SENSE WHETHER OR NOT THOSE RECOMMENDATIONS DO SOMETHING IN THAT ACTIVATION OF THE SOCIAL PATHWAYS OF INTEREST. WE COMPLETED A THREE MONTH POST FEEDBACK ASSESSMENT AND TEN MONTH POST FEEDBACK ASSESSMENT. BOTH WERE CONDUCTED OVER THE PHONE. ALL OF THIS WAS DONE IN EITHER SPANISH OR ENGLISH. WHATEVER THE PARTICIPANT PREFERRED. SO WE RECRUITED 500 MEMBERS OF 162 HOUSEHOLDS. AT THE CLOSE OF THE STUDY WE RETAINED SUCCESSFULLY ALMOST 93% OF THE SAMPLE WHICH I THINK IS PRETTY PHENOMENAL AND IT SPEAKS TO REALLY DOING A COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH AND FACT THAT I WAS ABLE TO INTEGRATE MYSELF INTO THAT RESEARCH INFRASTRUCTURE THAT M.D. ANDERSON ESTABLISHED. JUST TO GIVE YOU A SENSE OF WHAT THE FEEDBACK LOOKED LIKE, WE USED FAMILY HEALTH WARE WHICH IS A FAMILY HEALTH HISTORY ASSESSMENT TOOL DEVELOPED BY THE CDC, CENTERS FOR DISEASE CONTROL AND PREVENTION. THIS TOOL IS CURRENTLY AVAILABLE FOR RESEARCH PURPOSES ONLY BUT THE GOAL WAS TO MOVE IT TO EVENTUALLY INTO A CLINICAL SETTING. IN THE STUDY AS A WHOLE WE STUDIED FOUR DISEASES, DIABETES, HEART DISEASE, COLON AND BREAST CANCER. EVERYBODY ALL PARTICIPANTS RECEIVED A FAMILY HEALTH HISTORY PEDIGREE, ALONG WITH A PRIMER HOW TO INTERPRET THIS. SO THIS WAS ESSENTIALLY THE SURGEON GENERAL'S FAMILY HISTORY TOOL, I DON'T KNOW WHERE OF THAT YOU ARE, IT WAS THANKSGIVING AND EVERYONE WAS SUPPOSED TO TALK ABOUT FAMILY HISTORY OF DISEASE, A LOT ATE TURKEY LAST WEEK BUT THAT'S THE SURGEON GENERAL'S TOOL AVAILABLE TO THE PUBLIC. IT'S ONLINE AND A TOOL FOR COLLECTING FAMILY HEALTH HISTORY BUT IT DOES NOT DO -- I TAKE THAT BACK. THEY'RE WORKING ON RISK EVALUATIONS WITHIN THEIR TOOL, AT THE TIME WE DID THAT STUDY, IT DID NOT HAVE RISK ASSESSMENTS INTEGRATED WITHIN THE TOOL ITSELF. THE CDC FAMILY HEALTH WARE DEVELOPED PERSONALIZED RISK ASSESSMENT FROM THE INDIVIDUAL'S FAMILY HISTORY INFORMATION. AND SO BASICALLY WHAT THAT RISK ASSESSMENT DOES IS TELLS THE INDIVIDUAL WHETHER THEY ARE AT STRONG OR MODERATELY INCREASED RISK OF DEVELOPING A PARTICULAR DISEASE DUE TO FAMILY HEALTH HISTORY. IT GIVES INDICATION AS THE TO WHY SO IT MIGHT SAY YOU HAVE ONE FIRST DEGREE RELATIVE DIAGNOSED WITH TIE BETEASE AT EARLY AGE, SO THAT PUTS YOU IN THE STRONG RISK CATEGORY SO THEY'RE GIVING INFORMATION HOW TO INTERPRET THE PEDIGREE A LITTLE BETTER. IT ALSO PROVIDES THESE RISK OR THESE BEHAVIORAL RECOMMENDATIONS BASED ON WHAT THEY HAD TOLD US AT BASELINE. SO IF THEY HAVE NOT BEEN SCREENING BLOOD SUGAR OR BEEN ADHERENT TO SCREENING REGIMENS, THAW EAR TOLD TO GET THEIR BLOOD SUGAR TESTED. YEP. (OFF MIC) >> I ACTUALLY HAD TO GET AN MTA TO USE IT SO I HAVE AN AGREEMENT WITH CDC TO BE ABLE TO USE THIS ASPECT OF THE SOFTWARE FOR MY RESEARCH ENDEAVOR. SO YOU HAVE TO CONTACT CDC TO SEE -- TO DEVELOP COLLABORATION WITH THEM. I CAN SAY THE SURGEON GENERAL'S TOOL, I DON'T KNOW EXACTLY WHEN THE GOAL IS TO HAVE THAT OUT AND IF THE GOAL IS TO HAVE IT OUT TO THE PUBLIC. BUT THEY HAVE DEVELOPED A RISK ASSESSMENT COMPONENT FOR COLORECTAL KAREN WITHIN THE TOOL. THEY ALSO HAVE A RISK ASSESSMENT COMPONENT THEY'RE WORKING ON FOR TYPE 2 DIABETES. THERE'S SOME INTERESTING DIALOGUE THAT WAS HAPPENING BETWEEN FOLKS DEVELOPING THE SURGEON GENERAL'S TOOL AND THE CDC FOLKS DEVELOPING THIS TOOL. THERE'S SOME FOLKS THAT FEEL LIKE RISK ASSESSMENT SHOULD HAPPEN WITHIN A CLINICAL SETTING. IT SHOULDN'T HAPPEN IN A MORE PUBLIC CONTEXT. THERE'S SOME THAT FEEL LIKE IT'S IMPORTANT TO GIVE THIS RISK ASSESSMENT TO THE PEOPLE. WE DO