_____________________________________________________________________________________________________________
Fam Proc 31:197-199, 1992
Editorial: The California Family Health Project In this issue, we begin the publication of a series of reports from the California Family Health Project, an ambitious study that examines the interrelationships between structural and behavioral characteristics of families, on the one hand, and the health status of individuals within these families, on the other hand. Aditional articles will be appearing in the next two issues of the journal. In all, the series will include a total of seven articles. A growing body of literature dating back over three decades has suggested that family factors may play an important role in the onset and clinical course of a wide variety of medical and psychiatric conditions. But for most of these studies, family variables have been only a small part of a larger research agenda and, hence, have been addressed at a relatively superficial level. In the California Family Health Project, two distinguished family researchers, Lawrence Fisher and Donald Ransom, and their colleagues, have designed a study that places the family at the forefront of interest. A total of 225 families living in a central California community were randomly identified and recruited for participation in the study. The members of these families filled out a mountain of questionnaires, engaged in family tasks, and solved problems together. They told the researchers about their views of the world, about their priorities and ambitions, about their perceptions of family life, about their attitudes toward health, about their health behaviors (for example, smoking and alcohol use), and about their physical and emotional aches and pains. Out of the mounds and mounds of data that emerged from the study, the investigators then carried out a complex series of multivariate statistical analyses designed to identify a series of key dimensions of family behavior that might correlate with the health status of the individuals in these families. In these reports, they will be walking us through this processfirst describing the overall strategy of the study, then examining the major findings for each of the facets of family behavior, and finally discussing the implications of the relationship patterns (between family and health parameters) that emerged from the study. These will be a tough and challenging series of articles to read. The researchers have taken on a formidable taskto look at a broad range of family and health variables in the same study. Further, because they have looked at a community sample of families, the relationships they seek are often "buried" in a structure that by and large looks relatively healthy. That is, they have not attempted to load things in their favor by looking at families in which medical or psychiatric problems have already emerged. But they also have gained much from this strategy. Research that examines health problems after the fact (once the illness is already present) is rarely able to tell us whether patterns seen in such families are there because the illness is also present and has laid the family low, or if these patterns were antecedent factors that made the families vulnerable to the full-blown emergence of the health condition being investigated. With a community sample, one is able to see more clearly not only the broad-brush patterns of relationships between family and health parameters; one is also able to delineate more clearly what family factors seem to strengthen resistance to disease (resiliency factors), and which ones seem helpful in attenuating the effects of illness once it emerges. These data, in turn, might be thought of as the first step in exploring prevention programs focusing on family health issues. For if we can point to specific factors that have resiliency potential for families and their members, and others that seem to place individuals at risk to develop physical illness, then service delivery can be far more effectively targeted. For example, establishing linkages between family world views, family health attitudes, and individual health behaviors and health status may provide interesting clues as to how family-focused prevention programs might influence health-promoting behavior at the level of the individual. These articles will make for challenging reading because the conclusions they arrive at are not simple and straightforward. These are not conclusions that can be easily reduced to a few succinct "bullets" in an opening summary. Instead, what emerges from the study is a complex mosaic of relationships suggesting not only that health status is itself a multidimensional construct, but also that the influence of family variables on health status may be differentially experienced by different family members (that is, a family-level pattern that works well for one family member may not serve another family member well at all). As you will see in the unfolding series of reports from this project, the investigators have done an admirable job of digesting the multitude of findings from their study and presenting us with a credible "road map" for understanding how the findings might fit together. However, it is important to remember that theirs is only one possible explanation for how this "world" of data might be patterned. That is, despite the wealth of data already collected, we are still at the stage of hypothesis generation about these variables and their interrelationships. In an ideal situation, a reasonable next step might be an attempt at replication of the Project's findings, perhaps using a more diverse community sample to test the generalizability of findings. But the fact is that ambitious studies like the
1
_____________________________________________________________________________________________________________
California Family Health Project are rarely replicated. They are simply too costly and time-consuming to be repeated the same way with a second sample of families. Yet it is probably fair to say that if such a replication were undertaken, it is unlikely that exactly the same pattern of family/health status findings would emergeespecially given the heavy reliance here on complex multivariate statistical procedures. Why then devote this degree of energy to such studies? Basically for two reasons. The first is that the study can be thought of as making major contributions to our understanding of those domains of family life that are relevant to the field of health psychology. The second is that the study points us toward specific interrelationships that may have the highest yield in more narrowly defined questions about family and health, questions that would then be more appealing to the next round of researchers and clinicians because the initial territory has already been mapped for us. As one example, my own guess is that one of the "maps" that is likely to survive second and third looks is the notion that family attitudinal domains may mean more in the long run than actual family behaviors in determining the relative risk versus resiliency of family members to medical and psychiatric illness. And if this proves so, it would provide powerful support for a redirecting of health care strategies aimed not only toward prevention, but also toward a greater emphasis on psychosocially oriented programs addressed at families and their health attitudes. So dig in, find what you will, and allow yourself to challenge and be challenged by this ambitious set of articles. Peter Steinglass, Editor
