Talking (or Not) About Family Health History in Families of Latino Young Adults

Abstract

Although individuals recognize the importance of knowing their family’s health history for their own health, relatively few people (e.g., less than a third in one national survey) collect this type of information. This study examines the rates of family communication about family health history of cancer, and predictors of communication in a sample of English-speaking Latino young adults. A total of 224 Latino young adults completed a survey that included measures on family communication, cultural factors, religious commitment, and cancer worry. We found that few Latino young adults reported collecting information from their families for the purposes of creating a family health history (18%) or sharing information about hereditary cancer risk with family members (16%). In contrast, slightly more than half of the participants reported generally “talking with their mothers about their family’s health history of cancer.” Logistic regression results indicated that cancer worry (odds ratio [OR] = 2.31; 95% confidence interval [CI] = 1.08-4.93), being female (OR = 3.12; 95% CI = 1.02-8.08), and being older (OR = 1.33; 95% CI = 1.01-1.76) were associated with increased rates of collecting information from family members. In contrast, orientation to the Latino culture (OR = 2.81; 95% CI = 1.33-5.94) and religious commitment (OR = 1.54; 95% CI = 1.02-2.32) were associated with increased rates of giving cancer information. Results highlight the need for prevention programs to help further general discussions about a family’s history of cancer to more specific information related to family health history.

Keywords

cancer communication family health history Latino adults

Cancer prevention continues to be a public health need within the Latino community. Cancer is the second leading cause of death among Latinos in the United States, and the most frequently diagnosed cancers are prostate cancer (men), and breast cancer (women; American Cancer Society [ACS], 2009). Even though 50% of Latino men and 33% of women will be diagnosed with cancer in their lifetime (ACS, 2009), Latinos are less likely than others to engage in cancer prevention screenings (ACS, 2009) or to seek out cancer prevention information (Vanderpool, Kornfeld, Rutten, & Squiers, 2009; Waters, Sullivan, & Rutten, 2009). Hawkins, Berkowitz, and Peipins (2010) further found that Latino adults reported fewer cancer prevention strategies compared with non-Hispanic Whites. Together, these studies suggest that new strategies are needed to promote Latinos’ awareness of cancer risk, and cancer prevention knowledge and behaviors.

One potential intervention strategy is to increase Latinos’ awareness of their family history of cancer. About 5% to 10% of cancers are strongly hereditary (ACS, 2012), but an even larger proportion of cancers are “familial” and include both genetic and environmental factors that cluster in families. In fact, twin studies suggest about 25% of cancer incidence is due to shared genetic factors (Lichtenstein et al., 2000). Knowing family history is currently the most comprehensive and accessible genomic public health tool for capturing genetic cancer risk in a population (Ramsey, Yoon, Moonesinghe, & Khoury, 2006). In fact, leaders in evidence-based practice guidelines (e.g., U.S. Preventive Services Task Force, American Cancer Society, National Comprehensive Cancer Network) recommend tailoring screening practices for these cancers based on family history information.

Much of the literature highlighting the importance of family health history discussions has focused on older adults providing information to their children, communication about genetic test results, or communication in families with a history of cancer. Fewer studies have examined family health history discussions about cancer as reported by young adults, particularly those in minority families. This gap in the literature is concerning because many forms of cancer are the result of unhealthy behavioral choices that are typically formed during the adolescent and young adult years and because college students show low levels of cancer knowledge. For example, Daley (2007) found that college students had little biomedical knowledge of cancer risk factors and screening procedures but 71% had a family history of cancer. Smith et al. (2011) found that the majority of college students believed it was their primary responsibility, or that they shared responsibility with their physicians, for initiating family health history discussions. Yet less than two thirds of students actually reported having these types of discussions with their health care provider. For young adults to share and discuss their family cancer risk with health care providers, they first need to gather information about cancer occurrence in their family and also have a family climate in which the sharing of risk and prevention information among family members occurs. This study expands on the literature about family health history discussion by examining the rates and predictors, including cultural factors, of communication about family health history as reported by Latino young adults.

