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Lee SS, Senft Everson N, Sanderson M, Selove R, Blot WJ, King S, Gilliam K, Kundu S, Steinwandel M, Sternlieb SJ, Cai Q, Warren Andersen S, Friedman DL, Connors Kelly E, Fadden MK, Freiberg MS, Wells QS, Canedo J, Tyndale RF, Young RP, Hopkins RJ, Tindle HA. Feasibility of precision smoking treatment in a low-income community setting: results of a pilot randomized controlled trial in The Southern Community Cohort Study. Addict Sci Clin Pract 2024; 19:16. [PMID: 38491559 PMCID: PMC10941447 DOI: 10.1186/s13722-024-00441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The feasibility of precision smoking treatment in socioeconomically disadvantaged communities has not been studied. METHODS Participants in the Southern Community Cohort Study who smoked daily were invited to join a pilot randomized controlled trial of three smoking cessation interventions: guideline-based care (GBC), GBC plus nicotine metabolism-informed care (MIC), and GBC plus counseling guided by a polygenic risk score (PRS) for lung cancer. Feasibility was assessed by rates of study enrollment, engagement, and retention, targeting > 70% for each. Using logistic regression, we also assessed whether feasibility varied by age, sex, race, income, education, and attitudes toward precision smoking treatment. RESULTS Of 92 eligible individuals (79.3% Black; 68.2% with household income < $15,000), 67 (72.8%; 95% CI 63.0-80.9%) enrolled and were randomized. Of these, 58 (86.6%; 95% CI 76.4-92.8%) engaged with the intervention, and of these engaged participants, 43 (74.1%; 95% CI 61.6-83.7%) were retained at 6-month follow-up. Conditional on enrollment, older age was associated with lower engagement (OR 0.83, 95% CI 0.73-0.95, p = 0.008). Conditional on engagement, retention was significantly lower in the PRS arm than in the GBC arm (OR 0.18, 95% CI 0.03-1.00, p = 0.050). No other selection effects were observed. CONCLUSIONS Genetically informed precision smoking cessation interventions are feasible in socioeconomically disadvantaged communities, exhibiting high enrollment, engagement, and retention irrespective of race, sex, income, education, or attitudes toward precision smoking treatment. Future smoking cessation interventions in this population should take steps to engage older people and to sustain participation in interventions that include genetic risk counseling. TRIAL REGISTRATION ClinicalTrials.gov No. NCT03521141, Registered 27 April 2018, https://www. CLINICALTRIALS gov/study/NCT03521141.
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Affiliation(s)
- Scott S Lee
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA.
| | - Nicole Senft Everson
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | | | - William J Blot
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Stephen King
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Suman Kundu
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Mark Steinwandel
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Sarah J Sternlieb
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Qiuyin Cai
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Shaneda Warren Andersen
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- University of Wisconsin-Madison, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Debra L Friedman
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Erin Connors Kelly
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Matthew S Freiberg
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Quinn S Wells
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Rachel F Tyndale
- Centre for Addiction and Mental Health, and Departments of Pharmacology & Toxicology, and Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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2
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Wallingford CK, Kovilpillai H, Jacobs C, Turbitt E, Primiero CA, Young MA, Brockman DG, Soyer HP, McInerney-Leo AM, Yanes T. Models of communication for polygenic scores and associated psychosocial and behavioral effects on recipients: A systematic review. Genet Med 2023; 25:1-11. [PMID: 36322150 DOI: 10.1016/j.gim.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to systematically review current models for communicating polygenic scores (PGS) and psycho-behavioral outcomes of receiving PGSs. METHODS Original research on communicating PGSs and reporting on psycho-behavioral outcomes was included. Search terms were applied to 5 databases and were limited by date (2009-2021). RESULTS In total, 28 articles, representing 17 studies in several disease settings were identified. There was limited consistency in PGS communication and evaluation/reporting of outcomes. Most studies (n = 14) presented risk in multiple ways (ie, numerically, verbally, and/or visually). Three studies provided personalized lifestyle advice and additional resources. Only 1 of 17 studies reported using behavior change theory to inform their PGS intervention. A total of 8 studies found no evidence of long-term negative psychosocial effects up to 12 months post result. Of 14 studies reporting on behavior, 9 found at least 1 favorable change after PGS receipt. When stratified by risk, 7 out of 9 studies found high PGS was associated with favorable changes including lifestyle, medication, and screening. Low-risk PGS was not associated with maladaptive behaviors (n = 4). CONCLUSION PGS has the potential to benefit health behavior. High variability among studies emphasizes the need for developing standardized guidelines for communicating PGSs and evaluating psycho-behavioral outcomes. Our findings call for development of best communication practices and evidence-based interventions informed by behavior change theories.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah Kovilpillai
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Clare A Primiero
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia; Dermatology Department, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia.
