Translating Genomic Research into Public Health Applications

April 7, 2010

Debra DuquetteGenetic Alliance

Posted in the Resource Repository at:http://www.resourcerepository.org/documents/1934/translatinggenomicresearchintopublichealthapplications/

Genomics Translation for Public Health Webinar

April 9, 2010

Debra Duquette, MS, CGC Genomics Coordinator

Michigan Department of Community Health

DuquetteD@michigan.gov 517-335-8286

Promise of Genomics for Public Health Practice

  Increase understanding of underlying genetic susceptibility to common chronic diseases and infections

  Awareness of genomic risk may be a motivating factor for behavior change and screening uptake

  Family-centered approaches to risk reduction may be more effective and have longer impact

  Cross-cutting topic across many public health disciplines

  Decrease early mortality of common chronic diseases   Earlier detection of at-risk populations   Target interventions to high-risk

populations   Improve screening, diagnosis and

treatment

“DNA nebula” discovered 80 light years away

http://news.nationalgeographic.com/news/2006/03/0317_060317_dna_nebula.html

Poll Question: What do you think is the greatest barrier to genomics translation for public health practice?

A) Lack of time, staff and funding B) Lack of genomic competency C)  Lack of interest in genomics relevance D)  Lack of evidence that genomics improves

health outcomes

Barriers to Genomics in Public Health Practice

Lack of:   Time   Staff   Funding   Population-based Genomic Data   Genomic Competency   Genomic Literacy   Interest and Knowledge of

Genomics Relevance   Evidence-base for Genomic

Applications   Proven Genomics Applications

Leading to Improved Health Outcomes

Other Difficulties:   Other Public Health Priorities   Staying Abreast of Current

Genomics Developments   Commercialization of Genomic

Tests   Access to Services and

Technologies   Health Disparities   Financing/Reimbursement for

Genomic Services and Tests

Overcoming Barriers to Genomics Translation

  Integrate into Programs   Build Upon Resources   Enhance Data Sources   Add to Population-Based Surveys   GAPPNet!

Integrating into Existing Programs: Healthy People 2020 (HP 2020)

  Started in 1979   10-year national objectives for

promoting health and preventing disease

  HP 2020 marks first time for genomics objectives

  Encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities

  Works to achieve increased quality and years of healthy life and the elimination of health disparities.

http://www.healthypeople.gov/hp2020/

Integrating into Existing Programs: Comprehensive Cancer Control Plan for Michigan 2009-2015 Managing a Course for Excellence in Michigan

Three cross-cutting goals:   Health Disparities   Access to Care   Emerging Science and Technology

New Genomics Goal:

  Increase availability of cancer-related genetic information to the Michigan public and decrease barriers to risk-appropriate services

http://michigancancer.org/

Integrating into Existing Programs: Michigan Cancer Consortium (MCC) Special Project Objective

  By 2011, expand public knowledge about the impact of genetics on cancer risk and management (breast, ovarian, and colorectal cancers)

–  Disseminates existing family history resources on website

–  Includes recently recorded radio public service announcements and radio interviews

–  Includes recently developed family history poster by MCC and American Cancer Society

http://michigancancer.org

Building Upon Existing Resources: US Surgeon General Tool for Family Health History

http://www.hhs.gov/familyhistory/

  US Surgeon General declared Thanksgiving to be National Family History Day since 2004

  Revised “My Family Health Portrait” allows users to organize family history and share with others

  Family history is traditional core element of clinical care

  Use of family history precedes evidence-based methods

  Evidence base supporting family history of chronic diseases in primary care is weak

  Additional studies needed!

 Developed and distributed since November 2004

 16 issues created and disseminated   Sent via e-mail to all Michigan

libraries, genetics clinics, chronic disease partners, and others

  Focus on awareness of disease or risk factor month

•  Number of hits to newsletters ~400-800/month

•  Recent Survey indicated: - 92% said newsletters were

informative or very informative

- 15% further disseminated to 50 or more people www.michigan.gov/genomics

Building Upon Existing Resources: MDCH Family History and Your Health Newsletters

Using Existing Data Sources and Surveys

  Data Sources of Genomics Relevance –  Vital records data

  Surveillance of early mortality of chronic diseases –  Cancer registry data

  Surveillance of early onset cases, males with breast cancer, multiple primaries, site-specific factors

  Examples of Population-Based Surveys –  Behavioral Risk Factor Survey

  State-based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury.

–  PRAMS   collects state-specific, population-based data on maternal attitudes

and experiences before, during, and shortly after pregnancy

Sudden Cardiac Death of the Young (SCDY)

  Death occurring out-of-hospital or in the emergency room or as “dead on arrival” with an underlying cause of death reported as a cardiac disease

  Variably defined as < 30, < 35, < 40 years of age   Especially tragic event; often high-profile, associated with young

athletes   A potentially preventable condition, due to the heritable nature of

certain cardiac disorders –  More likely to have genetic determinants than similar conditions in older persons –  Immediate family members of SCDY victims may be at increased risk of sudden death –  Family history is the greatest risk factor

To learn more about Sudden Cardiac Death in the Young in Michigan, please visit: http://www.michigan.gov/documents/mdch/SCDYReportfinalJan09_269478_7.pdf

Using Existing Data Sources: Descriptive Statistics and Mortality Rates for SCDY in Michigan

Using Existing Population-Based Surveys: Michigan BRFS Family History of SCDY

•  2,856 Michigan adults were asked about family history of SCDY in 2007

•  6.3% have a family history of SCDY •  26.2% with multiple relatives •  35.5% with first degree relative

•  Significantly more blacks (11.2%) than whites (5.4%) reported family history of SCDY

BRFS SCDY Family History Data

For listing of state-added BRFS questions, please visit: http://depts.washington.edu/cgph/pdf/Compiled_Genomics_Questions_BRFSS.pdf

Staying Abreast of Current Genomics Developments: Resources

  Genomics & Health Weekly Update http://www.cdc.gov/genomics/update/current.htm

  Summer Institute at University of Washington

http://depts.washington.edu/cgph/summinst_main.htm

  4th National Public Health Genomics Conference

https://www.cmpinc.net/2010PHGConference/savethedate.aspx

Importance of GAPPNet to Public Health Professionals

  Identify needs for public health professionals and work to fill these ‘gaps’

  Create a safety ‘net’ to share successes and lessons learned

  Please join GAPPNet

Coming together is a beginning. Keeping together is progress. Working together is success.

--Henry Ford

Thank you to the Centers for Disease Control and Prevention National Office of Public Health Genomics for funding this work through Cooperative Agreement #U58/CCU522826 and #5U38GD000054