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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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Driver MN, Kuo SIC, Dron JS, Austin J, Dick DM. The impact of receiving polygenic risk scores for alcohol use disorder on psychological distress, risk perception, and intentions to reduce drinking. Am J Med Genet B Neuropsychiatr Genet 2023. [PMID: 36856135 DOI: 10.1002/ajmg.b.32933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/29/2023] [Indexed: 03/02/2023]
Abstract
For the return of polygenic risk scores to become an acceptable clinical practice in psychiatry, receipt of polygenic risk scores must be associated with minimal harm and changes in behavior that decrease one's risk for developing a psychiatric outcome. Data from a randomized controlled trial was used to assess the impact of different levels of hypothetical polygenic risk scores for alcohol use disorder on psychological distress, risk perception, and intentions to change drinking behaviors. The analytic sample consisted of 325 participants recruited from an urban, public university. Results demonstrated that there were significant increases in psychological distress as the level of genetic risk for alcohol use disorder increased. In addition, the perceived chance of developing alcohol use disorder significantly increased as the level of genetic risk increased. Promisingly, a greater proportion of participants indicated that they would intend to engage in follow-up behaviors, such as seeking additional information, talking to a healthcare provider about risk, and reducing drinking behaviors, as the level of genetic risk increased. Returning polygenic risk scores for alcohol use disorder in a clinical setting has the potential to promote risk-reducing behavior change, especially with increasing levels of genetic risk. The study was registered on ClinicalTrials.gov (Identifier: NCT05143073).
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Affiliation(s)
- Morgan N Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
| | - Jacqueline S Dron
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danielle M Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA.,Rutgers Addiction Research Center, Brain Health Institute, Rutgers University, Piscataway, New Jersey, USA
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Driver MN, Kuo SIC, Dick DM. Returning complex genetic risk information to promote better health-related behaviors: a commentary of the literature and suggested next steps. Transl Behav Med 2023; 13:115-119. [PMID: 36125098 PMCID: PMC9972341 DOI: 10.1093/tbm/ibac071] [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] [Indexed: 11/14/2022] Open
Abstract
Genome-wide association studies aim to identify genetic variants that are associated with a disease phenotype in order to enhance precision medicine efforts. Despite the excitement surrounding the promise of precision medicine and interest among the public in accessing personalized genetic information, there has been little effort dedicated to understanding how complex genetic risk information could be incorporated into clinical practice to inform prevention, screening, and treatment. In this article, we briefly summarize the literature on the impact of receiving genetic risk information on health-related behavior, discuss the limitations of these studies, and outline the challenges that will need to be overcome, along with suggested next steps for future studies, to understand the true promise of precision medicine. The current literature demonstrates that there is no consistent or strong evidence that receiving complex genetic risk information, such as polygenic risk scores, has an impact on behavior; however, there are a number of limitations that may impact the failure to find significant effects associated with receiving genetic feedback. Behavior change is a complex process and simply providing genetic risk information without incorporating a theoretical perspective on behavior change diminishes the potential impact of receiving genetic risk information on actual behavior change. Future studies and interventions which return genetic feedback should be designed using theoretical frameworks of behavior change models to improve the impact of receiving personalized genetic information.
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Affiliation(s)
- Morgan N Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Danielle M Dick
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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4
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Driver MN, Kuo SIC, Austin J, Dick DM. Integrating Theory with Education about Genetic Risk for Alcohol Use Disorder: The Effects of a Brief Online Educational Tool on Elements of the Health Belief Model. Complex Psychiatry 2023; 9:89-99. [PMID: 37404871 PMCID: PMC10315003 DOI: 10.1159/000530222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/14/2023] [Indexed: 10/01/2023] Open
Abstract
Introduction The utility of genetic risk information relies on the assumption that individuals will use the information to change behavior to reduce risk of developing health problems. Educational interventions designed to target elements of the Health Belief Model have shown to be effective in promoting behaviors for positive outcomes. Methods A randomized controlled trial (RCT) was conducted in 325 college students to assess whether a brief, online educational intervention altered elements of the Health Belief Model that are known to be associated with motivations and intentions to change behavior. The RCT included a control condition, an intervention condition that received information about alcohol use disorder (AUD), and an intervention condition that received information about polygenic risk scores and AUD. We used t tests and ANOVA methods to compare differences in beliefs related to the Health Belief Model across study conditions and demographic characteristics. Results Providing educational information did not impact worry about developing AUD, perceived susceptibility and severity of developing alcohol problems, or perceived benefits and barriers of risk-reducing actions. Individuals in the condition that received educational information about polygenic risk scores and AUD reported higher perceived chance of developing AUD than individuals in the control condition (adj. p < 0.01). Sex, race/ethnicity, family history, and drinking status were associated with several components of the Health Belief Model. Conclusion Findings from this study demonstrate the need to better design and refine the educational information intended to accompany the return of genetic feedback for AUD to better promote risk-reducing behaviors.