Family Health History and Cancer Prevention

Multiple investigators have shown that family health history communication is associated with cancer preventive behaviors and self-efficacy (Ersig, Williams, Hadley, & Koehly, 2009; Harris et al., 2010; Jones, Denham, & Springston, 2006; Lewis et al., 2012; Madlensky, Esplen, Gallinger, McLaughlin, & Goel, 2003; Manne, Kashy, Weinberg, Boscarino, & Bowen, 2012; Nguyen & Belgrave, 2011). For example, Nguyen and Belgrave found a positive association between talking to family members and cervical screenings and higher levels of breast and cervical screening self-efficacy in a sample of Asian women. Tracy et al. (2008) found that women with a first degree relative with breast cancer were 2.1 times more likely to have had a mammogram within the past year and believed they were at a higher risk for breast cancer compared with women without this history. Thus, promoting an individuals’ awareness of family health history can facilitate identification of cancer risk and promote preventive behaviors.

Although most individuals believe that knowing their family’s health history has important implications for their own health, relatively few people actively collect this information. Yoon et al. (2004) reported that 96.3% of 4,345 respondents who completed the Centers for Disease Control and Prevention’s (CDC) HealthStyles Survey believed that knowledge of family health history was “very important” or “somewhat important” for their own personal health. However, only 29.8% of respondents had actively collected information regarding family health history. Identified barriers to communication about family health history include strained family relationships, lack of perceived usefulness of the information, seriousness of the message, and concern that the message will be rejected (Claes et al., 2003; Hughes et al., 2002; Kenen, Ardern-Jones, & Eeles, 2004).

Not knowing one’s family health history is more pronounced in minority families and may contribute to cancer-related health disparities. Data from the CDC HealthStyles Survey show that Latinos were less likely than others to actively collect family health history information (Yoon et al., 2004). Kaphingst, Lachance, Gepp, D’Anna, and Rios-Ellis (2011) found that only 44% of Latino adults knew about the concept of family health history prior to participating in the study. Finally, Orom, Kiviniemi, Underwood, Ross, and Shavers (2010) found that between 15% and 30% of the difference between minority (Black, Hispanic, Asian) and White participants perceived cancer risk was explained by less reporting of family history in the minority groups. These studies illustrate a need for more work that examines family communication about health history of cancer within Latino families, including studies that identify cultural factors that may promote or inhibit family discussions about health history.

Factors Associated With Family Health History Discussions

Even though few studies have examined family health history discussions between young adults and their parents, we draw on prior literature on family health history discussions and young adult–parent health discussions to identify factors associated with these discussions. Gender has consistently been found to affect family health history discussions. For example, Harris et al. (2010) found that first-degree relatives of an individual with melanoma reported talking to mothers about melanoma more than other family members, including fathers. In addition, Kaphingst, Goodman, Pandya, Stafford, and Lachance (2011) found that women were more likely than men to talk about family health history with family members. As a result, we focused on mother–young adult discussions in this study. Research has also indicated that older adolescents report more communication with their mothers about health-related topics than younger adolescents. Thus, we hypothesize that being female and older would predict family health history discussions about cancer.