HAVE A PAPER THAT CAME OUT I DON'T KNOW IF IT WAS LAST YEAR IN THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE THAT SHOWED A MESSAGE THEY WERE AT MODERATE AND STRONG RISK MORE LIKELY TO TAKE THIS INFORMATION TO THEIR HEALTHCARE PROVIDER THAN THOSE WHO DID NOT RECEIVE ANY RISK ASSESSMENT SO RECEIVED THE PEDIGREE ONLY AND THOSE WHO RECEIVED A WEAK OR AVERAGE BASED RISK ASSESSMENT. SO I THINK THERE IS SOMETHING TO BE SAID ABOUT PROVIDING THE PUBLIC WITH INTERPRETATION OF FAMILY HEALTH HISTORY THEY HAD TO UNDERSTAND THAT CONSTELLATION OF DISEASE MEANS THEY'RE AT INCREASED RISK. THAT HAS MOTIVATION A INFLUENCE IN TERMS OF SHARING THAT WITH THEIR PHYSICIAN. THIS IS A SIDE NOTE, AS I WAS WORKING ON THE STUDY AND FAMILY HISTORY ASSESSMENT, I WAS REALLY SENSITIVE TO HOW MY HEALTHCARE PROVIDERS WERE COLLECTING THAT INFORMATION. IT IS INTERESTING THE DIVERSITY AND WHAT INFORMATION ARE COLLECTED. THERE'S SOMETHING THAT HAS ENUMERATED RISK OF FIRST AND SECOND DEGREE RELATIVES. FOR EACH ONE OF THOSE FIGURING OUT WHETHER OR NOT YOU KNOW ANY INFORMATION ABOUT THEIR HEALTH. DO I KNOW ANYTHING. I DON'T KNOW A LOT ABOUT MY AUNT'S AND UNCLE'S HEALTH. MAYBE THAT MIGHT MOTIVATE ME TO GO COLLECT THAT INFORMATION. DOES THAT MAKE SENSE? I DON'T KNOW IF Y'ALL HAVE PAID MUCH ATTENTION TO THAT, BUT I WOULD GO TO MY PHYSICIAN AND SAY IS ANYONE IN YOUR FAMILY DIAGNOSED WITH A, B OR C. SO IT DOESN'T ACTUALLY LIST ALL OF THE PEOPLE. SO YOU DON'T GET A SENSE OF WHAT YOU KNOW AND WHAT YOU DON'T KNOW. (OFF MIC) >> I CAN HOLD THAT QUESTION UNTIL THE END OR TALK ABOUT IT NOW. IT'S NOT THE POINT I WAS GOING TO COME TO, WERE YOU GOING TO TELL A COMMENT? THE QUESTION WAS THE ROLE OF BEING ISOLATED, HAVING LESS CONVERSATIONS LIKE BEING ISOLATED IN TERMS OF WHO YOU TALK TO ABOUT THESE THINGS VERSUS WHO -- HAVING INCLUDING HE CAN TENDED FAMILY MEMBERS IN THAT CONVERSATION. IS THAT KIND OF -- THAT'S A GOOD POINT TO BRING UP HERE. ONE OF THE REASONS THEY DID THIS STUDY ON FAMILIES OF MEXICAN ORIGIN, THE LITERATURE SUGGESTS THEY'RE LARGER FAMILIES. SO THERE'S MORE INFORMATION. THE FAMILY HISTORY IS MORE INFORMATIVE IN TERMS OF THEIR RISK. SMALLER FAMILIES, THERE'S GOING TO BE INFORMATION IN THAT FAMILY HISTORY ASSESSMENT. IF YOU'RE ADOPTED YOU DON'T HAVE THAT INFORMATION. SO THAT MIGHT CREATE INTERESTING QUESTIONS ABOUT THE ROLE WHEN IS FAMILY HISTORY GOOD ENOUGH VERSUS WHEN MY GENOMIC RISK INFORMATION, FOR EXAMPLE, BE MORE INFORMATIVE. THAT MAKE SENSE? ONE OF THE THINGS THAT'S COME OUT OF THIS QUESTION, THIS PROJECT, IF YOU REMEMBER THE YOUNGER FAMILY MEMBERS DID NOT KNOW A LOT. THEY ALSO WERE MISSING A LOT OF SECOND DEGREE RELATIVES ON THEIR PEDIGREES. SO YOU CAN SEE THAT BECAUSE THEY ALL ENUMERATED FIRST AND SECOND DEGREE RELATIVES SO THEY COULD MATCH AUNTS AN UNCLES WITH THE SIBLINGS AND THEIR PARENTS. IN LARGE PART THE PEOPLE THAT WERE MISSING FROM THEIR FAMILY FROM THEIR FAMILY HISTORIES, SECOND DEGREE RELATIVES MISSING WERE FOLKS WHO WERE STILL IN MEXICO. SO THERE'S SOMETHING TO BE SAID ABOUT ABOUT MOBILITY AND HOW THAT MIGHT DISCONNECT YOU FROM FAMILY MEMBERS AND DISCONNECT YOU FROM SEEING WHAT'S HAPPENING IN TERMS OF HEALTH OF FAMILY MEMBERS, WHOSE HEALTH IS ASSOCIATED WITH YOUR RISK. I'M JUST A SAMPLE SIZE OF ONE SO THIS IS JUST ONE DATA POINT. I'M 3,000-MILES AWAY FROM MY FIRST DEGREE RELATIVES. SO I DON'T SEE WHAT'S HAPPENING TO HEM IN TERMS OF HEALTH. SO THERE'S A LOT I DON'T KNOW IN TERMS OF THEIR HEALTH HISTORY. AND WE'RE GOING TO TALK ABOUT