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Affiliation(s)
- Morgan N. Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Danielle M. Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
- Rutgers Addiction Research Center, Brain Health Institute, Rutgers University, Piscataway, NJ, USA
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5
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Everson NS, Klein WMP, Lee SS, Selove R, Sanderson M, Blot WJ, Tyndale RF, King S, Gilliam K, Kundu S, Steinwandel M, Sternlieb SJ, Andersen SW, Friedman DL, Connors E, Fadden MK, Freiberg MS, Wells QS, Canedo J, Young RP, Scott RJ, Umeukeje EM, Griffith DM, Tindle HA. Dispositional optimism and optimistic bias: Associations with cessation motivation, confidence, and attitudes. Health Psychol 2022; 41:621-629. [PMID: 35901400 PMCID: PMC9830640 DOI: 10.1037/hea0001184] [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] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To test whether 2 conceptually overlapping constructs, dispositional optimism (generalized positive expectations) and optimistic bias (inaccurately low risk perceptions), may have different implications for smoking treatment engagement. METHOD Predominantly Black, low-income Southern Community Cohort study smokers (n = 880) self-reported dispositional optimism and pessimism (Life Orientation Test-Revised subscales: 0 = neutral, 12 = high optimism/pessimism), comparative lung cancer risk (Low/Average/High), and information to calculate objective lung cancer risk (Low/Med/High). Perceived risk was categorized as accurate (perceived = objective), optimistically-biased (perceived < objective), or pessimistically-biased (perceived > objective). One-way ANOVAs tested associations between dispositional optimism/pessimism and perceived risk accuracy. Multivariable logistic regressions tested independent associations of optimism/pessimism and perceived risk accuracy with cessation motivation (Low/High), confidence (Low/High), and precision treatment attitudes (Favorable/Unfavorable), controlling for sociodemographics and nicotine dependence. RESULTS Mean dispositional optimism/pessimism scores were 8.41 (SD = 2.59) and 5.65 (SD = 3.02), respectively. Perceived lung cancer risk was 38% accurate, 27% optimistically-biased, and 35% pessimistically-biased. Accuracy was unrelated to dispositional optimism (F(2, 641) = 1.23, p = .29), though optimistically-biased (vs. pessimistically-biased) smokers had higher dispositional pessimism (F(2, 628) = 3.17, p = .043). Dispositional optimism was associated with higher confidence (Adjusted odds ratio [AOR] = 1.71, 95% CI [1.42, 2.06], p < .001) and favorable precision treatment attitudes (AOR = 1.66, 95% CI [1.37, 2.01], p < .001). Optimistically-biased (vs. accurate) risk perception was associated with lower motivation (AOR = .64, 95% CI [.42, .98], p = .041) and less favorable precision treatment attitudes (AOR = .59, 95% CI [.38, .94], p = .029). CONCLUSIONS Dispositional optimism and lung cancer risk perception accuracy were unrelated. Dispositional optimism was associated with favorable engagement-related outcomes and optimistically-biased risk perception with unfavorable outcomes, reinforcing the distinctiveness of these constructs and their implications for smoking treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Nicole Senft Everson
- Vanderbilt University Medical Center, Nashville, TN, USA
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Scott S. Lee
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, ON, CA
| | - Stephen King
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Suman Kundu
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Shaneda Warren Andersen
- Vanderbilt University Medical Center, Nashville, TN, USA
- University of Wisconsin-Madison; Carbone Cancer Center, Madison, WI, USA
| | | | - Erin Connors
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Matthew S. Freiberg
- Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Quinn S. Wells
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Juan Canedo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Derek M. Griffith
- Georgetown University, Departments of Health Services Administration and Oncology, Washington, DC, USA
| | - Hilary A. Tindle
- Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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6
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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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7
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Learning one's genetic risk changes physiology independent of actual genetic risk. Nat Hum Behav 2018; 3:48-56. [PMID: 30932047 DOI: 10.1038/s41562-018-0483-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023]
Abstract
Millions of people now access personal genetic risk estimates for diseases such as Alzheimer's, cancer and obesity1. While this information can be informative2-4, research on placebo and nocebo effects5-8 suggests that learning of one's genetic risk may evoke physiological changes consistent with the expected risk profile. Here we tested whether merely learning of one's genetic risk for disease alters one's actual risk by making people more likely to exhibit the expected changes in gene-related physiology, behaviour and subjective experience. Individuals were genotyped for actual genetic risk and then randomly assigned to receive either a 'high-risk' or 'protected' genetic test result for obesity via cardiorespiratory exercise capacity (experiment 1, N = 116) or physiological satiety (experiment 2, N = 107) before engaging in a task in which genetic risk was salient. Merely receiving genetic risk information changed individuals' cardiorespiratory physiology, perceived exertion and running endurance during exercise, and changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner. Effects of perceived genetic risk on outcomes were sometimes greater than the effects associated with actual genetic risk. If simply conveying genetic risk information can alter actual risk, clinicians and ethicists should wrestle with appropriate thresholds for when revealing genetic risk is warranted.