In addition to demographic factors, we were also interested in identifying cultural factors that may relate to family health history discussions. Acculturation generally refers to the process by which individuals change their behavior and attitudes toward those of the mainstream culture (Rogler, Cortes, & Malgady, 1991). The relationship between cancer risk and prevention and acculturation is complex. On the one hand, studies have demonstrated that acculturation is positively associated with cancer-related risk behaviors (e.g., decreased physical activity, increased alcohol use, smoking; Ham, Yore, Kruger, Heath, & Moeti, 2007; Safer & Piane, 2007; Trinidad, Gilpin, Messer, White, & Pierce, 2006). At the same time, less acculturated Latinos have less knowledge regarding cancer risk and prevention strategies and are less likely to engage in cancer-preventive behaviors (Abraído-Lanza, Chao, & Gates, 2005; O’Malley, Kerner, Johnson, & Mandelblatt, 1999). How acculturation relates to family health history discussions about cancer is less known, partly because most studies only include a measure of acculturation to the mainstream culture or proxy measures of acculturation (e.g., immigration status). These mixed findings are further complicated by the fact that acculturation is not a unidimensional process and includes a connection to both the mainstream culture and one’s culture of origin (Abraído-Lanza, Armbrister, Florez, & Aguirre, 2006). Thus, including both a measure of connection to the mainstream culture and one’s culture of origin is needed. Similarly, given the centrality of the family in the Latino culture, it is possible that the cultural value of familism relates to family health history discussions. Relatively few studies have examined the association between familism and parent-adolescent discussions, but we hypothesize that high levels of familism and orientation to the Latino culture (but not to the mainstream culture) will be related to increased family health history discussions in this sample.

Finally, we were interested in whether a family-level factor, openness to communication within the family, and an individual-level factor, cancer worry, were related to family health history discussions. Harris et al. (2010) highlighted the importance of family structure variables such as family adaptability, cohesion, and flexibility in openness to share family health discussions. Less attention has been paid to relation between cancer worry and family health discussions; however, Kaphingst, Goodman, et al. (2011) found that adults were more likely to discuss health history with their family members if they had a family history of cancer. Other literature has shown that individuals with a family history of cancer show increased levels of cancer worry (Hay, Buckley, & Ostroff, 2005; Price, Butow, Lo, Wilson, & Kathleen Cunningham Consortium for Research into Familial Breast Cancer Psychosocial Group, 2007). Thus, we hypothesized that both openness to communicate and cancer worry would predict family health discussions as reported by Latino young adults. In sum, the current study contributes to the growing literature on family health history discussions about cancer by focusing on communication between young adults and their parents, examining family health history discussions in a minority population and by identifying cultural factors that are associated with family history discussions within the context of other factors that have been shown to affect such discussions.

Method

Participants

A total of 224 Latino young adults (age 18-25 years) completed measures on demographics (e.g., age, gender), cultural factors (e.g., acculturation, familism), religious commitment, cancer worry, and knowledge and communication regarding family’s cancer risk and family health. Participant characteristics are shown in Table 1. Participants’ mean age was 20.97 years (SD = 1.69), and 62% were female. Seventy-two percent of participants were born in the United States, 14% in a Central American country, 11% in a South American country, and 2% in the Caribbean. The majority of U.S.-born participants had immigrant parents. About half of immigrant participants (52%) were 9 years old or younger when they immigrated to the United States, 35% were 10 to 17 years old, and 13% were 18 years or older (not shown in Table 1). Young adults were eligible for the current study if they (a) self-identified as Latino, (b) were between 18 and 25 years old, and (c) could complete the survey in English.

Table 1.

Participants’ Characteristics

Demographic Variables	Percentage	N
Gender
Male	38.4	86
Female	61.6	138
Year in school
Freshman	13.4	29
Sophomore	22.7	49
Junior	29.6	64
Senior	25.5	55
Graduate/other	8.8	19
Marital status
Single, never married	96.9	217
Married	2.2	5
Other	0.9	2
Born in the United States
Yes	72	161
No	28	62
Mother born in the United States
Yes	17.5	39
No	82.5	184
Father born in the United States
Yes	18	39
No	82	178
Family’s income ($)
<25,000	15	32
25,000-50,000	28.6	61
50,000-75,000	20.2	43
75,000-100,000	15.5	33
>$100,000	20.7	44
Religious affiliation
Protestant or other	22.3	50
Christian	64.7	145
Catholic	7.6	17
No religious background	5.4	12

Note. N ranged from 213 to 224 because of missing data.

