Motivating smoking cessation among dental patients: smokers' interest in biomarker testing for susceptibility to tobacco-related cancers

Genetic feedback for psychiatric conditions: Where are we now and where are we going

Genome-wide association studies are rapidly advancing our understanding of the genetic architecture of complex disorders, including many psychiatric conditions such as major depression, schizophrenia, and substance use disorders. One common goal of genome-wide association studies is to use findings for enhanced clinical prediction in the future, which can aid in identifying at-risk individuals to enable more effective prevention screening and treatment strategies. In order to achieve this goal, we first need to gain a better understanding of the issues surrounding the return of complex genetic results. In this article, we summarize the current literature on: (a) genetic literacy in the general population, (b) the public's interest in receiving genetic test results for psychiatric conditions, (c) how individuals react to and interpret their genotypic information for specific psychiatric conditions, and (d) gaps in our knowledge that will be critical to address as we move toward returning genotypic information for psychiatric conditions in both research and clinical settings. By reviewing extant studies, we aim to increase awareness of the potential benefits and consequences of returning genotypic information for psychiatric conditions.

Promoting Tobacco Abstinence Among Older Adolescents in Dental Clinics

The health care setting, and most notably dental clinics, may hold promise in delivering effective tobacco intervention to adolescents. Adolescents between the ages of 14 and 17 were randomly assigned to brief advice from dental hygienists and dentists only or to brief advice plus a motivational interview and follow-up telephone contact from a study hygienist. Due to difficulties in identifying and recruiting subjects, study goals were expanded from cessation only to cessation and prevention. No differences in smoking prevalence were found between treatment conditions at either 3- or 12-month follow-up. Firm conclusions cannot be drawn about the effectiveness of treatment due both to problems in enrolling subjects and limited implementation of the motivational intervention.

Are smokers interested in genetic testing for smoking addiction? A socio-cognitive approach

Genetic advances have made genetically tailored smoking cessation treatments possible. In this study, we examined whether smokers are interested in undergoing a genetic test to identify their genetic susceptibility to nicotine addiction. In addition, we aimed to identify socio-cognitive determinants of smokers' intention to undergo genetic testing. Following the protection motivation theory (PMT), we assessed the following constructs using an online survey among 587 smokers: threat appraisal (i.e. susceptibility and severity), fear, coping appraisal (i.e. response efficacy and self-efficacy), response costs and intention. In addition, knowledge, social norms and information-seeking behaviour were measured. Mean intention rates were 2.57 on a 5-point scale. Intention was significantly associated with threat appraisal and coping appraisal, as predicted by the PMT. Fear of the outcome was negatively associated with the intention to undergo genetic testing, but response costs, knowledge and social influence were not. Intention to undergo genetic testing in turn was positively related to seeking information about genetic testing and genetically tailored smoking cessation treatments. Smokers seem ambivalent or 'on the fence' with regard to undergoing a genetic test for smoking addiction. Socio-cognitive concepts such as susceptibility, severity, response efficacy and self-efficacy may be used to inform or educate smokers about the value of genetically tailored smoking cessation treatments.

Intentions to participate in genetics research among African American smokers

Although prior studies have shown that African American smokers are likely to carry some of the genetic variants associated with smoking risk, additional research with African American smokers is needed to replicate these findings. Limited information is available on interest in participating in research to identify genetic risk factors for smoking among African American smokers; therefore, the goals of the present study were to describe intentions to participate in smoking and genetics research, and to determine factors that are associated with participation intentions. Subjects were 128 African American male and female adult smokers. Sociodemographic characteristics, clinical factors, attitudes about genetic testing, and intentions to participate in genetics research were evaluated during a structured telephone interview. Overall, 58% of respondents reported that they would be very likely to participate in research to identify genetic risk factors for smoking. Greater beliefs about the benefits of participating in medical research (odds ratio, 3.17; 95% confidence interval, 1.45-6.94; P = 0.004) and fewer perceptions of the limitations and risks of genetic testing (odds ratio, 0.90; 95% confidence interval, 0.82-0.98; P = 0.01) had significant independent associations with reporting a high likelihood of participating in this type of research. Recruitment messages and protocols that address the benefits of research participation, as well as concerns about the limitations and risks of genetic testing, may enhance African American participation in research on genetics and smoking.

Dispositional motivations and genetic risk feedback

This study examined interest in genetic testing for lung cancer susceptibility among college students, a group whose smoking rates have increased significantly in the last decade. Sixteen smokers who participated in focus group discussions indicated a generally high level of interest in testing. They also indicated that knowledge of genetic susceptibility would make them feel anxious and motivate them to quit smoking. The study also examined, in a separate sample of undergraduate smokers (n=186), whether these outcomes depend on personality differences in threat sensitivity-responsiveness of the behavioral inhibition system (BIS)--and reward sensitivity--responsiveness of the behavioral activation system (BAS). Smokers completed measures of personality and risk perceptions at baseline and rated risk perceptions, affect, and likelihood of changing smoking behavior in response to 2 hypothetical risk feedback scenarios (high vs. low risk). Smokers higher in reward sensitivity (reward responsiveness) evidenced greater interest in taking genetic tests. If a test indicated elevated risk smokers higher in reward responsiveness would perceive themselves at increased risk and attempt to quit smoking. Threat sensitive smokers would react with greater negative affect. Overall, results indicate that genetic biomarker feedback is a motivator for college student smokers to quit and would be more effective among smokers high in reward sensitivity.

Risk perception of oral cancer in smokers attending primary care: a randomised controlled trial

To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients' oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.

Are biomarkers a useful aid in smoking cessation? A review and analysis of the literature

Healthcare providers' ability to motivate people to try to quit smoking or to remain abstinent is limited. Even with our best treatments, most smokers relapse within 1 year. Therefore it is important that we constantly strive to develop and test new, effective smoking interventions. Providing feedback on one's biomarkers (e.g., biological indices of smoking-related harm, harm exposure, or genetic susceptibility to disease) have been suggested as potentially useful for increasing smokers' motivation or ability to quit smoking. In fact, variations of this strategy are commonly incorporated into behavioral smoking-cessation interventions, but little empirical evidence has specifically addressed whether this approach is effective. In this article, the author reviews the theoretical rationale and empirical evidence regarding this practice. Although the preliminary evidence is promising, more research is needed to determine the efficacy of using biomarkers and the limits of the strategy's effectiveness. Future investigations should address these issues.