Is there a space for place in family history assessment? Underserved community views on the impact of neighborhood factors on health and prevention.

Family health history tools rarely incorporate environmental and neighborhood factors, although the social and physical environments in which people live are recognized as major contributors to chronic diseases. This paper discusses beliefs about neighborhood influences on chronic disease risk among racially and ethnically diverse individuals in low-income communities in Cleveland, Ohio. We report findings from a qualitative study consisting of 121 interviews with White, African American, and Hispanic participants. Results are organized into four major themes: (1) social and economic environment, (2) physical environment, (3) barriers to healthy behaviors, and (4) participants' views on integrating genetic and non-genetic determinants of health to understand and address disease prevention and management. Findings suggest that integrating environmental factors into family health history assessments would better reflect lay perceptions of disease causation. Results have implications for improving patient-clinician communication and the development of strategies to prevent and manage chronic diseases.