Human genes and race in the age of "The X-Files".

Abstract: The purpose of this study was to determine if African Americans have a more negative attitude toward genetic testing and engage in more media behaviors than European Americans. The results reveal no effect for race, thus suggesting a more general approach to the genetic counseling experience. Media use, however, yielded statistically significant findings, such that individuals who regularly read the newspaper and science fiction books possess a more deterministic attitude about genetics and a more positive attitude toward genetic counseling in general. In general, participants held strong positive beliefs regarding genetic testing. Given the AA legacy associated with medical research in the U.S. and associated distrust of the medical system, AA participants 'positive views may denote cautious optimism regarding equity in access to benefits relating to genetic testing. It should also be noted at the same time, however, that AAs differed in their use of many media associated with genetic health information from EAs, including movies, talk shows, crime and drama shows, and science fiction shows. This may suggest that AAs more often rely on such media to bridge gaps in the availability and use of formal health information about these issues.

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The mapping of the human genome has ushered in an age of genomic health care in which knowledge about the role of genes in health is in transition from a focus on single gene diseases to diseases with multiple genetic links, including cancer and heart disease. The media in all its varied forms have covered this revolution. The current study considers the possible influence of media use on attitudes toward genetic testing. Participants (N = 717) expressed moderate to strong levels of agreement regarding the efficacy of genetic testing. Participants who self-designated race as African American (n = 273) were often more likely than participants who self-designated race as European American (n = 470) to use media in ways that exposed them to information about genetics and health. This included watching movies that show how genes affect human health or the environment harms human genes. It also included watching talk shows that discuss the effects of genes on human health or how the environment harms human genes or how people's behaviors affect what genes do, science fiction shows such as X-Files that talk about human genetics, and criminal and drama shows such as Law & Order. Finally, these media use difference patterns were observed regarding reading science fiction books that talk about human genetics and newspaper articles that discuss the effects of genes on human health, with the latter more often engaged in by European Americans. Implications for studies of health in the US are discussed.

MEDIA EXPOSURE AND PERCEPTIONS OF GENETIC TESTING

The salience of heredity in health may increase when people can identify with a specific population portrayed in the media. As geneticists and health practitioners learn more about how different diseases and illnesses relate to genetics, the public is presented with information that stresses the importance of how genes and health are interrelated (Henderson & Kitzinger, 1999). More importantly, they are challenged to understand how their own medical and family histories can affect their present and future health status (Foxall, Barren, & Houfek, 1998). Becoming better informed about genetics is a difficult process for most (Jallinoja & Aro, 2000). While current medical developments in human genetic research (HGR) saturate newspapers, television, and the Internet, the medical community has become increasingly concerned with how health practitioners can bridge the knowledge gap for the public regarding the topic of human genetics and health (D'Espiro, 1998).

Media scholars have long acknowledged that media use satisfies various needs, with the two broadest categories comprised of instrumental, goal-directed, relating to learning and seeking behavioral guidance, versus habitual, relating to entertainment and relaxation (Swanson, 1987). For individuals with limited knowledge, genetic information and the prospect of genetic testing can be quite daunting. Thus, they may seek to increase their use of the media in order to make informed health decisions. Increased media use allows the lay public to gather important and accurate information from the health community that clearly explains current developments in human genetic research. As an extension, lay individuals can choose from several different forms of media they perceive will most effectively meet their individual needs. Essentially, they are able to seek sources that fulfill their specific need for health information not offered by other resources.

Research supports the argument that this is a complex process, particularly for members of different racial groups (Culver, Burke, Yasui, Durfy, & Press, 2001; Kinney, Croyle, Dudley, Bailey; Pelias, & Neuhausen, 2001; Well, 2001). As a member of a racial group predisposed to a given disease, racial minorities face the task of understanding the relationship between genes, health, and race. Racial groups must seek information about the relationship between genes and health as well as their susceptibility to disease because of their racial group membership. Information seeking strategies may include, but are not limited to, increased use of the media. Social science research has found that AAs watch more television, movies, crime dramas, and talk shows (Tucker, 1997) than other racial groups. Therefore, the possibility exists that AAs may report more exposure to media with content pertaining to genetics.