2
Fam Proc 31:197-199, 1992
Editorial: The California Family Health Project In this issue, we begin the publication of a series of reports from the California Family Health Project, an ambitious study that examines the interrelationships between structural and behavioral characteristics of families, on the one hand, and the health status of individuals within these families, on the other hand. Aditional articles will be appearing in the next two issues of the journal. In all, the series will include a total of seven articles. A growing body of literature dating back over three decades has suggested that family factors may play an important role in the onset and clinical course of a wide variety of medical and psychiatric conditions. But for most of these studies, family variables have been only a small part of a larger research agenda and, hence, have been addressed at a relatively superficial level. In the California Family Health Project, two distinguished family researchers, Lawrence Fisher and Donald Ransom, and their colleagues, have designed a study that places the family at the forefront of interest. A total of 225 families living in a central California community were randomly identified and recruited for participation in the study. The members of these families filled out a mountain of questionnaires, engaged in family tasks, and solved problems together. They told the researchers about their views of the world, about their priorities and ambitions, about their perceptions of family life, about their attitudes toward health, about their health behaviors (for example, smoking and alcohol use), and about their physical and emotional aches and pains. Out of the mounds and mounds of data that emerged from the study, the investigators then carried out a complex series of multivariate statistical analyses designed to identify a series of key dimensions of family behavior that might correlate with the health status of the individuals in these families. In these reports, they will be walking us through this processfirst describing the overall strategy of the study, then examining the major findings for each of the facets of family behavior, and finally discussing the implications of the relationship patterns (between family and health parameters) that emerged from the study. These will be a tough and challenging series of articles to read. The researchers have taken on a formidable taskto look at a broad range of family and health variables in the same study. Further, because they have looked at a community sample of families, the relationships they seek are often "buried" in a structure that by and large looks relatively healthy. That is, they have not attempted to load things in their favor by looking at families in which medical or psychiatric problems have already emerged. But they also have gained much from this strategy. Research that examines health problems after the fact (once the illness is already present) is rarely able to tell us whether patterns seen in such families are there because the illness is also present and has laid the family low, or if these patterns were antecedent factors that made the families vulnerable to the full-blown emergence of the health condition being investigated. With a community sample, one is able to see more clearly not only the broad-brush patterns of relationships between family and health parameters; one is also able to delineate more clearly what family factors seem to strengthen resistance to disease (resiliency factors), and which ones seem helpful in attenuating the effects of illness once it emerges. These data, in turn, might be thought of as the first step in exploring prevention programs focusing on family health issues. For if we can point to specific factors that have resiliency potential for families and their members, and others that seem to place individuals at risk to develop physical illness, then service delivery can be far more effectively targeted. For example, establishing linkages between family world views, family health attitudes, and individual health behaviors and health status may provide interesting clues as to how family-focused prevention programs might influence health-promoting behavior at the level of the individual. These articles will make for challenging reading because the conclusions they arrive at are not simple and straightforward. These are not conclusions that can be easily reduced to a few succinct "bullets" in an opening summary. Instead, what emerges from the study is a complex mosaic of relationships suggesting not only that health status is itself a multidimensional construct, but also that the influence of family variables on health status may be differentially experienced by different family members (that is, a family-level pattern that works well for one family member may not serve another family member well at all). As you will see in the unfolding series of reports from this project, the investigators have done an admirable job of digesting the multitude of findings from their study and presenting us with a credible "road map" for understanding how the findings might fit together. However, it is important to remember that theirs is only one possible explanation for how this "world" of data might be patterned. That is, despite the wealth of data already collected, we are still at the stage of hypothesis generation about these variables and their interrelationships. In an ideal situation, a reasonable next step might be an attempt at replication of the Project's findings, perhaps using a more diverse community sample to test the generalizability of findings. But the fact is that ambitious studies like the
1
_____________________________________________________________________________________________________________
California Family Health Project are rarely replicated. They are simply too costly and time-consuming to be repeated the same way with a second sample of families. Yet it is probably fair to say that if such a replication were undertaken, it is unlikely that exactly the same pattern of family/health status findings would emergeespecially given the heavy reliance here on complex multivariate statistical procedures. Why then devote this degree of energy to such studies? Basically for two reasons. The first is that the study can be thought of as making major contributions to our understanding of those domains of family life that are relevant to the field of health psychology. The second is that the study points us toward specific interrelationships that may have the highest yield in more narrowly defined questions about family and health, questions that would then be more appealing to the next round of researchers and clinicians because the initial territory has already been mapped for us. As one example, my own guess is that one of the "maps" that is likely to survive second and third looks is the notion that family attitudinal domains may mean more in the long run than actual family behaviors in determining the relative risk versus resiliency of family members to medical and psychiatric illness. And if this proves so, it would provide powerful support for a redirecting of health care strategies aimed not only toward prevention, but also toward a greater emphasis on psychosocially oriented programs addressed at families and their health attitudes. So dig in, find what you will, and allow yourself to challenge and be challenged by this ambitious set of articles. Peter Steinglass, Editor
2