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3
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Colorectal Cancer Survivors' Receptivity toward Genomic Testing and Targeted Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Cancer Recurrence. J Community Genet 2022; 13:201-214. [PMID: 34997901 PMCID: PMC8941057 DOI: 10.1007/s12687-021-00574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
Abstract
Genomic testing and targeted use of non-steroidal anti-inflammatory drugs (NSAIDs) may mitigate cancer recurrence risks. This study examines colorectal cancer (CRC) survivors' interest and receptivity to these strategies. Patients diagnosed with stage I-III CRC in 2004-2012 were recruited through the New Mexico Cancer Registry to complete a cancer survivorship experiences survey. We assessed interest in genomic testing, daily aspirin (ASA) and NSAID use, and receptivity to future daily ASA/NSAIDs. Descriptive statistics and multivariable logistic regression models estimated factors associated with genomic testing interest. Receptivity to future ASA/NSAIDs use was estimated for non-users of ASA/NSAIDs. Among CRC survivors (n = 273), 83% endorsed interest in genomic testing, 25% were ASA users and 47% ASA/NSAIDs users. In our final model, genomic testing interest was associated with being uncoupled [OR = 4.11; 95% CI = 1.49-11.35], low income [OR = 0.35, 95% CI: 0.14-0.88], smoking history [OR = 0.35, 95% CI: 0.14-0.90], low [OR: 0.33, 95% CI: 0.07-1.43] and moderate [OR: 0.26, 95% CI: 0.11-0.61] health literacy, and personal CRC risk worry [OR: 2.86, 95% CI: 1.63-5.02, p = 0.0002]. In our final model, ASA use was associated with age [OR: 1.05, 95% CI: 1.01-1.10] and cardiovascular disease history [OR: 2.42, 95% CI: 1.23-4.73, p = 0.010]. Among non-users ASA/NSAIDs, 83% reported receptivity to ASA/NSAIDs to reduce cancer risks, and no significant correlates were identified. The majority of survivors' expressed genomic testing interest and endorsed receptivity toward ASA/NSAIDs use for cancer risk management. Further research to optimize ASA/NSAIDs use guided by genomic testing is warranted.
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Bourdon JL, Dorsey A, Zalik M, Pietka A, Salyer P, Bray MJ, Bierut LJ, Ramsey AT. In-vivo design feedback and perceived utility of a genetically-informed smoking risk tool among current smokers in the community. BMC Med Genomics 2021; 14:139. [PMID: 34039360 PMCID: PMC8152342 DOI: 10.1186/s12920-021-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The use of genetically-informed personalized risk information for behavioral disorders, namely smoking and smoking-related behaviors, is a promising yet understudied area. The Genetics and Smoking Risk Profile, or RiskProfile, leverages genetic and environmental information to communicate one's risk for smoking-related diseases. Although prior studies have examined attitudes toward genetic results, little research has investigated these perceptions through a lens of in-vivo testing; that is, user-centered design feedback in response to personalized genetic results being returned contemporaneously. This qualitative study engaged current smokers in usability testing of the RiskProfile within the context of concurrently receiving this personalized, genetically-informed smoking cessation intervention. METHODS Eighty-nine participants who were current smokers responded to open-ended interview questions on perceptions of smoking-related genetic information and the content and format of the RiskProfile intervention that they had received moments before. Data were analyzed via the conventional content analysis approach in which themes were allowed to emerge throughout the analysis. RESULTS Participants were able to reference and offer design input on specific elements of the RiskProfile. Overall, current smokers perceived the RiskProfile to have high potential utility. Constructive feedback that current smokers offered about the tool centered around suggested improvements to optimize its usability and technical content. CONCLUSIONS The detailed and constructive feedback from participants highlights that in-vivo feedback offers a useful design approach that addresses concerns of rigor and relevance when returning genetic results. This unique method demonstrated perceived utility and constructive design feedback for the RiskProfile among current smokers and can play an important role in optimizing the design and implementation of personalized genetic risk interventions moving forward.