The reality that many media forms, including television and movies, designed to entertain now contain content relating to DNA, genes, and human characteristics points to the potential for impact in this arena based on both instrumental and habitual media use. To better educate the general public in these areas, health practitioners must explore the underlying factors that contribute to how the lay public understands human genetics. The current study considers the possible influence of media use on attitudes toward genetic testing.

METHOD

RESPONDENTS

Participants for this project (N = 717) were part of a larger study (Parrott, Silk, Weiner, Condit, Harris, & Bernhardt, 2004). The focus of this study was to assess public knowledge, attitudes, and behavior regarding human genetics research. Data were collected in community-based settings in four geographic locations and via an online survey. The geographic locations included: (a) a southeastern town located near a large land grant university; (b) a southeastern, metropolitan city; (c) a northeastern town located near a large state university; and (d) a northeastern, metropolitan city. Southern participants comprised 65.7% of the sample (n = 471) and northern participants comprised 27.3% of the sample (n = 195). Regarding geographic location, we purposed to use northern and southern locations because of the historic differences between these regions of the nation. One method without geographic specificity was an on-line version of the survey (n = 51), which accounted for 7.1% of the data collected. At the southeastern locations, researchers collected data at a health fair, restaurants, churches, retailers, barbershops, beauty parlors, an airport, laundromats, and the university. At the northeastern locations, researchers collected data at a train station, bus station, outlet mall, and business office as well as at a large, land grant university. The goal was to obtain an economically, racially, and educationally diverse sample approximating the characteristics of the communities represented. For more detail on formative research, instrument development, and cluster analysis, please see the article by Parrott et. al. (2004), specifically pages 108-111.

Participants included 132 black males, 135 black females, 155 white males, and 295 white females. In order to have a sufficient cultural specificity, we chose to purposely diversify our advisory boards and representative samples by recruiting participants from the two largest cultural groups in the area (e.g., African Americans and European Americans). Twenty-six participants did not report their sex and therefore, were excluded from analyses. Ages of participants ranged from 18 to 73 years of age (M = 29.28); SD = 10.18). Education levels varied from less than high school (3%), high school diploma (17.3%), some college (26.9%), college degree (30.5%), vo-tech degree (4.3%) to advanced degrees (18%). Most participants had not taken a genetics course in college (86.8%). The majority (63.6%) of the participants did not have children, 24.2% had either one or two children, while 12.1% of the sample had three or more children. In addition, 87.9% of the sample had health insurance (see Table 1). Preliminary research has shown participants from different age cohorts (younger and older) are more likely to represent differing opinions on various social issues; thus, our target population was 18 to 45 year olds. Efforts were made during recruitment to have an educationally diverse sample. As the results indicate, however, approximately 76% of participants had some education beyond high school. Thus, given the participants' relatively young age and level of education, they may be more interested in and actually use different types of media as an educational resource than would older individuals and those with less education.

INSTRUMENTS

Participants were asked to complete a survey instrument that included a series of questions about genetics research and demographic information. The survey instrument contained two items that measured attitudes about genetic testing and perceived likelihood of developing a disease and the identification of effective treatments. Respondents were asked to rate the following statements on a Likert-type scale (1 = strongly disagree, 5 = strongly agree): (a) genetic testing helps identify how likely you are to get a disease, and (b) genetic testing identifies which treatments will work best.