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8
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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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Horne J, Madill J, O'Connor C, Shelley J, Gilliland J. A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory? Lifestyle Genom 2018; 11:49-63. [PMID: 29635250 DOI: 10.1159/000488086] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. PURPOSE This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. METHODS Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB. RESULTS Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of "poor" quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be "fair"). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition. CONCLUSIONS It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided.
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Affiliation(s)
- Justine Horne
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Janet Madill
- School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Colleen O'Connor
- School of Food and Nutritional Sciences, Brescia University College at The University of Western Ontario, London, Ontario, Canada
| | - Jacob Shelley
- Faculty of Law, The University of Western Ontario, London, Ontario, Canada.,School of Health Studies, The University of Western Ontario, London, Ontario, Canada.,Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jason Gilliland
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada.,Department of Geography, The University of Western Ontario, London, Ontario, Canada.,Department of Paediatrics, The University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
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10
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French DP, Cameron E, Benton JS, Deaton C, Harvie M. Can Communicating Personalised Disease Risk Promote Healthy Behaviour Change? A Systematic Review of Systematic Reviews. Ann Behav Med 2018; 51:718-729. [PMID: 28290066 PMCID: PMC5602036 DOI: 10.1007/s12160-017-9895-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The assessment and communication of disease risk that is personalised to the individual is widespread in healthcare contexts. Despite several systematic reviews of RCTs, it is unclear under what circumstances that personalised risk estimates promotes change in four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. PURPOSE The present research aims to systematically identify, evaluate and synthesise the findings of existing systematic reviews. METHODS This systematic review of systematic reviews followed published guidance. A search of four databases and two-stage screening procedure with good reliability identified nine eligible systematic reviews. RESULTS The nine reviews each included between three and 15 primary studies, containing 36 unique studies. Methods of personalising risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimating and communicating risk, the reviews found no evidence that risk information had strong or consistent effects on health-related behaviours. The most promising effects came from interventions using visual or imaging techniques and with smoking cessation and dietary behaviour as outcomes, but with inconsistent results. Few interventions explicitly used theory, few targeted self-efficacy or response efficacy, and a limited range of Behaviour Change Techniques were used. CONCLUSIONS Presenting risk information on its own, even when highly personalised, does not produce strong effects on health-related behaviours or changes which are sustained. Future research in this area should build on the existing knowledge base about increasing the effects of risk communication on behaviour.
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Affiliation(s)
- David P French
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Manchester, M13 9PL England
| | - Elaine Cameron
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Manchester, M13 9PL England
| | - Jack S Benton
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Manchester, M13 9PL England
| | - Christi Deaton
- School of Clinical Medicine, Forvie Site, University of Cambridge, Cambridge, CB2 0SR England
| | - Michelle Harvie
- Nightingale Centre, University Hospital South Manchester, Manchester, M23 9LT England
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11
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Olfson E, Hartz S, Carere DA, Green RC, Roberts JS, Bierut LJ. Implications of Personal Genomic Testing for Health Behaviors: The Case of Smoking. Nicotine Tob Res 2016; 18:2273-2277. [PMID: 27613923 DOI: 10.1093/ntr/ntw168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/27/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Direct-to-consumer personal genomic testing has the potential to influence health behaviors, including smoking. Critics of this testing highlight limited evidence to support positive behavioral benefits and caution that genomic results may provide false reassurance, leading to unhealthy behaviors. This study investigates interest in genetic risks of smoking-related diseases and changes in smoking behaviors among genomic testing consumers. METHODS From 2012 to 2013, a longitudinal series of web surveys was conducted. A total of 1464 customers of 23andMe and Pathway Genomics completed a survey prior to viewing genomic test results, of which 1002 participants provided data on smoking behaviors 6 months after receiving results. RESULTS At baseline, 64% of participants were never smokers, 29% were former smokers, and 7% were current smokers. Most baseline current smokers were very interested in genetic risk results for lung cancer (65%) and heart disease (72%). For lung cancer, this interest was significantly greater than former (50% very interested) and never smokers (37% very interested) (p < .0001). Even though participants were interested in smoking-related disease genetic risks, 96% reported the same smoking status at baseline and 6-month follow-up. Importantly, only 1% (n = 13/916) of former and never smokers became current smokers at 6 months and 22% (n = 14/64) of current smokers reported quitting. CONCLUSIONS Overall, smokers show a high level of interest in genetic risks of smoking-related illnesses. The experience of receiving direct-to-consumer genomic health risks does not appear to have obvious harms related to smoking behaviors, with some potential benefits. IMPLICATIONS In the setting of ongoing controversy surrounding direct-to-consumer genomic testing, this study provides evidence that consumers are interested in genetic risk results of smoking-related diseases. Receiving genomic testing results does not lead to smoking initiation among never smokers or reinitiation among former smokers and may be associated with a higher quit rate among current smokers at 6-month follow-up than the general population. These findings ease concerns that direct-to-consumer genomic testing could lead to false reassurance and unhealthy behaviors related to smoking.