IT ON THE PHONE BUT IN GENERAL WHEN WE TALK ABOUT THE PHONE IT'S NOT ABOUT THAT. KIND OF SAD TO SAY BUT THE OTHER SIDE IS MY MOTHER'S FAMILY NONE REALLY MOVED. THEY ALL LIVED IN THE SAME TOWN THEY HAVE DINNERS ONCE A WEEK AND THEY KNOW EVERYTHING ABOUT THEIR FAMILY HEALTH HISTORY. SO THERE IS THIS INTERESTING PARADOX I THINK WITH MOBILITY WHAT COMES WITH MOBILITY. WITH THIS PARTICULAR SAMPLE, 7 P 0% OF THEM WERE MEXICAN IMMIGRANTS. THEY'RE MOBILE. SEPARATED FROM THEIR FAMILY, SO THAT LEADS TO THIS -- I THINK THAT MIGHT BE RELATED TO WHY IN PART THESE YOUNGER FOLKS DIDN'T KNOW AS MUCH ABOUT FAMILY HEALTH HISTORY. DOES THAT GET AT -- OKAY. SO WHAT I'M GOING TO TALK ABOUT OR PRESENT TO YOU IN TERMS OF DATA IS LOOKING AT SPECIFICALLY THE FEEDBACK INTERVENTION COMPONENTS THOSE FEEDBACK CONDITIONS AND HOW THAT WAS RELATED TO THE ACTIVATION OF SOCIAL PATHWAYS WITHIN THESE FAMILIES. HOW IS THAT RELATED TO THE DEVELOPMENT OF RISK COMMUNICATION PATHWAYS WITHIN THE FAMILY SPECIFICALLY AT THE THREE MONTH ASSESS. THEN HOW WAS THAT RELATED TO ENCOURAGEMENT PATHWAYS ASSOCIATED WITH PREVENTATIVE BEHAVIORS. I'M GOING THE LOOK AT THAT AT THE TEN MONTH ASSESSMENT. AND THIS IN LARGE PART GOES BACK TO THAT COMMUNEAL COPING MODEL WHERE THE PREMISE IS RISK OF COMMUNICATION IS A PRECURSOR TO THE COOPERATIVE STRATEGIES. SO FIRST I NEED TO GET THE FAMILY MEMBERS TO TALK RISK, AND THEN WHAT WILL FOLLOW IS EPICOURAGEMENT PROCESSES. JUST TO GIVE YOU A SENSE OF KEY MEASURES, THIS INCLUDES FIRST AND SECOND DEGREE RELATIVES. THEN WE ASKED OUR PARTICIPANTS TO PROVIDE A LIST OF THOSE OTHER IMPORTANT PEOPLE IN THEIR LIVES SO THIS MIGHT BE A SPOUSE, IT MIGHT BE AND IN LAW OR IT MIGHT BE WHAT WE REFER TO AS SOCIAL KIN. FRIENDS LIKE FAMILY. DIABETES OR HEART DISEASE. WHO HAS EBB COURAGED YOU -- ENCOURAGED YOU TO GET YOUR BLOOD SUGAR, BLOOD CHOLESTEROL, BLOOD PRESSURE CHECKED AND WHO HAS ENCOURAGED LIFESTYLE FACTORS SUCH AS INCREASING FRUIT AND VEGETABLE CONSUMPTION, PHYSICAL ACTIVITY LEVELS. THEN WE HAD A MESSAGE RELATED TO MAINTAINING A HEALTHY WEIGHT. ASK WHO ENCOURAGED YOU TO MAINTAIN A HEALTHY WEIGHT. I DIDN'T CHANGE THAT. SO WE HAVE BOTH SCREENING AND LIFESTYLE ENCOURAGEMENT SO TO GIVE YOU A SENSE OF THE SAMPLE, WE HAVE JUST OVER HALF OF OUR SAMPLES ARE FEMALE. THIS IS FANTASTIC FROM OUR VIEWPOINT BECAUSE MOST RESEARCH HAS A HIGHER PROPORTION OF WOMEN THAN MENING SO WE HAVE A NICE BALANCE HERE IN TERMS OF MALE REPRESENTATION. SOME INDIVIDUALS MAJORITY ARE MEXICAN IMMIGRANTS, MAJORITY TOOK THE SURVEY IN SPANISH. 36% WERE WITHOUT HEALTH INSURANCE. A LOT OF FOLKS FIND SURPRISING SUCH A LARGE PROPORTION OF OUR SAMPLE DID HAVE HEALTH INSURANCE. IN HOUSTON THEY HAVE A REALLY GREAT COMMUNITY HEALTH SERVICE. THERE SO THERE WAS ACCESS TO HEALTHCARE FOR THOSE COMMUNITIES. SO JUST TO GIVE YOU A SENSE AT BASELINE, IN GENERAL OUR PARTICIPANTS HAD A FAMILY SIZE OF 17 ENUMERATED FAMILY MEMBERS SO THIS SPEAKS, THESE ARE LARGE FAMILIES. THERE WAS NOT A LOT OF DISCUSSION ABOUT THEIR FAMILY RISK OF DISEASE. ENGAGED IN SUCH CONVERSATIONS AND THERE WAS LESS EPICOURAGEMENT WITH RESPECT TO SCREENING BEHAVIORS AND SIMILAR ENCOURAGEMENT WITH RESPECT TO LIFESTYLE FACTORS. THE REASON I SAY THIS IS SLOW IS THAT I'M CONTRASTING THIS WITH OUR FAMILIES WITH DOMINANTLY INHERITED CANCER SUSCEPTIBILITY SYNDROMES. A NUMBER OF PEOPLE ENGAGED IN THOSE CONVERSATIONS, QUITE A BIT HIGHER. TALKING ABOUT DIABETES AND HEART DISEASE RISK IS NOT VERY COMMON WITHIN THESE FAMILIES. SO OUR GOAL WAS