In addition to the assessment of attitudes about genetic testing, eleven items measured media exposure. These items specifically asked participants to report to what degree they have been exposed to television programs (e.g., "I watch science fiction shows [e.g., X-Files] that talk about human genetics"), films (e.g., "I watch movies that show how the environment harms human genes"), newspapers (e.g., "I read newspaper articles that discuss the effects of genes on human health"), and books (e.g., "I read science fiction books that talk about human genetics") that contain genetic information relative to health, behavior, and the environment. Survey items were rated on a Likert-type scale (1 = never, 5 = always).

RESULTS

The Statistical Package for the Social Sciences (SPSS) version 10.1 was used to conduct all analyses. Independent t-tests were conducted to examine whether differences existed between African Americans (AA) and European Americans (EA) on the two genetic testing items (i.e., "genetic testing helps to identify how likely you to get a disease" and "genetic testing identifies which treatments will work best") and the 11 media items. Additionally, all cases were converted to z-scores, standardizing the values for comparison. The tests showed no statistically significant mean differences between AA and EA perceptions regarding the two genetic testing items. Both groups were in agreement that testing helps to identify how likely one is to get a disease, while both groups ranged between neutral and agree with regard to attitudes about whether genetic testing is efficacious in identifying treatments. There were statistically significant mean differences for AAs and EAs on nine of the eleven media use items. More specifically, for the item "I watch movies that show how genes affect human health," AAs scored higher than EAs, indicating that AAs watch movies relating to this topic more than EAs. The same pattern emerged for the following items: "I watch movies that show the how the environment harms human genes," "I see talk shows that discuss the effects of genes on human health," "I see talk shows that discuss how the environment harms human genes," "I see talk shows that discuss how people's behaviors affect what their genes do," "I watch science fiction shows that talk about human genetics," "I read science fiction books that talk about human genetics," and "I watch crime drama shows on television." The means reveal that there is awareness of media use aligned with genetic information, but that this use occurs "seldom" or "sometimes" rather than "frequently," suggesting that respondents have great latitude for increasing exposure in the future.

Descriptive statistics provide additional information regarding the mean differences between AAs and EAs on these items. For example, 45.5% of EAs, compared to 38.1% of AAs say they never watch movies that show how genes affect human health. In terms of talk shows, a similar pattern emerged. Results reveal that AAs tend to watch talk shows that discuss genetics more than EAs. For example, 47% of EAs compared to 36.3% of AAs say they neverwatch movies that show how genes affect human health; 80.4% of EAs compared to 64.5% of AAs indicate they never or seldom watch talk shows that discuss how the environment harms human genes; and 84.3% of EAs compared to 71.8% of AAs indicate they never or seldom watch talk shows that discuss how people's behaviors affect what their genes do. Even though a greater percentage of EAs watch less (i.e., talk shows) compared to AAs, results reveal that both racial groups tend to watch very little (i.e., greatest percentages in the never and seldom response categories). In terms of viewing television crime drama programs, a greater percentage of AAs (61.9%) indicated they sometimes or frequently watched such shows, compared to EAs (50%).

The science fiction media items also yielded statistically significant differences between AAs and EAs. A greater percentage of EAs (81.3%) indicated that they never or seldom read science fiction books that talk about human genetics, compared to AAs (77.7%). In terms of viewing science fiction televisions shows that talk about human genetics, a similar trend was apparent. That is, 61.5% of EAs indicated they never or seldom watch science fictions shows that talk about human genetics, compared to 56.8% of AAs. It is interesting to note that there are statistically significant differences between AAs and EAs on these two items for this particular content area (i.e., science fiction), even though these two items tap different types of mediums (i.e., print and television).