Procedures

Participant recruitment was done by posting flyers in community locations and through e-mails sent to Latino student organizations at local universities. For some Latino student organizations, we held a recruitment meeting (with free food) to describe the study and recruit participants. Interested students were given the option to complete the survey during the recruitment meeting or to make an appointment to complete the survey at a later date. Students who were recruited through flyers posted in the community or e-mails sent to community organizations were provided with the project coordinator’s contact information so that they could receive further information about the study. Interested participants were given the option to complete the survey in a campus library, in the research offices, or another private location at a time that was convenient for them. The survey took approximately 45 to 60 minutes to complete, and participants received $25 for completing the survey.

Measures

Demographics

Participants were asked to report on their age, gender, race, ethnicity, nativity status, generational status, educational level, marital status, and current living situation. They also reported on their parents’ nativity status, race/ethnicity, educational level, and estimated family income.

Family communication about family health history

Participants were asked three questions pertaining to family communication about the family health history. First, participants were asked, “Have you ever actively collected cancer information from your parents for the purpose of creating a family health history?” If participants answered yes, they were then asked what information was collected (i.e., age at diagnosis, cancer type, genetic test results). Second, participants were asked, “Have you ever actively given your parents information about hereditary cancer risk? (Hereditary cancer risk is cancer that tends to run in the family.)” If participants answered yes, they were asked to identify what information they gave (i.e., medical information, family risk for cancer, cancer prevention suggestions, and genetic testing results). These two items were slightly modified from their original version that was first used in the CDC’s HealthStyles survey (Yoon et al., 2004). Rather than using the word “relatives,” for this study, we asked participants whether they had communicated specifically with their parents. Finally, participants were asked, “Have you ever talked to your mother about your family’s history of cancer?” This third item is similar to items used by other researchers (e.g., “I talk with family members about our family health history”– Kaphingst, Goodman, et al., 2011). Responses to each of the three questions were dichotomized into yes or no answers.

Acculturation

Participant’s acculturative status was assessed using Scale 1 of the Acculturation Rating Scale for Mexican Americans–II (Cuéllar, Arnold, & Maldonado, 1995). Scale 1 includes 30 items developed to assess cultural orientation toward Mexican (17 items) and Anglo (13 items) cultures, independently. We changed the word Mexican to Latino to make the scale applicable to a diverse group of Latinos. Items are rated on a 5-point Likert-type scale from 1 = not at all to 5 = extremely often or almost always. The items for each subscale are summed and then averaged to obtain a mean score for the Latino Orientation (LOS) and Anglo Orientation (AOS) scales. Higher scores indicate a greater orientation to the cultural group. In a sample of 379 college students, the internal reliability coefficients were .86 and .88 for the AOS and LOS, respectively (Cuéllar et al., 1995). Reliability coefficients in the current study were adequate (α = .69 for AOS and α = .92 for LOS).

Familism

Participants completed the familism subscale of the Mexican American Cultural Values Scale for Adolescents and Adults (Knight et al., 2010). The familism subscale consists of 16 items that are rated on a scale from 1 = not at all to 5 = completely. Items are summed to create a total familism score and then averaged so that higher scores represent higher levels of familism. The familism subscale has shown adequate internal reliabilities in prior work with Mexican-origin adolescents and their parents (Knight et al., 2010) and had an alpha of .93 in the current sample.

Communication openness

Participants completed a modified version of the nine item Openness of Discussion in the Family Scale (Mesters et al., 1997). We omitted the first question (i.e., “I talk as little as possible about my illness because I don’t want to make my family uneasy”) because this was not a sample of young adults with a diagnosed illness. In addition, two items that included “partner” or “children” were reworded to read “relatives” and combined into one item: “My relatives don’t like me to talk about health problems.” The final scale included six items that were rated on a 4-point Likert-type scale ranging from 1 = strongly agree to 4 = strongly disagree. Higher scores reflect a more open environment for family health communication. In prior work, the nine-item measure demonstrated good internal consistency and validity (Mesters et al., 1997). The alpha in the current sample was .80.