TO INCREASE THIS PERCENTAGE HOPEFULLY SIGNIFICANTLY WITH THE RISK FEEDBACK. JUST TO KIND OF STOP HERE AND ASK IF THERE'S ANY QUESTIONS ABOUT THE DESIGN OR THE ASSESS MENTS[na >> SO CURRENTLY IN TERMS OF PRIVACY AND HEALTH INFORMATION OF PHYSICIANS DOES NOT HAVE THE RIGHT TO CONTACT FAMILY MEMBERS TO SHARE THE HEALTH INFORMATION OF ANOTHER PERSON WITH THEM. SO THOUGH THOSE FAMILY MEMBERS ARE AT RISK THEY CAN GO WITHOUT KNOWING THAT IF NO ONE TELLS THEM. (OFF MIC) >> YOU'RE GETTING ON A PROJECT THAT WE'RE CURRENTLY WORKING ON IN MY LAB WHERE WE'RE TRYING TO DEVELOP A MOBILE APPLICATION THAT ALLOWS THE SHARING AND UPDATING OF FAMILY HEALTH HISTORY. ONE THING THAT KEEPS COMING UP IN OUR CONVERSATION IS THIS ISSUE OF PRIVACY. IT'S A DIFFERENT THING IF A PHYSICIAN IS SHARING THAT INFORMATION, BUT IF I'M CHOOSING TO SHARE THAT INFORMATION WITH FAMILY MEMBERS, THERE'S SOMETHING THAT FEELS DIFFERENT ABOUT THAT. I THINK THAT WHAT'S GOING TO HAPPEN, IT'S EMPOWERING THE PATIENTS OR FACILITATING THAT PROCESS OR THE PATIENT TO SHARE THAT. I KNOW THERE'S A LOT OF ELECTRONIC MISDEMEANORCAL RECORDS DIFFERENT APPROACHES TO EMRs THAT ARE BEING DEVELOPED AND IMPLEMENTED. THAT MIGHT BE AN INTERESTING WAY TO INTEGRATE SOME OF THE TECHNOLOGY FOR SHARING SO IT'S NOT -- THOUGH THE PHYSICIAN HAS ACCESS TO THE INFORMATION, THE FAMILY MEMBER IS SHARING THE INFORMATION. (OFF MIC) >> EVERYONE WHO PARTICIPATED. IT WASN'T THAT WE CONTACTED ALL THE ENUMERATED PEOPLE, SO WE'RE LOOKING AT BASICALLY TRIPLES AND IN SOME CASES QUADS IN THE FAMILY SO THAT LIMITS OUR ABILITY TO LOOK AT NETWORK STRUCTURE PER SE. BUT IT DOES ALLOW US TO LOOK AT THESE SOCIAL PATHWAYS OF INFLUENCE. THERE'S A LITTLE BIT OF STRUCTURE IN THERE THAT WERE HOPING TO GET AT IN THE FUTURE. (OFF MIC) PART OF THE ISSUE IS THAT WE DIP -- NOT ALL OF THE SIB L LINGS WITHIN A FAMILY WERE PARTICIPATING BUT WHAT WE CAN LOOK AT IS WHETHER THEY'RE ENGAGING -- LET ME STEP BACK. WHAT WE HAVE LOOKED AT IN TERMS OF THE STRUCTURE IS THE PATTERN OF FEEDBACK SHARING. NOT SOMETHING I'M GOING TO TALK ABOUT. BUT WHAT WE'RE SEEING IN LARGE PART IS EVERYTHING IS GOING THROUGH THE MOTHER. SO WHAT HAPPENS AT THREE MONTHS ESSENTIALLY IS THAT THE TWO, FOR 80% WHO ARE THESE PARTS, THE SPOUSE AND CHILD TELL THEIR MOTHER, THE SPOUSE AND MOTHER AND THEN THE MOTHER AND THE SPOUSE WILL TELL THEIR EXPANDED OR EXTENDED FAMILY MEMBERS. DOES THIS -- SO THE PATHWAY DOWN TO OTHER SIBLING IS GOING THROUGH THE MOTHER. WHICH IS CONSISTENT. WHERE WE HAVE A FAMILY OF RISK EVALUATIONS THERE'S MORE INTERACTION AS A FATHER IN THOSE FAMILIES. BASICALLY WHAT I DID IS THEY'RE CONDITIONED ON BEING NO COMMUNICATION AT BASELINE. SO THIS LOOKS AT JUST THOUGH PEOPLE WHO ARE NOT ENGAGED IN CONVERSATIONS AT BASE LINE AND HOW MANY FOLKS WERE ENGAGED IN CONVERSATION FOLLOWING THE RECEIPT OF FEEDBACK. JUST TO ORIENT YOU, I'M GOING TO TALK ABOUT TWO DISEASES, DIABETES AN HEARTzx DISEASE, THE YELLOW BARS ARE GOING TO BE THOSE FOLKS WHERE ONLY A SICKLE INDIVIDUAL RECEIVED A SUPPLEMENTAL RISK ASSESSMENT AND BLUE WERE ALL FAMILY MEMBERS RECEIVED THAT. THE DARKER ONES WILL BE THOSE THAT HAD THE RECOMMENDATIONS ADDED TO THE RISK ASSESSMENT. IN TERMS OF TIE BETEASE, WHAT WE FOUND IS THERE IS ACTUALLY NO EFFECTIVE FEEDBACK CONDITION BUT WE DID SEE A SIGNIFICANT INCREASE IN CONVERSATIONS AMONG YOU WILL ALL THOSE FEEDBACK CONDITIONS. 