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Affiliation(s)
- Jessica L Bourdon
- Wellbridge Center for Addiction Treatment and Research, Center for Addiction Science, 525 Jan Way, Room 1523, Calverton, NY, 11922, USA.
| | - Amelia Dorsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Maia Zalik
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Pietka
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Patricia Salyer
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael J Bray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alex T Ramsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
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5
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Lewis ACF, Green RC. Polygenic risk scores in the clinic: new perspectives needed on familiar ethical issues. Genome Med 2021; 13:14. [PMID: 33509269 PMCID: PMC7844961 DOI: 10.1186/s13073-021-00829-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Clinical use of polygenic risk scores (PRS) will look very different to the more familiar monogenic testing. Here we argue that despite these differences, most of the ethical, legal, and social issues (ELSI) raised in the monogenic setting, such as the relevance of results to family members, the approach to secondary and incidental findings, and the role of expert mediators, continue to be relevant in the polygenic context, albeit in modified form. In addition, PRS will reanimate other old debates. Their use has been proposed both in the practice of clinical medicine and of public health, two contexts with differing norms. In each of these domains, it is unclear what endpoints clinical use of PRS should aim to maximize and under what constraints. Reducing health disparities is a key value for public health, but clinical use of PRS could exacerbate race-based health disparities owing to differences in predictive power across ancestry groups. Finally, PRS will force a reckoning with pre-existing questions concerning biomarkers, namely the relevance of self-reported race, ethnicity and ancestry, and the relationship of risk factors to disease diagnoses. In this Opinion, we argue that despite the parallels to the monogenic setting, new work is urgently needed to gather data, consider normative implications, and develop best practices around this emerging branch of genomics.
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Affiliation(s)
- Anna C F Lewis
- E J Safra Center for Ethics, Harvard University, 124 Mount Auburn, Street, Cambridge, 02138, USA.
| | - Robert C Green
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
- Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA 02215, USA
- Broad Institute of Harvard and MIT, 415 Main St, Cambridge, MA 02142, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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6
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Driver MN, Kuo SIC, Dick DM. Genetic feedback for psychiatric conditions: Where are we now and where are we going. Am J Med Genet B Neuropsychiatr Genet 2020; 183:423-432. [PMID: 32812348 PMCID: PMC8108123 DOI: 10.1002/ajmg.b.32815] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/12/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Morgan N. Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine, Richmond, Virginia
| | - Sally I-Chun Kuo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle M. Dick
- Department of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine, Richmond, Virginia,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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7
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Ramsey AT, Bourdon JL, Bray M, Dorsey A, Zalik M, Pietka A, Salyer P, Chen LS, Baker TB, Munafò MR, Bierut LJ. Proof of Concept of a Personalized Genetic Risk Tool to Promote Smoking Cessation: High Acceptability and Reduced Cigarette Smoking. Cancer Prev Res (Phila) 2020; 14:253-262. [PMID: 32958583 DOI: 10.1158/1940-6207.capr-20-0328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/16/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Relatively little is known about the possible effects of personalized genetic risk information on smoking, the leading preventable cause of morbidity and mortality. We examined the acceptability and potential behavior change associated with a personalized genetically informed risk tool (RiskProfile) among current smokers. Current smokers (n = 108) were enrolled in a pre-post study with three visits. At visit 1, participants completed a baseline assessment and genetic testing via 23andMe. Participants' raw genetic data (CHRNA5 variants) and smoking heaviness were used to create a tailored RiskProfile tool that communicated personalized risks of smoking-related diseases and evidence-based recommendations to promote cessation. Participants received their personalized RiskProfile intervention at visit 2, approximately 6 weeks later. Visit 3 involved a telephone-based follow-up assessment 30 days after intervention. Of enrolled participants, 83% were retained across the three visits. Immediately following intervention, acceptability of RiskProfile was high (M = 4.4; SD = 0.6 on scale of 1 to 5); at 30-day follow-up, 89% of participants demonstrated accurate recall of key intervention messages. In the full analysis set of this single-arm trial, cigarettes smoked per day decreased from intervention to 30-day follow-up [11.3 vs. 9.8; difference = 1.5; 95% confidence interval (0.6-2.4); P = 0.001]. A personalized genetically informed risk tool was found to be highly acceptable and associated with a reduction in smoking, although the absence of a control group must be addressed in future research. This study demonstrates proof of concept for translating key basic science findings into a genetically informed risk tool that was used to promote progress toward smoking cessation.Prevention Relevance: This study demonstrates that personal genetic information can be incorporated into a risk feedback tool that was highly acceptable to current smokers and associated with reductions in smoking. These findings may pave the way for effectiveness and implementation research on genetically-informed behavior change interventions to enhance cancer prevention efforts.