To further examine the relationship of media exposure on attitudes toward genetic testing, separate regression models were conducted for each of the dependent variables. The first regression model (see Table 2) contained the dependent variable "Genetic testing helps to identify how likely you are to get a disease," with the eleven media items entered as a block. Three media exposure items--reading science fiction books that talk about human genetics, reading newspapers that discuss how the environment harms human genes, and reading newspapers articles that discuss the effects of genes on human health--emerged as statistically significant predictors of attitudes toward genetic testing (overall F(11,705) = 2.10, p = .02, adjusted [R.sup.2] = .03) and its utility in identifying the likelihood of getting a disease. More specifically, in terms of variance accounted for, exposure to newspaper articles about the effects of genes on human health was the strongest predictor in terms of the belief that genetic testing identifying likelihood of getting a disease. The other two items indicated a negative relationship with the dependent variable, which means participants who read science fiction books that talk about human genetics and read newspaper articles that discuss how the environment harms human genes are less likely to believe that genetic testing helps identify likelihood of developing a disease.

The second regression model contained the dependent variable "Genetic testing identifies which treatments will work best," with the eleven media items entered as a block. The overall model was not statistically significant (F(11,705) = 1.49, p =. 15, adjusted [R.sup.2] = .007); none of the media exposure variables were statistically significant predictors for the item "Genetic testing identifies which treatments will work best."

DISCUSSION

As the science related to the role of genes for human health increases, the American public's awareness of and benefit from this knowledge may often depend upon media use. Despite the lack of research measuring how audiences use the media to access genetic information, it is quite possible that society is becoming increasingly dependent on the media to gain a full sense of what the societal implications are for the Human Genome Project. The current findings revealed that reading science fiction books that talk about human genetics and/or newspaper articles that discuss how the environment harms human genes negatively related to belief that genetic testing helps to identify the likelihood of getting a disease. Reading newspaper articles that discuss effects of genes on human health, on the other hand, positively impacted efficacy perceptions.

In general, participants held strong positive beliefs regarding genetic testing. This represents both hope and a dilemma for American health care, as the expectations that citizens hold may far outdistance the available technology, driving consumer satisfaction in a negative direction based on false assumptions. On the other hand, the availability of testing is associated with hope that individuals can maintain control over their health status.

The lack of differences between AAs and EAs regarding belief in genetic testing's efficacy is noteworthy as well. Given the AA legacy associated with medical research in the U.S. and associated distrust of the medical system, AA participants' positive views may denote cautious optimism regarding equity in access to benefits relating to genetic testing. It should also be noted at the same time, however, that AAs differed in their use of many media associated with genetic health information from EAs, including movies, talk shows, crime and drama shows, and science fiction shows. This may suggest that AAs more often rely on such media to bridge gaps in the availability and use of formal health information about these issues. Scholars have found that television in particular is a socializing agent that provides a mental framework for understanding the world in which we live (Woo & Dominick, 2001). By sharing information with mass audiences about local, national, and international events, television contributes to understanding and knowledge of the world (Brosius & Kepplinger, 1990) and creates a sense of what is normative and expected (Morton & Duck, 2001).

Burne (2001) posits that authors are able to break down the complexities of genetics by using fictional characters and events to demonstrate how genetic research affects our health, science, technology, and the environment. While some stories are unrealistic in nature, readers are informed about a topic that may be difficult to comprehend in other forms or that some individuals have fewer opportunities to be exposed to in other forms, such as interaction with physicians. To date, scant research has been conducted on if and how media motivate patients to address particular health issues with health care professionals. Based on our findings, it seems probable that health care practitioners ranging from primary care practice to specialists in genetic counseling settings are interacting with clients whose media use possibly affects their knowledge and understanding of genetic health. The recent trend in television programming reflects a public interest in these developments (e.g. The X-Files, CSI: Crime Scene Investigators). Although participants did not share program names of shows that addressed genetics, their responses may reflect television programming trends by network (ABC, CBS, and NBC) and cable television executives (TLC, CourtTV,, Discovery Channel) created to reflect the audience's growing interest in forensic science (cf. Adams, 2000). Such programs entertain as well as educate audiences about the complex nature of human genes and their impact on the lay public. Strategic health communication efforts designed with regard to genetics and health should factor in beliefs conveyed by popular media, perhaps offering a bit of realism into the optimistic forecast while sustaining support for medical research and its hope for the future.