15 TO 20% WERE ENGAGED AT THIS FOLLOW-UP ASSESSMENT. WHICH IS REALLY ENCOURAGING BECAUSE THAT'S MORE THAN -- MORE THAN DOUBLED THOSE CONVERSATIONS FROM THE BASELINE ASSESSMENT. IN TERMS OF HEART DISEASE THOUGH, WHAT WE DID FIND IS THAT THERE WAS A MAIN EFFECT FOR ALL VERSUS ONE. SO THOSE HOUSEHOLDS WHERE EVERYONE RECEIVED THE SUPPLEMENTAL RISK ASSESSMENTS WERE HAVING SIGNIFICANTLY MORE CONVERSATIONS ABOUT HEART DISEASE RISK FOR THOSE IN WHICH A SINGLE INDIVIDUAL BUT THAT WAS ATTENUATED BY RECEIPT OF THE BEHAVIORAL RECOMMENDATIONS. WHICH IS COUNTER INTUITIVE. 'ALLY ATTENUATED THOSE ACCORDANCES WITHIN THESE HOUSEHOLDS. AND I THINK THAT KIND OF SPEAKS TO HOW WE MIGHT WANT TO DEVELOP OUR INTERVENTIONS IN THE FUTURE, THAT WE MAY WANT TO GIVE INITIALLY GET THE CONVERSATION GOING AND TALK ABOUT WHAT THAT INFORMATION AT A LATER STAGE IN OUR INTERVENTION. SO TO GO TO THE EPICOURAGEMENT PROCESSES SO AGAIN THE SAME FORMAT. I'M GOING TO FOCUS ON SCREENING ENCOURAGEMENT SO BLOOD CHOLESTEROL, BLOOD PRESSURE AND BLOOD SUGAR. WE DID SEE SIGNIFICANT EFFECT FOR ALL VERSUS ONE. SO THOSE WHERE EVERYONE RECEIVED SUPPLEMENTAL INFORMATION MORE LIKELY TO DEVELOP ENCOURAGEMENT PATHWAYS AT THE TEN MONTH ASSESSMENT THAN THOSE WHICH ONLY ONE. THERE WAS NO EFFECT OF THE RECEIPT OF BEHAVIORAL RECOMMENDATIONS. FOR BLOOD PRESSURE H WE FOUND IS AN INTERESTING INTERACTION WHICH IS ENCOURAGING. THOUSANDS HOUSEHOLDS RISK ASSESSMENTS AND BEHAVIORAL RECOMMENDATIONS HAVE THE HIGHEST LEVEL OF DEVELOPMENT OF NEW ENCOURAGEMENT PATHWAYS WITH RESPECT TO BLOOD PRESSURE TESTING.Z MUT:tQ(U TO BLOOD SUGAR TE STING. AT THE TEN MONTH FOLLOW-UP THE PROVISION OF BEHAVIORAL RECOMMENDATIONS IN THE CONTEXT OF FAMILY BASED INTERVENTION OR FEEDBACK CONDITION, IS THE SITUATION IN WHICH WE'RE SEEING THE HIGHEST ACTIVATION OF THESE ENCOURAGEMENT PATHWAYS. NOW IN TERMS OF BEHAVIORAL RECOMMENDATIONS, HOAR WE HAD PHYSICAL ACTIVITY, HEALTHY DIET AND WEIGHT. WITH RESPECT TO PHYSICAL ACTIVITY WE DID SEE THE DEVELOPMENT OF NEW ENCOURAGEMENT PATHWAYS NOT QUITE A DOUBLING BUT ABOUT FIVE PERCENT OF THOSE NOT ENENGAGED IN THOSE CONVERSATIONS WERE ENGAGED AT TEN MONTHS BUT THERE WAS NO EFFECT DUE TO FEEDBACK CONDITION. HOWEVER, FOR HEALTHY DIET FOR THE FAMILY VERSUS INDIVIDUAL CON TEXT. FOR HEALTHY WEIGH WE SAW A MAIN EFFECT FOR A PROVISION OF RECOMMENDATIONS FOR RISK ASSESSMENT INTEGRATE THERE. SO WE HAVE MIXED RESULTS MANY TERMS OF LIFESTYLE FACTORS. BUT I THINK WHAT THE KEY POINT IS BEHAVIORAL RECOMMENDATIONS IS IMPORTANT FOR THE DEVELOPMENT OF THE BEHAVIORAL ENCOURAGEMENT PATHWAYS. AN PROVISION OF THE RISK INFORMATION IS IMPORTANT FOR THE DEVELOPMENT OF THE RISK COMMUNICATION PATHWAYS. FIRST WE TALK FAMILY RISK, SECOND WE TALK ABOUT HOW TO REDUCE RISK. WHO ARE THE KNEW COMMUNITYTORS AND NEW ENCOURAGERS? IN TERMS OF THE FOLKS THAT WERE INVOLVED IN THE NEW COMMUNICATION PROCESSES IN LARGE PART THEY TENDED TOXICKINGS AND -- TO BE SIBLINGS AND AUNTS AND UNCLES. THIS WAS PARTICULARLY ENCOURAGING IN TERMS OF RESULTS BECAUSE IF YOU RECALL, ONE OF OUR KEY OUTCOMES WAS CAN WE EXTEND THE ROACH OF THESE CONVERSATIONS, CAN WE GET FAMILY MEMBERS TALKING TO AUNTS AND UNCLES BECAUSE SECOND DEGREE RELATIVES IN THERE THE RISK FACTORS ARE IMPORTANT TO PARTICIPANTS RISK FACTORS. OUR INTERVENTION DID APPEAR TO EXTEND THE REACH OF THAT INFORMATION. IN TERMS OF ENCOURAGEMENT, WHERE WE SAW INTERESTING RESULTS, THIS WAS IN CONTRAST TO THAT PAPER YOU READ IS THAT OUR INTERVENTION SEEMS PARTICULARLY SALIENT IN TERMS OF SHIFTING OR ACTIVATING SO IT'S SOMETHING HAPPENING IN TERMS OF ENGAGING THOSE YOUNGER GENERATIONS IN THAT ENCOURAGEMENT