Cancer worry

Cancer worry was measured with the 4-item Cancer Worry Scale (CWS; Lerman et al., 1991). Participants were asked to rate the frequency of their worry using 4-point Likert-type scales. Ratings for each item were summed to obtain a total cancer worry score and then divided by four to obtain an average worry score, with higher scores indicating greater worry. The CWS has been widely used and is considered the gold standard for measuring cancer worry (Gramling, Anthony, Frierson, & Bowen, 2007). The CWS had an alpha of .75 in the current study.

Religious commitment

Participants completed the 10-item Religious Commitment Index–10 (Worthington et al., 2003). Items were rated on a 5-point scale ranging from not at all true of me to totally true of me. Items were summed to form a total religious commitment score. Reliability coefficients for a religiously diverse sample of college students ranged from .92 to .98 for specific religious groups (Worthington et al., 2003). In the current study, the Religious Commitment Index–10 showed adequate internal consistency (α = .95).

Data Analysis Plan

The goal of the current manuscript is to identify the individual (i.e., cancer worry), family (i.e., openness to communicate), and cultural factors (i.e., familism, acculturation, religious commitment) associated with communication about family health history. First, descriptive statistics of family health history communication are presented. Second, we conducted chi-square tests of independence and t tests to identify demographic variables (e.g., age, gender, education level, immigrant status) that may need to be controlled for in the regression analyses. Demographic variables that were significantly associated with the outcome variables at the .05 significance level were entered into regression analyses as covariates. Last, we conducted three logistic regressions to identify the cultural and individual factors associated with family discussions controlling for demographic factors. Covariates and other variables were entered into the regressions simultaneously. To interpret findings, we first examined whether the overall model was significant when all variables are entered in the equation. To assess the model fit, we then performed the Hosmer and Lemeshow test, with nonsignificant results suggesting an adequate goodness of fit. Last, predictors for each outcome were classified as significant at the .05 alpha level; odds ratios and confidence intervals are provided.

Results

Family Health History Discussions Between Latino Young Adults and Their Parents

Overall, the rates of discussions between Latino young adults and their parents about family health history about cancer were low. Specifically, 18.3% of 224 Latino young adult participants reported actively collecting cancer risk information from their parents for the purposes of creating a family health history. Information collected included the type of cancer of the affected family member (16.5%, n = 37), age of diagnosis (5.8%, n = 13), and genetic testing results (0.9%, n = 2). Similarly, only 16.1% of the 224 participants in the study had actively given information to their parents about hereditary cancer risk: 8.9% (n = 20) gave information about the risk of cancer for the family, 8.9% (n = 20) gave information on how to prevent cancer, and 8.5% (n = 19) gave medical information. Finally, 58.3% of Latino young adults reported generally talking to their mothers about their family’s history of cancer.

Discussions about family health history between Latino young adults and their parents varied by participant gender, age, and education level. Specifically, Latino females (Latinas) collected more information about cancer from their parents than their male peers, χ²(1, N = 224) = 7.56, p < .01 (23.9% of females vs. 9.3% of males collected information). However, no gender differences were found for actively giving cancer risk information to parents, χ²(1, N = 224) = .094, p = .76 (16.7% of females vs. 15.1% of males). Latinas were also more likely to report having talked to their mothers about the family’s cancer history than males, χ²(1, N = 223) = 6.50, p < .05 (65% of females vs. 47.7% of males). Latino young adults who collected cancer information from their parents were older (M = 21.8 years) than those who did not collect this type of information (M = 20.8 years), t(214) = −3.34, p < .01. No age differences were found in giving information to parents about hereditary cancer risk or talking with their mothers about the family’s history of cancer. Similarly, Latino young adults who reported a higher educational level (M = 4.66) were more likely to report having collected cancer information from their parents, t(221) = −3.91, p < .001, than those who did not collect family health history information (M = 3.92). However, this difference was not observed for actively giving cancer risk information to parents or talking with their mothers about the family history of cancer. Because of their significant association with at least one outcome variable, gender, age, and education status were entered as covariates in all regression analyses. Last, participant’s immigrant status was not related to collecting or giving cancer risk information or talking with mothers about the family health history of cancer. Despite this nonsignificant finding, we included immigrant status as a covariate in regression analyses based on prior literature.