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Affiliation(s)
- Emily Olfson
- Child Study Center and Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Deanna Alexis Carere
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | | | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO;
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12
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Hollands GJ, French DP, Griffin SJ, Prevost AT, Sutton S, King S, Marteau TM. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ 2016; 352:i1102. [PMID: 26979548 PMCID: PMC4793156 DOI: 10.1136/bmj.i1102] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the impact of communicating DNA based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours. DESIGN Systematic review with meta-analysis, using Cochrane methods. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials up to 25 February 2015. Backward and forward citation searches were also conducted. STUDY SELECTION Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA based estimates of disease risk for conditions where risk could be reduced by behaviour change. Eligible studies included a measure of risk-reducing behaviour. RESULTS We examined 10,515 abstracts and included 18 studies that reported on seven behavioural outcomes, including smoking cessation (six studies; n=2663), diet (seven studies; n=1784), and physical activity (six studies; n=1704). Meta-analysis revealed no significant effects of communicating DNA based risk estimates on smoking cessation (odds ratio 0.92, 95% confidence interval 0.63 to 1.35, P=0.67), diet (standardised mean difference 0.12, 95% confidence interval -0.00 to 0.24, P=0.05), or physical activity (standardised mean difference -0.03, 95% confidence interval -0.13 to 0.08, P=0.62). There were also no effects on any other behaviours (alcohol use, medication use, sun protection behaviours, and attendance at screening or behavioural support programmes) or on motivation to change behaviour, and no adverse effects, such as depression and anxiety. Subgroup analyses provided no clear evidence that communication of a risk-conferring genotype affected behaviour more than communication of the absence of such a genotype. However, studies were predominantly at high or unclear risk of bias, and evidence was typically of low quality. CONCLUSIONS Expectations that communicating DNA based risk estimates changes behaviour is not supported by existing evidence. These results do not support use of genetic testing or the search for risk-conferring gene variants for common complex diseases on the basis that they motivate risk-reducing behaviour. SYSTEMATIC REVIEW REGISTRATION This is a revised and updated version of a Cochrane review from 2010, adding 11 studies to the seven previously identified.
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Affiliation(s)
- Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Simon J Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - A Toby Prevost
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah King
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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13
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Lipkus IM, Schwartz-Bloom R, Kelley MJ, Pan W. A preliminary exploration of college smokers' reactions to nicotine dependence genetic susceptibility feedback. Nicotine Tob Res 2014; 17:337-43. [PMID: 25173776 DOI: 10.1093/ntr/ntu155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Many young smokers underestimate their risk for becoming addicted to cigarettes. We explored whether informing light college smokers (i.e., fewer than 5 cigarettes/day) of their genetic predisposition to nicotine dependence influenced their perceived risks and worry about becoming addicted, their ability to quit (i.e., self-efficacy), their desire to quit, and smoking cessation. METHODS College smokers (n = 142) received educational materials on mechanisms and consequences of nicotine addiction and were offered genetic susceptibility testing for nicotine dependence. Participants who accepted testing were randomized to receive feedback or no feedback (i.e., control). Tested participants learned they were above or not above average genetic risk for nicotine dependence. All participants responded to questions about perceived risks and worry about becoming addicted, efficacy to quit, and desire to quit. Cessation was assessed during a 1-month follow-up. RESULTS Efficacy beliefs, worry about becoming addicted, and desire to quit did not differ by study condition or feedback. Perceived risk for becoming addicted was highest among tested participants informed they were above average risk for nicotine dependence. Overall, self-reported 30- but not 7-day quit rate was higher among participants who underwent genetic testing compared with control participants. CONCLUSIONS This pilot study is the first to show that among light college smokers, receipt of genetic susceptibility feedback to nicotine dependence potentially curbs smoking without producing detrimental effects.