PROCESS. WE ALSO SAW SOME SHIFT IN TERMS OF INCLUDING SPOUSE. THE REASON I POINT THIS OUT IS I'M GOING TO MENTION SOME RESEN ANALYSES IN THE MOMENT RELATED TO CHILDREN AND SPOUSES. JUST TO SUMMARIZE RESULTS. I HOPE WHAT I HAVE SHOWN YOU IS THAT RELATIONSHIPS ARE IMPORTANT IN TERMS OF HEALTH OUTCOMES AND WE MIGHT WANT TO FOCUS OUR INTERVENTIONS NOT ON CHANGING THE HEALTH OUTCOME DIRECTLY BUT ACTUALLY SHIFTING SOME OF THOSE MODEIATIONAL PROCESSES IN TERMS OF SOCIAL PATHWAYS AND THOSE SHIFTS IN TERMS OF SOCIAL PATHWAYS MIGHT HAVE MORE LONG TERM IMPACT ON THOSE PARTICULAR HEALTH OUTCOMES IN THE FUTURE. THAT FAMILY HEALTH HISTORY INFORMATION MAYBE IMPORTANT COMMUNEAL COPING PROCESSES IN THESE AT RISK FAMILIES. WE SAW THAT THE PROVISION OF GENOMIC RISK INFORMATION INCREASING THE REACH OF THAT INFORMATION BY ENGAGING SECOND DEGREE RELATIVES IN THESE RISK CONVERSATIONS. AND NEW ENCOURAGERS TENDED TO BE CHILDREN AND SPOUSES. WHERE ARE WE GOING WITH THIS? ONE IS REALLY TO LOOK AT THE NEXT PHASE OF THIS PROCESS. SO WE LOOK AT HOW FEEDBACK CONDITIONS WITH HAVE IMPACTED OR INFLUENCED SOCIAL PATHWAYS BUT HOW ARE THE SOCIAL PATHWAYS RELATED TO PARTICULAR HEALTH OUTCOME? WHERE OUR ANALYSES FOCUS ON ACTIVITY. HOW ARE WE SEEING ARE WE SEEING CHANGES IN PHYSICAL ACTIVITY AND WHAT IS THE ROLE OF THESE RELATIONSHIPS IN THAT PROCESS. MY FORMER POST-DOC HERE RECENTLY DID SOME ANALYSIS LOOKING AT THE ROLE OF CHILDREN IN THIS ENCOURAGEMENT PROCESS HOW THAT RELATES TO PARENTS PHYSICAL ACTIVITY. INCREASE ENCOURAGEMENT IN OUR HOUSEHOLDS WHERE EVERYONE RECEIVED RISK ASSESSMENTS. BETWEEN PARENTS AND CHILDREN THAT ENCOURAGEMENT RELATED TO PHYSICAL ACTIVITY. AND THAT AN THESE PATHWAYS WERE ASSOCIATED WITH DEVELOPING CO-ENGAGEMENT AND PHYSICAL ACTIVITY. SO THOSE PARENTS THAT BEGAN TO ENGAGE IN PHYSICAL ACTIVITY WITH CHILDREN WERE MORE LIKELY PARENTS WHO HAD SHIFT IN PROCESSES AS A RESULT OF THE FEEDBACK CONDITION. MY FORMER POST BACK KELLY KAPINSKY IS LOOKING AT SPOUSE COUPLE DATA. SHE HAS FOUND AN INCREASE IN PHYSICAL ACTIVITY AMONG OUR WOMEN IN THIS SAMPLE DUE TO SPOUSES INCREASE RISK. SO WOMEN WHO GOT A RISK MESSAGE THEY WERE INCREASE RISK DIDN'T CHANGE THEIR PHYSICAL ACTIVITY IN RESPONSE TO THAT INFORMATION. BUT THEY DID CHANGE PHYSICAL ACTIVITY IN RESPONSE TO INCREASED MESSAGE FROM SPOUSE. SO WHAT THIS IS SPEAKING TO IS THERE IS THIS PROCESS THAT MIGHT BE HAPPENING AMONG SPOUSE COUPLES IN RESPONSE IN THE RISK OF INFORMATION THAT EACH OTHER IS GETTING. THEN SHE FOUND ENCOURAGEMENT MODERATES THIS EFFECT. SO WOMEN WHO ENCOURAGE SPOUSES TO INCREASE THEIR PHYSICAL ACTIVITY ARE ACTUALLY MORE LIKELY TO HAVE INCREASED THEIR OWN PHYSICAL ACTIVITY IN RESPONSE TO THE INTERVENTION. THAT WOULD BE AN INTERESTING RESULT WE'RE SEEING WITH THESE HOUSEHOLDS. SO NEXT STEPS IN LINKING PATHWAYS TO BEHAVIORS. WE'RE IN THE MIDST OF DEVELOPING FAMILY BASED INTERVENTIONS, THAT REALLY ARE TARGETING INTERVENTIONISTS WITHIN THE FAMILY. PARTICULARLY INFLUENTIAL PEOPLE WITHIN THAT FAMILY THAT WE MIGHT ENGAGE IN INTERVENTION EFFORTS AND WE'RE DOING A STUDY IN AUSTRALIA RIGHT NOWb=– ENGAGING IN BETWEEN 8 AND P 12 AND RISK AS A WAY TO MOTIVATE FAMILY LEVEL CHANGES WITH RESPECT TO DIET AND PHICAL ACTIVITY. -- PHYSICAL ACTIVITY AND INCREASING FAMILY DIVERSITY. SO IN THIS PROJECT, WE ONLY HAVE FAMILIES OF MEXICAN ORIGIN. SO WE CAN'T SPEAK TO WHETHER OR NOT RESULTS WILL GENERALIZE FAMILIES OTHER CULTURAL OR ETHNIC BACKGROUNDS. WE LIKE TO INCREASE DIVERSITY SO WE CAN SPEAK TO