As a major public health issue, type 2 diabetes (DM2) is now at epidemic levels in the United States. Although effective preventive behaviors have been identified, intervention efforts to encourage these behaviors have been only moderately successful, due in part to difficulty involved in making the necessary lifestyle changes (e.g., diet, exercise). This study will investigate the lay public's genetic explanations for the development of DM2, a previously unexplored potential source of influence on attitudes and behaviors that may contribute to the development of this disease. Research suggests that with current emphasis on genetic explanations for disease in medical research and in the popular press, a large majority of the public will invoke genetic explanations to account for the origins of DM2. Genetic explanation is associated with the belief that disease is uncontrollable, which can then lead to the lack of sustained effort to prevent the development of disease. This proposed link has significance for health disparities, because some minority populations, in which the prevalence of DM2 is particularly high, tend to hold fatalistic approaches to disease. Fatalistic beliefs are conceptually consistent with genetic explanation and beliefs about the uncontrollability of disease, and thus, the use of genetic explanations in these groups may be common and contribute to increased risk of developing DM2. This study will investigate four research questions relevant to this hypothesized path from genetic explanations to preventive attitudes and behaviors: (1) How does the lay public conceptualize genetic influences on DM2? (2) What is the association between genetic explanations for the development of DM2 and perceived control over the development of the disease? (3) What is the association between perceived control over the development of DM2 and key attitudinal and behavioral outcomes related to disease prevention? (4) How do genetic explanations, perceived family history, and perceived risk of developing DM2 together influence key attitudinal and behavioral outcomes related to disease prevention? To examine these questions, we will conduct a two-phase survey of Americans representing three ethnic/racial groups, specifically, non- Hispanic White Americans, African Americans, and Mexican Americans. As our focus is on prevention, we will only include individuals who have not been diagnosed with diabetes. In Phase I, a structured survey will be administered to representative samples of respondents (N=400 per ethnic/racial group). Phase II of this project will involve a qualitative, open-ended survey of selected respondents who completed Phase I (N=50 per ethnic/racial group). With the use of information generated in these studies, we will be able to better target DM2 preventive interventions to at-risk populations and to develop educational and clinical outreach programs tailored to the needs of individuals in specific minority groups. Importantly, the conceptual basis for this study has application to other chronic diseases with both genetic and behavioral risk factors and may serve as a basis for future research.

Public Health Relevance

In light of the epidemic levels of type 2 diabetes in the United States, it is critical to identify and understand factors that likely contribute to the rising prevalence of this disease. This study will investigate how the public's genetic explanations for type 2 diabetes may undermine preventive efforts because such explanations tend to imply that the development of diabetes is not controllable. By examining the link between this causal belief system and key health attitudes and behaviors, we can better inform preventive intervention efforts.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Ethical, Legal, and Social Implications of Human Genetics Study Section (ELS)
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Hunter, Christine
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University of Michigan Ann Arbor
Schools of Public Health
Ann Arbor
United States
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Carmichael, Alicia G; Hulswit, Bailey B; Moe, Emily J et al. (2016) A Qualitative Study of Anticipated Decision Making around Type 2 Diabetes Genetic Testing: the Role of Scientifically Concordant and Discordant Expectations. J Genet Couns :
Giordimaina, Alicia M; Sheldon, Jane P; Kiedrowski, Lesli A et al. (2015) Searching for the Kinkeepers: Historian Gender, Age, and Type 2 Diabetes Family History. Health Educ Behav 42:736-41