Predictors of Family Health History Discussions

We also sought to identify the predictors of family health history communication about cancer in families of Latino young adults. We conducted a series of logistic regressions to identify the individual, family and cultural factors associated with communication about family health history. Our first logistic regression examined predictors of collecting cancer information from relatives for the purposes of creating a family health history. When individual (i.e., cancer worry), family (i.e., openness to communicate), and cultural (i.e., familism, acculturation, religious commitment) factors were entered into a logistic regression along with demographic variables (age, gender, education level, immigrant status), the omnibus model for collecting cancer information from parents was significant, χ²(12, N = 213) = 31.50, p <.01. The Hosmer and Lemeshow test provided evidence that our model has adequate fit, χ²(8, N = 213) = 2.27, p = .97. In brief, the logistic regression revealed that being older, female, and reporting higher levels of cancer worry significantly predicted collecting cancer information from parents for the purpose of creating a family health history (see Table 2 for odds ratios and confidence intervals). Similarly, when demographic variables and predictors were taken together, the omnibus model for giving cancer risk information with their parents was significant, χ²(12, N = 213) = 32.18, p <.01, and yielded two significant predictors. The Hosmer and Lemeshow test confirmed an acceptable fit for our model, χ²(8, N = 213) = 4.18, p = .84. Specifically, findings showed that having a stronger orientation toward the Latino culture and higher levels of religious commitment were associated with sharing cancer risk information with parents (see Table 3 for odds ratios and confidence intervals). A final logistic regression was performed to examine predictors of talking with mothers about the family’s cancer history; however, the overall model was not significant, χ²(12, N = 213) = 14.25, p =.29.

Table 2.

Logistic Regression Predicting Collection of Cancer Information Among Latino Young Adults

Variable	B	SE	Wald χ²(1)	Odds Ratio	95% Confidence Interval	p
Age	0.29	0.14	3.99	3.12	[1.20, 8.08]	.019
Gender	1.14	0.49	5.49	1.33	[1.01, 1.76]	.046
Educational level	0.32	0.20	2.53	1.37	[0.93, 2.03]	.112
Immigrant status
Participant	0.10	0.47	0.05	1.11	[0.45, 2.76]	.827
Mother	−0.01	0.02	0.12	0.99	[0.95, 1.04]	.733
Father	0.00	0.00	0.22	1.00	[0.99, 1.00]	.640
Acculturation
Latino orientation	0.09	0.32	0.08	1.09	[0.58, 2.04]	.784
Anglo orientation	0.04	0.46	0.01	1.04	[0.42, 2.57]	.927
Religious commitment	0.15	0.20	0.56	1.16	[0.79, 1.71]	.454
Familism	0.32	0.63	0.26	1.37	[0.40, 4.69]	.613
Openness to communicate	0.05	0.07	0.50	1.05	[0.91, 1.21]	.479
Cancer worry	0.84	0.38	4.64	2.31	[1.08, 4.93]	.031

Table 3.