WHETHER THERE ARE DIFFERENCES IN WHAT THOSE FAMILIES LOOK LIKE AND WHO MIGHT HAVE ENGAGED AS INTERVENTIONISTS WITH FAMILIES WITH MOODY VERSE BACKGROUNDS. SO JUST WANT TO ACKNOWLEDGE MY FUNDING. PROJECT RAMA WAS FUBBED WHICH THE INTRAMURAL RESEARCH PROGRAM, MY COLLABORATOR MD ANDERSON WAS FUND BY THE NATIONAL CANCER INSTITUTE, THROUGH A KO-7 AND MANA COHORT THAT INFRASTRUCTURE WAS FUNDED BY SEVERAL FOLKS AT MD ANDERSON. THIS WAS JUST MY TEAM. THESE WERE OUR INTERVIEWERS. THEY LIVED WITHIN THE NEIGHBORHOODS AND WERE PART OF THE COMMUNITY. SO WE REALLY TOOK A PR APPROACH TO THIS PROJECT. ARE THERE ANY QUESTIONS? I DON'T KNOW WHAT TIME IT IS, I'M PROBABLY LIKE WAY OVER. NO? OKAY. [APPLAUSE] >> SORRY. I'LL TRY TO SEE IF -- [LAUGHTER] >> WE ALWAYS PULL OUT THE GEMS THAT WE HEAR SO I'LL REPEAT IT. SO THE QUESTION WAS WHETHER OR NOT GENOMICS SCREENING WHICH BY -- WHICH SOME HAVE SAID HAS POTENTIAL TO INCREASE THE POWER OF PERSONALIZED MEDICINE, MAY NOT BE ACCESSIBLE TO SOME COMMUNITIES SO MAYBE MORE EXPENSIVE IN SOME CONTEXT FOR FOLKS THAT DONE HAVE ACCESS TO CARE SO THAT MIGHT INCREASE SEVERITY. SO I'LL TWIST THAT AND GIVE YOU, THIS IS MY VIEWPOINT. SO I'M NOT GOING TO -- I DON'T WANT TO ATTRIBUTE IT TO THE NHGRI OR ANYTHING. I FOUND IN MY WORK, NOT JUST RAMA BUT SOME WORK WE HAVE DONE WITH LYNCH SYNDROME FAMILY, AND ELSEWHERE THAT THERE'S SOMETHING ABOUT EXPERIENCE THAT GIVES MEANING TO RISK THERE'S SOMETHING ABOUT FOR EXAMPLE IN LYNCH SYNDROME FAMILY ALL RECEIVED GENETIC SERVICES. THEY WERE PART OF THE NIH STUDY. WHAT WAS MORE SALIENT TO THEIR MOTIVATION WAS FACT THAT SOMEONE THEY WERE CLOSE TO HAD THE DISEASE AND WATCHED THEM THROUGH THAT PROCESS. SO THAT IN A WAY SPEAKS TO FAMILY HISTORY. AND THE ROLE OF THE -- SALIENCE OF THAT LIVED EXPERIENCE IN TERMS OF MOTIVATING HEALTH BEHAVIOR. THIS PRESENTS A DIFFERENT VIEWPOINT IN TERMS OF WHAT IS GENOMIC INFORMATION GOING TO BY YOU IF YOUR FOCUS IS ON CHANGING HEALTH BEHAVIOR SO IT'S A SLIGHTLY DIFFERENT SPIN ON WHAT YOU'RE SAYING. THE QUESTION IS, I DON'T KNOW BECAUSE I THINK THAT THAT IS A GREAT STUDY TO TEST PARTICULAR HYPOTHESIS. MY HYPOTHESIS WOULD BE THAT IN THE ABSENCE OF THE EXPERIENCE OF FAMILY HEALTH HISTORY IS NOT GOING TO BE AS MOTIVATIONAL AS THE LIVED EXPERIENCE. SO I'M SHIFTING FROM YOUR DISPARITIES QUESTION AND ECONOMIC ASPECTS OF IT. I DON'T KNOW A LOT ABOUT THAT. BUT WHAT I SEE IS THERE'S SOMETHING ABOUT WATCHING SOMEONE YOU LOVE BE AFFECTED BY THE DISEASE THAT HAS INCREASED MOTIVATION ON YOUR BEHAVIOR. (OFF MIC) >> THAT'S ACTUALLY SOMETHING WE'RE HOPING TO MOVE FORWARD IN PART OF THE CHIN SEEK STUDY, I DON'T KNOW IF YOU HER MUCH ABOUT THAT. WHOLE EXOME WHOLE GENOME SEQUENCING ON -- I THINK THERE'S A THOUSANDS PEOPLE IN THE COHORT. HE RETURNS RESULTS THAT HE -- HE'S IDENTIFIED MARKERS ASSOCIATED WITH CERTAIN DISEASE OUTCOMES GETTING RETURNS TO THE PARTICIPATES. RIGHT NOW I'M WORKING ON A PROPOSAL FOCUSED PRIMARILY ON CARRIER STATUS. BUT KAYLA ANRY TRYING TO FIGURE OUT WHAT WOULD BE INTERESTING COMPARISONS IN THAT REGARD, WHERE WE LOOK AT DISSEMINATION OF CARRIER STATUS RESULTS WITHIN FAMILY. WE MIGHT WANT TO COMPARE THAT TO INDIVIDUALS WHO ARE GETTING INFORMATION THAT HAS MORE DIRECT MEDICALLY ACTIONABLE IMPLICATIONS, SO MAYBE SOMEONE GETTING A BRAC RESULT. WHAT DO THOSE PROCESSES LOOK LIKE THAT -- ARE THEY DIFFERENT? IS THERE SOMETHING DIFFERENCE ABOUT GETTING A CARRIER RESULT IN A CONTEXT THERE'S NOT A CONSTELLATION OF FOLKS NOT AFFECTED BY THAT DISEASE VERSUS IF