CHES AREA

Responsibility X-Advancing the Profession of Health Education

REFERENCES

Adams, W. J. (2000, Winter). How people watch television as investigated using focus group techniques. Journal of Broadcasting and Electronic Media, 44, 78-93.

Brosius, H. B., & Kepplinger, H. M. (1990). The agenda-setting function of television news: Static and dynamic views (n1). Communication Research, 17, 183-212.

Burne, J. (2001). The most wondrous map ever made: Why don't books about the human genome project ask awkward questions? Financial Times, p. 4.

Culver, J., Burke, W., Yasui, Y., Durfy, S., & Press, N. (2001). Participation in breast cancer genetic counseling: The influence of educational level, ethnic background, and risk perception. Journal of Genetic Counseling, 10, 215-231.

D'Espiro, N. W. (1998). Mapping the human genome: Progress and promise. Patient Care, 32, 118-136.

Daniel, D. M., Lackland, D.T., Baron, L. F., Nixon, D. W., Garr, D. R., Gross, A. J., et al. (1995). Comparison of white and African-American barriers to mammography: A need for a barrier-specific approach to care. Cancer Prevention International, 2, 3-21.

Elliott, W. R., & Rosenberg, W. L. (1987). Media exposure and beliefs about science and technology. Communication Research, 14, 164-188.

Foxall, M. J., Barren, C. R., & Houfek, J. (1998). Ethnic differences in breast self-examination practice and health beliefs. Journal of Advanced Nursing, 27, 419-429.

Henderson, L., & Kitzinger, J (1999). The human drama of genes: Media representations of inherited breast cancer. Sociology of Health and Illness, 21, 560-578.

Jallinoja, P., & Aro, A. R. (2000). Does knowledge make a difference? The association between knowledge and genes and attitudes toward gene tests. Journal of Health Communication, 5, 29-39.

Kinney, A. Y., Croyle, R.T., Dudley, W. N., Bailey, C. A., Pelias, M. K., & Neuhausen, S. L. (2001). Knowledge, attitudes, and interest in breast-ovarian cancer gene testing: A survey of a large African-American kindred with a BRCA1 mutation. Preventive Medicine, 33, 543-551.

Morton, T. A., & Duck, J. M. (2001). Communication and health beliefs: Mass and interpersonal influences on perceptions of risk to self and others. Communication Research, 28, 602-625.

Parrott, R., Silk, K., Weiner, J., Condit, C., Harris, T. M., & Bernhardt, J. (2004). Deriving lay models of uncertainty about genes' role in illness causation to guide communication about human genetics. Journal of Communication, 54, 107-122.

Swanson, D. L. (1987). Gratification seeking, media exposure, and audience interpretations: Some directions or research. Journal of Broadcasting and Electronic Media, 31, 237-254.

Tucker, L. R. (1997). Was the revolution televised? Professional criticism about "The Cosby Show" and the essentialization of black cultural expression. Journal of Broadcasting and Electronic Media, 41, 90-108.

Weil, J. (2001). Multicultural education and genetic counseling. Clinical Genetics, 59, 143-149.

Tina M. Harris, PhD, is affiliated with the Department of Speech Communication at the University of Georgia. Judith Weiner, PhD, is affiliated with the Annenberg School for Communication at the University of Pennsylvania and Roxanne Parrott, PhD, is affiliated with the Department of Communication and Arts and Sciences at Pennsylvania State University. Address all Correspondence to Tina M. Harris, 128 Terrell Hall, Athens, GA 30602; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Demographic Information for African and European Americans

                      African Americans      European Americans

                      Males      Females      Males      Females
                    (n = 132)   (n = 135)   (n = 155)   (n = 295)