Logistic Regression Predicting Giving Cancer Risk Information to Relatives Among Latino Young Adults

Variable	B	SE	Wald χ²(1)	Odds Ratio	95% Confidence Interval	p
Age	0.14	0.15	0.83	1.14	[0.85, 1.55]	.363
Gender	0.12	0.45	0.07	1.12	[0.47, 2.72]	.795
Educational level	−0.34	0.24	2.00	0.72	[0.45, 1.14]	.157
Immigrant status
Participant	−0.51	0.51	1.00	0.60	[0.22, 1.63]	.317
Mother	0.01	0.02	0.08	1.01	[0.96, 1.06]	.778
Father	0.00	0.00	0.12	1.00	[0.99, 1.00]	.732
Acculturation
Latino orientation	1.03	0.38	7.28	2.81	[1.33, 5.94]	.007
Anglo orientation	−0.36	0.48	0.56	0.70	[0.27, 1.80]	.455
Religious commitment	0.43	0.21	4.26	1.54	[1.02, 2.32]	.039
Familism	−0.02	0.66	0.00	0.98	[0.27, 3.59]	.979
Openness to communicate	0.13	0.08	2.88	1.14	[0.98, 1.33]	.090
Cancer worry	0.66	0.39	2.82	1.93	[0.90, 4.16]	.093

Discussion and Implications

We found that relatively few Latino young adults reported “actively” collecting cancer information from their parents for the purpose of creating a family health history or giving information about hereditary cancer risk. However, 58.3% of Latino young adults reported talking to their mother generally “about their family’s history of cancer.” One possibility for these low rates of communication is that few Latino young adults are familiar with the idea of creating a family health history for cancer or its relevance for their own health behaviors. In a sample of Latino older adults, Kaphingst, Lachance, et al. (2011) found that only 44% of Latino adults knew about the concept of family health history before participating in an intervention. Exactly what Latino young adults understand about family health history is less known. For example, it is possible that Latino young adults talk to their parents more generally about their family’s health history but do not “actively” collect specific information for the purposes of creating family health histories or for giving hereditary cancer risk information to family members because they have less of an understanding of the importance of such detailed information.

It is also possible that actively collecting information from parents goes against Latino cultural scripts for parent–child relationships. Interestingly, we found that cultural factors were only associated with giving cancer risk information and not with generally talking to mothers about family health history or actively collecting information from parents. Specifically, Latino young adults who reported being connected to their cultural group and more religious were more likely to share cancer risk information with their parents. These findings are consistent with other literature that demonstrates the protective effect of Latino orientation and religiosity on health behaviors within the Latino community (e.g., Abraído-Lanza et al., 2006). However, these results also highlight a potentially important distinction in family communication within Latino families. To actively collect information, Latino young adults would likely have to ask their parents potentially sensitive questions about their own health or their family’s health. This type of question asking from child to parent may go against cultural scripts for family relationships. In contrast, sharing information may not require much question asking and may fit better with cultural scripts for parent–child relationships and also the cultural value of familismo that may suggest family members want to promote other family member’s well-being. Thus, interventions that attempt to capitalize on young adult discussions as a way of motivating health behavior changes in themselves and their families may need to find culturally appropriate ways to help them collect information from their parents.

It is also possible that the younger age of this sample (compared with other samples focused on general populations) affected the rates of actively collecting and giving information to parents. In fact, we found that as age increased, participants were more likely to report collecting information about cancer from family members. Perhaps as Latino young adults (and their parents) get older, actively collecting and giving this information to their parents becomes more relevant.

Finally, it is evident that the wording of the questions used in this study could have affected participant responses given cultural norms. The wording of the questions also makes it less clear who initiated discussions. For example, “actively collecting” information implies that the Latino young adult likely took an approach that included asking questions. In contrast, talking generally to one’s mother about family health history could be answered positively if the young adult initiated much of the conversation or if the mother was sharing information. Thus, future research should examine family communication from the perspective of multiple family members to better understand the flow of information regarding family health history (e.g., parent–child, child–parent) and whether promoting communication from young adults to parents may affect parent behavior (Mosavel, Simon, & Van Stade, 2006). Better understanding the process of family communication is needed to inform family health history interventions.