THERE'S CONSTELLATION OF FOLK WHOSE HAVE BEEN AFFECTD BY THAT DISEASE IN THE FAMILY. BUT I THINK IT'S HARD. IT'S AN INTERESTING PROBLEM BECAUSE YOU’Ny MIGHT EXPECT -- THERE'S A CORRELATION BETWEEN FAMILY HISTORY AND GENETIC RISK INFORMATION. SO STUDY DESIGN IS DIFFICULT LIKE WHEN DO YOU -- HOW DO YOU FIND PEOPLE THAT HAVE GENETIC RISK WITH OUTSIDE THE CONTEXT OF THE FAMILY HISTORY. THIS MIGHT GET TO FAMILY SIZE, THAT MIGHT BE A WAY TO THINK ABOUT THAT. HOW DOES FAMILY SIZE GET INTO THAT. OR FOLKS ADOPTED, WHERE THE GENETIC ABOUT GENOMIC RISK INFORMATION. I RECENTLY WHEN THROUGH AND GOT MY WHOLE GENOMIC HEALTH PROFILE. IT'S INTERESTING. I DID THAT IN LARGE PART BECAUSE I WANTED TO SEE WHAT IT WAS LIKE IN TERMS OF EXPERIENCE, I'M ESSENTIALLY A RESEARCH SUBJECT IN THAT NOW. WE HAD TO DO ALL MY CONSENTING AND IN TERMS OF WHAT IS SALIENT IN TERMS OF RESULTS AND WHAT HASN'T. THINGS THAT CAME BACK THAT I HAVE A FAMILY HISTORY FOR, IT'S LOOK I'M NOT SURPRISED BUT IT'S SALIENT BECAUSE I HAVE A FAMILY HISTORY FOR IT BUT THINGS THAT CAME BACK THAT I DON'T. I'M LIKE THAT'S PROBABLY JUST AN ANOMALY SO IT'S JUST KIND OF AN INTERESTING -- IT WAS REALLY INTERESTING EXPERIENCE. DOING THOSE RELATIVE FINDER, SO REAL LIFE I COULD BE FINING OUT I HAVE RELATIVES BUT IT'S SCARY OR THAT I HAVE HEALTH INFORMATION NOW NOT JUST ABOUT ME BUT ABOUT MY PARTS AND ABOUT MY NEPHEWS AND NIECE. IT'S KIND OF BEEN A REALLY INTERESTING EXPERIENCE. DID I ANSWER YOUR QUESTION? >> THAT'S A REALLY INTERESTING IMPLEMENTATION QUESTION. WE GOT THAT IN TERMS OF PROJECT RAMA, HOW WE SCALE THIS UP TO PUBLIC HEALTH CONTEXT. THE WAY I HAVE BEEN THINKING ABOUT THAT IS MORE OF A FAMILY HEALTH EDGETOR MODEL. THIS MIGHT HAPPEN WITHIN A PUBLIC HEALTH CONTEXT WHERE WE MIGHT HAVE A PUBLIC HEALTH PRACTITIONER EDUCATING A FAMILY HEALTH EDUCATORS WHO WOULD THEN GO OUT AND EDUCATE THEIR FAMILY MEMBERS. SO THIS IDEA OF IDENTIFYING AN INTERVENTIONIST WITHIN THE FAMILY WHO WE WOULD ENGAGE IN THOSE SORT OF TRAINING OR EDUCATIONAL EFFORTS WITHIN A IMMUNITY SETTING. THAT'S HOW I SEE, I DON'T SEE US HAVING GENETIC COUNSELOR, THERE'S NOT ENOUGH FOLKS OUT THERE TO DO I'M NOT SURE WHAT THAT -- BUT MY SENSE IS THERE'S NOT ENOUGH FOLKS OUT THERE TO BE IMPLEMENTING THIS. SO IT COULD I GUESS HAPPEN WITHIN A HEALTHCARE SETTING CONTEXT TOO. LET ME STEP BACK A BIT. ONE THING THAT WE'RE GETTING IN TERMS OF CONTENT ANALYSIS FOR TOOL WE JUST DEVELOPED IS THAT FOLKS WANT TO KNOW HOW TO HAVE THOSE CONVERSATIONS. SO I THINK THERE HAS TO BE MORE DONE THAT WILL ALLOW US TO TEACH FOLKS TO HAVE CONVERSATIONS ABOUT FAMILY RISK especially for those qualitatively difficult family relationships. WE KNOW WHERE INFORMATION FLOWS. WE KNOW WHERE IT DOESN'T FLOW. SO HOW DO WE CREATE THE BRIDGE WHERE INFORMATION ISN'T FLOWING IN RELATIONSHIPS THAT ARE A LITTLE MORE DISTRESSED SO I THINK THAT'S SOMETHING WE HAVE TO THINK ABOUT IN THE FUTURE. WE'RE HAVING A TOUGH TIME RECRUITING FAMILY MEMBERS IN A PROJECT WE'RE DOING RELATED TO ALZHEIMER'S DISEASE. IT SEEMS LIKE THE CARE GIVING PROCESS CREATES SO MUCH STRESS THAT IT ALSO IN THAT -- WITHIN THAT CONTEXT OF DISTRESS, CREATING DISTRESS RELATIONSHIPS WITHIN THE FAMILY SO WE HAVE HAD LOT OF CAREGIVERS NOT WILLING TO -- BECAUSE OF THE NATURE THE QUALITATIVELY NEGATIVE NATURE OF THEIR RELATIONSHIP. THAT IS WHAT WE WANT TO STUDY AN FIGURE OUT HOW TO HELP IN THAT CONTEXT SO IT'S BEEN A CHALLENGE FIGURING OUT HOW TO RECRUIT. OKAY. THANK YOU. [APPLAUSE] >> THANK YOU, DR. KOEHLY.