Educational Level
  Less than HS           6           6           1           8
  HS diploma            38          32          13          38
  Some college          22          25          47          94
  College degree        23          41          64          85
  Vo-tech degree        11           8           4           7
  Advanced degree       20          20          25          61
College course in
    genetics
  Yes                   17          18          18          39
  No                   109         112         134         249
Children
  None                  61          57         118         210
  One to Two            42          53          24          51
  Three or more         22          24          12          27
Health Insurance
  Yes                  104         115         136         269
  No                    26          20          18          22

Table 2. Means, Standard Deviations, and Z-Scores for African and
European Americans

                                        African         European
Dependent Variables                    Americansn      Americansn

                                         (N=267)         (N=450)

                                       M      (SD)     M      (SD)

Genetic testing helps to identify
  how likely you are to get a
  disease.                            3.78    (.97)   3.87    (.77)
Genetic testing identifies which
  treatments will work best.          3.39   (1.00)   3.35    (.81)
Media Items
I watch M that show how genes
  affect human health.                2.02   (1.00)   1.81    (.86)
I watch M that show how the
  environment harms human genes.      2.23   (1.05)   1.86    (.84)
I see TS that discuss the effects
  of genes on human health.           2.07   (1.01)   1.75    (.82)
I see TS that discuss how the
  environment harms human genes.      2.10   (1.03)   1.72    (.80)
I see TS that discuss how people's
  behaviors affect what their
  genes do.                           1.95    (.97)   1.60    (.80)
I watch SFS [e.g., X-Files] that
  talk about human genetics.          2.38   (1.14)   2.17   (1.08)
I read SFB that talk about human
  genetics.                           1.77    (.94)   1.61    (.88)
I read NP articles that discuss the
  effects of genes on human health.   2.18   (1.06)   2.33    (.96)
I read NP articles that discuss how
  the environment harms human
  genes.                              2.25   (1.00)   2.22    (.95)
I watch MDS on television
  [e.g., E.R.].                       2.86   (1.15)   2.85   (1.19)
I watch CDS on television
  [e.g., Law & Order].                3.06   (1.14)   2.80   (1.24)

Dependent Variables                      Converted to Z-scores

                                        t      p      F      p

Genetic testing helps to identify
  how likely you are to get a
  disease.                            -1.26   .21    1.77    .18
Genetic testing identifies which
  treatments will work best.            .59   .55     .39    .53
Media Items
I watch M that show how genes
  affect human health.                 3.04   .00    9.27   .002
I watch M that show how the
  environment harms human genes.       4.97   .00   27.63   .000
I see TS that discuss the effects
  of genes on human health.            4.36   .00   21.19   .000
I see TS that discuss how the
  environment harms human genes.       5.23   .00   31.04   .000
I see TS that discuss how people's
  behaviors affect what their
  genes do.                            5.06   .00   28.15   .000
I watch SFS [e.g., X-Files] that
  talk about human genetics.           2.48   .01    6.13   .013
I read SFB that talk about human
  genetics.                            2.30   .02    5.30   .022
I read NP articles that discuss the
  effects of genes on human health.   -1.97   .05    3.89   .049
I read NP articles that discuss how
  the environment harms human
  genes.                                .36   .71     .13   .717
I watch MDS on television
  [e.g., E.R.].                         .07   .94     .01   .942
I watch CDS on television
  [e.g., Law & Order].                 2.88   .01    7.97   .005

Note. M = movies; TS = talk shows; SFS = science fiction shows;
SFB = science fiction books; NP = newspaper; MDS = medical drama
shows; CDS = crime drama shows.

Table 3. Regression of the Three Media Items on "Genetic
testing helps identify likelihood of getting a disease.

Variables            [beta]     t        P       [R.sup.2]     F

                                                   .03 **    2.10 **
I read science
fiction books
that talk about
human genetics.      -.13     -2.73   .006 **

I read NP articles
that discuss the
effects of genes
on human health       .17      2.97   .003 ***

I read NP article
that discuss how
the environment
harms human genes.   -.12     -2.08   .038 *

* p<.05, ** p<.01, *** p<.001