Regional differences in awareness and attitudes regarding genetic testing for disease risk and ancestry Charles R. JonassaintEunice R. SantosCrystal M. Glover • Perry W. PayneGrace-Ann FasayeNefertiti Oji-NjidekaStanley Hooker • Wenndy HernandezMorris W. FosterRick A. KittlesCharmaine D. Royal

Little is known about the lay public's aware- ness and attitudes concerning genetic testing and what factors influence their perspectives. The existing literature focuses mainly on ethnic and socioeconomic differences; however, here we focus on how awareness and attitudes regarding genetic testing differ by geographical regions in the US. We compared awareness and attitudes concerning genetic testing for disease risk and ancestry among 452 adults (41% Black and 67% female) in four major US cities, Norman, OK; Cincinnati, OH; Harlem, NY; and Washington, DC; prior to their participation in genetic ancestry testing. The OK participants reported more detail about their personal ancestries (p = 0.02) and valued ancestry testing over disease testing more than all other sites (p \ 0.01). The NY participants were more likely than other sites to seek genetic testing for disease (p = 0.01) and to see benefit in finding out more about one's ancestry (p = 0.02), while the DC participants reported reading and hearing more about genetic testing for African ancestry than all other sites (p \ 0.01). These site differences were not better accounted for by sex, age, education, self-reported ethnicity, religion, or previous experience with genetic testing/counseling. Regional dif- ferences in awareness and attitudes transcend traditional demographic predictors, such as ethnicity, age and educa- tion. Local sociocultural factors, more than ethnicity and socioeconomic status, may influence the public's aware- ness and belief systems, particularly with respect to genetics. Although the terms 'race' and 'racial' are used in this manuscript, this does not mean that the authors subscribe to the view that the human species substructures into biological races. 'Race' is used because of its common and colloquial (though inappropriate) usage in United States (US) social and government parlance, and its presence in the relevant literature.