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Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
| | - Jessica L Bourdon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Bray
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Amelia Dorsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Maia Zalik
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda Pietka
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Patricia Salyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, England, United Kingdom.,MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England, United Kingdom
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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8
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Ramsey AT, Bray M, Acayo Laker P, Bourdon JL, Dorsey A, Zalik M, Pietka A, Salyer P, Waters EA, Chen LS, Bierut LJ. Participatory Design of a Personalized Genetic Risk Tool to Promote Behavioral Health. Cancer Prev Res (Phila) 2020; 13:583-592. [PMID: 32209550 PMCID: PMC7335332 DOI: 10.1158/1940-6207.capr-20-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 02/07/2023]
Abstract
Despite major advancements in genomic medicine, research to optimize the design and communication of genetically informed interventions in behavioral health has lagged. The goal of this study was to engage potential end users in participatory codesign of a personalized genetically informed risk tool to intervene on high-risk health behaviors. We used structured interviews to examine end-user attitudes and interest in personalized genetics, qualitative interviews to guide iterative design of a genetically informed tool, and questionnaires to assess acceptability and potential utility of the tool. Participants expressed strong demand for using personal genetics to inform smoking and alcohol-related disease risk and guide treatment (78%-95% agreed). Via iterative design feedback, we cocreated a genetically informed risk profile featuring (i) explanation of genetic and phenotypic markers used to construct a risk algorithm, (ii) personalized risks and benefits of healthy behavior change, and (iii) recommended actions with referral to freely available resources. Participants demonstrated sufficient understanding and cited motivating behavior change as the most useful purpose of the tool. In three phases, we confirmed strong desire for personalized genetics on high-risk health behaviors; codesigned a genetically informed profile with potential end users; and found high acceptability, comprehensibility, and perceived usefulness of the profile. As scientific discovery of genomic medicine advances in behavioral health, we must develop the tools to communicate these discoveries to consumers who stand to benefit. The potential of genomic medicine to engage populations and personalize behavioral health treatment depends, in part, on preparatory studies to design for the future implementation of genetically informed interventions.
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Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
| | - Michael Bray
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Penina Acayo Laker
- Communication Design, Sam Fox School of Design & Visual Arts, Washington University, St. Louis, Missouri
| | - Jessica L Bourdon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Amelia Dorsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Maia Zalik
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda Pietka
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Patricia Salyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Erika A Waters
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Senft N, Sanderson M, Selove R, Blot WJ, King S, Gilliam K, Kundu S, Steinwandel M, Sternlieb SJ, Warren Andersen S, Friedman DL, Connors E, Fadden MK, Freiberg M, Wells QS, Canedo J, Tyndale RF, Young RP, Hopkins RJ, Tindle HA. Attitudes toward Precision Treatment of Smoking in the Southern Community Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1345-1352. [PMID: 31160346 PMCID: PMC6679740 DOI: 10.1158/1055-9965.epi-19-0179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease. METHODS We surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. Seven items assessed attitudes toward aspects of precision smoking treatment, from undergoing tests to acting on results. Items were dichotomized as favorable (5 = strongly agree/4 = agree) versus less favorable (1 = strongly disagree/2 = disagree/3 = neutral); a summary score reflecting generalized attitudes was also computed. Multivariable logistic regression tested independent associations of motivation (precontemplation, contemplation, and preparation) and confidence in quitting (low, medium, and high) with generalized attitudes, controlling for sociodemographic factors and nicotine dependence. RESULTS More than 70% of respondents endorsed favorable generalized attitudes toward precision medicine, with individual item favorability ranging from 64% to 83%. Smokers holding favorable generalized attitudes reported higher income and education (P < 0.05). Predicted probabilities of favorable generalized attitudes ranged from 63% to 75% across motivation levels [contemplation vs. precontemplation: adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI), 1.36-3.25, P = 0.001; preparation vs. precontemplation: AOR = 1.83, 95% CI, 1.20-2.78, P = 0.005; contemplation vs. preparation: AOR = 1.15, 95% CI, 0.75-1.77, P = 0.52] and from 59% to 78% across confidence (medium vs. low: AOR = 1.91, 95% CI, 1.19-3.07, P = 0.007; high vs. low: AOR = 2.62, 95% CI, 1.68-4.10, P < 0.001; medium vs. high: AOR = 0.73, 95% CI, 0.48-1.11, P = 0.14). CONCLUSIONS Among disproportionately burdened community smokers, most hold favorable attitudes toward precision smoking treatment. Individuals with lower motivation and confidence to quit may benefit from additional intervention to engage with precision smoking treatment. IMPACT Predominantly favorable attitudes toward precision smoking treatment suggest promise for future research testing their effectiveness and implementation.
