How Individual Genetic Test Disclosure May Affect Population Health

Abstract

Advances in the field of genomics raise a new set of scientific questions about risk communication and medical decision making. In the context of chronic disease prevention, a key desired outcome is motivation for behavioral change. Behavioral change has proven stubbornly resistant to both initial and sustained adoption. Innovative approaches being evaluated to intensify motivation for behavioral change include financial incentives and the application of marketing principles to induce healthy choices. 1 One approach is to use genetic testing to identify those at higher risk of disease with the premise that such information would help to motivate change in healthy behaviors. Empiric studies to evaluate the effect of genetic information on risk perceptions and behavioral change are helpful in anticipating the clinical relevance of genetic testing. However, it is of interest to evaluate the effect of genetic risk stratification on risk perceptions across the spectrum of test results. This is especially relevant when the absolute risk increase or decrease attributable to a genetic test is relatively small, as in the case of type 2 diabetes, 2 compared to the risk associated with clinical factors such as age, family history, and obesity. In this regard, the article published in this issue of Medical Decision Making by Vassy and colleagues, ‘‘Impact of Literacy and Numeracy on Motivation for Behavior Change after Diabetes Genetic Risk Testing’’, makes a significant contribution to the literature. 3 Using a vignette study design among