We also found that cancer worry was significantly associated with Latino young adults’ collecting cancer information from parents. Other literature has demonstrated the motivating effect that cancer worry has on preventive behaviors and family communication. For example, a meta-analysis of 12 prospective studies made a compelling argument for a significant association between breast cancer worry and screening practices (i.e., mammography or breast self-exam), in that higher levels of cancer worry were related to appropriate screening adherence (Hay, McCaul, & Magnan, 2006). In addition, Sinicrope et al. (2008) found that a higher degree of breast cancer worry/concern was associated with the provision of breast cancer prevention advice from mothers to their daughters. Although we have learned that cancer worry is related to preventive behaviors and family communication, we have less information about factors that may mediate or moderate this relationship, highlighting an area for future research. For example, do family structure variables (e.g., cohesion, flexibility) or screening intentions mediate or moderate the relationship between cancer worry and family health history discussions?

Although the results of this study contribute to the growing literature on communication about family health history, there are some limitations. First, we were unable to control for whether participants’ had a family history of cancer, yet some research has shown that communication about family health history is positively associated with family history of cancer (Sinicrope et al., 2008). How family history of cancer affects Latino young adult discussions with their parents is less known. Second, this was a convenience sample of English-speaking, predominately female Latino young adults. We did not collect data from Spanish-speaking Latinos, older adults, or Latinos with lower levels of education, thereby limiting the generalizability of the results. It is possible that the rates of family health history discussions may be lower if Spanish-speaking or immigrant Latinos were included in the sample since their family may not be living nearby making family discussions more difficult. In addition, since cancer screenings may not be something young adults typically have to engage in, it is likely that rates of family communication and the factors that predict communication may differ in a sample of older individuals. Also, although women tend to be the kin keepers in their families, obtaining more information about discussions with fathers and between mothers and sons is important for prevention efforts. Finally, we asked participants about their discussions with their parents but did not explore whether they spoke with other family members (e.g., cousins) about their health nor did we collect information about communication from the perspective of parents or other family members. Given the role of the extended family in Latino culture, it is likely that communication about health issues and family health history may extend beyond the nuclear family.

Despite these limitations, the results of the current study have potential intervention implications. Together, these findings highlight a need for prevention programs that can help move general family discussions about family history of cancer (e.g., “Uncle Tito has cancer”) to more specific discussions about cancer family health history (e.g., “Uncle Tito has colon cancer and he was diagnosed when he was 33 years old”). Increasing Latino young adults’ awareness of the publicly available tools for collecting family health history (https://familyhistory.hhs.gov/) may help facilitate family history discussions. Another potential method to improve family history communication among Latino young adults may be to simply help identify a “kin keeper” within their own families. Kin keepers include family members actively involved in communication and retention of familial health information as well as preserving family traditions and identity. They are typically female relatives, and there may be more than one in each family (Koehly et al., 2009; Nycum, Avard, & Knoppers, 2009; Wiseman, Dancyger, & Michie, 2010). Moreover, programs that encourage Latino young adults, especially Latinas, to serve as kin keepers for their family could have beneficial outcomes for the Latino young adults’ own lifestyle behaviors (e.g., physical activity and substance use) while at the same time influencing screening adherence among their parents and other older family members. Researchers have found that family communication (e.g., encouragement, advice) is related to cancer screening behaviors (Ersig et al., 2009; Sinicrope et al., 2008), and some work has highlighted the beneficial effect of adolescent-to-parent health discussions on family health (Mosavel et al., 2006). Finally, interventions may need to be culturally tailored, given the potentially sensitive nature of the topics being discussed and the potential effect that adolescent-to-parent discussions can have on family relationships. In sum, researchers should examine the content of family discussions, timing of discussions, frequency, and the style of communication from the perspective of multiple Latino family members so that appropriate intervention strategies can be developed.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by an Institutional Research Grant IRG-73-001-34 from the American Cancer Society to Dr. Corona.

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