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Affiliation(s)
- Nicole Senft
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | | | - William J Blot
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen King
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suman Kundu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Shaneda Warren Andersen
- Vanderbilt University Medical Center, Nashville, Tennessee
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Erin Connors
- Tennessee State University, Nashville, Tennessee
| | | | - Matthew Freiberg
- Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Quinn S Wells
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juan Canedo
- Meharry Medical College, Nashville, Tennessee
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
- Departments of Pharmacology and Psychiatry, University of Toronto, Ontario, Canada
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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10
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Most Current Smokers Desire Genetic Susceptibility Testing and Genetically-Efficacious Medication. J Neuroimmune Pharmacol 2018; 13:430-437. [PMID: 30370503 DOI: 10.1007/s11481-018-9818-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
The clinical translation of genetic research on nicotine dependence and treatment response requires acceptance of genetic testing by smokers. This study determines (1) which current smokers are receptive to genetic susceptibility testing for nicotine dependence and (2) to what potential extent smokers motivated to quit desire to take smoking cessation medication when hypothetical genetic results predict their pharmacogenetic medication response. Current smokers from a genetic nicotine dependence study (n = 1306) and an ongoing smoking cessation trial (n = 209) were surveyed on their hypothetical interest in seeing genetic testing results related to risk of nicotine dependence. Most current smokers (84.8%) reported high interest in receiving genetic testing results. Factors associated with high interest included age ≥ 40 years, having a college degree, and a positive medical history (≥1 medical condition). In the ongoing smoking cessation trial, current smokers motivated to quit (n = 474) were surveyed on their desire to take smoking cessation medication given hypothetical below or above average pharmacogenetic responses to the medication. When the hypothetical medication response changed from below to above average, significantly more smokers reported a desire to take medication (from 61.0% to 97.5%, p < .0001). These preliminary findings suggest that genetic testing for personalized smoking cessation treatment is well-received by smokers and that a positive hypothetical pharmacogenetic response increases desire to take smoking cessation medication among current smokers motivated to quit. Graphical abstract ᅟ.
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Wedow R, Zacher M, Huibregtse BM, Harris KM, Domingue BW, Boardman JD. Education, Smoking, and Cohort Change: Forwarding a Multidimensional Theory of the Environmental Moderation of Genetic Effects. AMERICAN SOCIOLOGICAL REVIEW 2018; 83:802-832. [PMID: 31534265 PMCID: PMC6750804 DOI: 10.1177/0003122418785368] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We introduce a genetic correlation by environment interaction model [(rG)xE] which allows for social environmental moderation of the genetic relationship between two traits. To empirically demonstrate the significance of the (rG)xE perspective, we use genome wide information from respondents of the Health and Retirement Study (HRS; n = 8,181; birth years 1920-1959) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 4,347; birth years 1974-1983) to examine whether the genetic correlation (rG) between education and smoking has increased over historical time. Genetic correlation estimates (rGHRS = -0.357; rGAdd Health = -0.729) support this hypothesis. Using polygenic scores for educational attainment, we show that this is not due to latent indicators of intellectual capacity, and we highlight the importance of education itself as an explanation of the increasing genetic correlation. Analyses based on contextual variation the milieus of the Add Health respondents corroborate key elements of the birth cohort analyses. We argue that the increasing overlap with respect to genes associated with educational attainment and smoking is a fundamentally social process involving complex process of selection based on observable behaviors that may be linked to genotype.
