Lay and Expert Models of Gene-Environment Interaction Grant

One of the projected health dividends of the Human Genome Project is the use of personalized multi-gene testing to identify individual susceptibilities, so that individuals can undertake preventive courses of action. Among other things, for this to be successful medical personnel must be able to convey this information without creating fatalism and in ways that are comprehensible and believable to lay people. To facilitate such health messages, this project will describe lay understandings of the interactions of genes with non- genetic factors (commonly referred to as "environmental" factors) in relationship to common complex diseases (adult onset diabetes, "heart" disease, depression, and lung cancer). It will compare these to the models employed in medical research and outreach, identifying areas of consonance and dissonance. It will then initiate studies to explore the effectiveness of use of particular models within health messages. Qualitative methods will be used to generate grounded, rich analyses of the models, and quantitative methods will be used to assess the frequency of distribution of various models. Medical research and clinical models will be assessed by examining published scientific journals and web-based clinical representations. Lay understandings will be assessed in a two stage process. In-depth, in-person interviews with lay people will be conducted. Then, these transcripts will be used to develop a closed question survey to be administered to a national random population sample to ascertain frequency and distributions of various models. After analysis of areas of commonalities in lay and expert models, preliminary "best message strategies" will be tested to assess 1) whether interactive models produce lower fatalism than non-interactive models, 2) whether use of consonant models increases belief, identity consonance, perceived efficacy, and intention to adhere to prescriptions and 3) whether some models are more effective than others at enhancing belief, identity consonance, perceived efficacy, and intention to adhere to prescriptions. This project will identify how lay people think about the role of genes in common diseases. It will develop ways of telling people the results of personalized genetic testing without increasing their fatalism. This will help recipients to adopt behaviors that will better stave off the risks identified by the tests.