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Affiliation(s)
- Robbee Wedow
- Department of Sociology, University of Colorado, Boulder, Colorado
- Health and Society Program and Population Program, Institute of Behavioral Science, University of Colorado, Boulder, Colorado
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
- Social Science Genetic Association Consortium (SSGAC)
- Direct correspondence to Robbee Wedow, Institute of Behavioral Science University of Colorado Boulder, 1440 15th Street, Boulder, CO 80302,
| | - Meghan Zacher
- Social Science Genetic Association Consortium (SSGAC)
- Department of Sociology, Harvard University, Cambridge, Massachusetts
| | - Brooke M. Huibregtse
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
- Department of Psychology, University of Colorado, Boulder, Colorado
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin W. Domingue
- Health and Society Program and Population Program, Institute of Behavioral Science, University of Colorado, Boulder, Colorado
- Graduate School of Education, Stanford University, Stanford, California
| | - Jason D. Boardman
- Department of Sociology, University of Colorado, Boulder, Colorado
- Health and Society Program and Population Program, Institute of Behavioral Science, University of Colorado, Boulder, Colorado
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado
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Bierut LJ, Tyndale RF. Preparing the Way: Exploiting Genomic Medicine to Stop Smoking. Trends Mol Med 2018; 24:187-196. [PMID: 29307500 DOI: 10.1016/j.molmed.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 12/15/2022]
Abstract
Clinical medicine of the future is poised to use an individual's genomic data to predict disease risk and guide clinical care. The treatment of cigarette smoking and tobacco use disorder represents a prime area for genomics implementation. The genes CHRNA5 and CYP2A6 are strong genomic contributors that alter the risk of heaviness of smoking, tobacco use disorder, and smoking-related diseases in humans. These biomarkers have proven analytical and clinical validity, and evidence for their clinical utility continues to grow. We propose that these biomarkers harbor the potential of enabling the identification of elevated disease risk in smokers, personalizing smoking cessation treatments, and motivating behavioral changes. We must prepare for the integration of genomic applications into clinical care of patients who smoke.
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Affiliation(s)
- Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Ontario, Canada
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Behavioural changes, sharing behaviour and psychological responses after receiving direct-to-consumer genetic test results: a systematic review and meta-analysis. J Community Genet 2017; 9:1-18. [PMID: 28664264 PMCID: PMC5752648 DOI: 10.1007/s12687-017-0310-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/08/2017] [Indexed: 01/22/2023] Open
Abstract
It has been hypothesised that direct-to-consumer genetic tests (DTC-GTs) could stimulate health behaviour change. However, genetic testing may also lead to anxiety and distress or unnecessarily burden the health care system. The aim is to review and meta-analyse the effects of DTC-GT on (1) behaviour change, (2) psychological response and (3) medical consumption. A systematic literature search was performed in three databases, using "direct-to-consumer genetic testing" as a key search term. Random effects meta-analyses were performed when at least two comparable outcomes were available. After selection, 19 articles were included involving 11 unique studies. Seven studies involved actual consumers who paid the retail price, whereas four included participants who received free genetic testing as part of a research trial (non-actual consumers). In meta-analysis, 23% had a positive lifestyle change. More specifically, improved dietary and exercise practices were both reported by 12%, whereas 19% quit smoking. Seven percent of participants had subsequent preventive checks. Thirty-three percent shared their results with any health care professional and 50% with family and/or friends. Sub-analyses show that behaviour change was more prevalent among non-actual consumers, whereas sharing was more prevalent among actual consumers. Results on psychological responses showed that anxiety, distress and worry were low or absent and that the effect faded with time. DTC-GT has potential to be effective as a health intervention, but the right audience needs to be addressed with tailored follow-up. Research is needed to identify consumers who do and do not change behaviour or experience adverse psychological responses.
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