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Affiliation(s)
| | | | | | - Wei Pan
- Duke University School of Nursing, Durham, NC
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14
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Giordimaina AM, Sheldon JP, Petty EM. Anticipated motivation for genetic testing among smokers, nonsmokers, and former smokers: an exploratory qualitative study of decision making. Public Health Genomics 2014; 17:228-39. [PMID: 25059656 DOI: 10.1159/000364803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This qualitative study explores the public's interest in genetic testing related to cigarette smoking, comparing the public's motivations with researchers' intentions for this technology. METHODS Adult nonsmokers (n=463), former smokers (n=163), and current smokers (n=129) completed an online survey. Within a hypothetical scenario, respondents decided whether they desired genetic testing related to smoking and explained their decision making. A non-parametric Kruskal-Wallis test was used to compare the interest in genetic testing by smoking history group. Inductive content analysis was used to investigate respondents' explanations for their testing decisions. RESULTS Most nonsmokers (64%) and former smokers (58%) did not want genetic testing. While most current daily smokers were interested in testing (56%), most current occasional smokers were not (52%). Respondents' decision-making explanations were categorized into 3 major themes: Causality, Relevancy and Utility (e.g. personal benefits or harms). The use of causality, relevancy and utility explanations varied by smoking history. Notable perceived benefits of testing included recreation and altruism. Notable perceived harms included fear of fatalistic thoughts and concern about genetic discrimination. CONCLUSIONS Interest in genetic testing was highest among current daily smokers, despite potential utility in other groups. Although respondents' motivations for testing paralleled researchers' intentions of tailoring smoking cessation therapies and increasing motivation to quit or abstain, respondents also raised alternative motivations and fears that healthcare providers would need to address.
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Affiliation(s)
- Alicia M Giordimaina
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Mich., USA
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15
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Lautenbach DM, Christensen KD, Sparks JA, Green RC. Communicating genetic risk information for common disorders in the era of genomic medicine. Annu Rev Genomics Hum Genet 2013; 14:491-513. [PMID: 24003856 DOI: 10.1146/annurev-genom-092010-110722] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Communicating genetic risk information in ways that maximize understanding and promote health is increasingly important given the rapidly expanding availability and capabilities of genomic technologies. A well-developed literature on risk communication in general provides guidance for best practices, including presentation of information in multiple formats, attention to framing effects, use of graphics, sensitivity to the way numbers are presented, parsimony of information, attentiveness to emotions, and interactivity as part of the communication process. Challenges to communicating genetic risk information include deciding how best to tailor it, streamlining the process, deciding what information to disclose, accepting that communications may have limited influence, and understanding the impact of context. Meeting these challenges has great potential for empowering individuals to adopt healthier lifestyles and improve public health, but will require multidisciplinary approaches and collaboration.
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16
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de Viron S, Malats N, Van der Heyden J, Van Oyen H, Brand A. Environmental and Genomic Factors as well as Interventions Influencing Smoking Cessation: A Systematic Review of Reviews and a Proposed Working Model. Public Health Genomics 2013; 16:159-73. [DOI: 10.1159/000351453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/18/2013] [Indexed: 11/19/2022] Open
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17
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Christensen KD, Green RC. How could disclosing incidental information from whole-genome sequencing affect patient behavior? Per Med 2013; 10:10.2217/pme.13.24. [PMID: 24319470 PMCID: PMC3852635 DOI: 10.2217/pme.13.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In this article, we argue that disclosure of incidental findings from whole-genome sequencing has the potential to motivate individuals to change health behaviors through psychological mechanisms that differ from typical risk assessment interventions. Their ability to do so, however, is likely to be highly contingent upon the nature of the incidental findings and how they are disclosed, the context of the disclosure and the characteristics of the patient. Moreover, clinicians need to be aware that behavioral responses may occur in unanticipated ways. This article argues for commentators and policy makers to take a cautious but optimistic perspective while empirical evidence is collected through ongoing research involving whole-genome sequencing and the disclosure of incidental information.
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Affiliation(s)
- Kurt D Christensen
- Department of Medicine, Division of Genetics, Brigham & Women's Hospital & Harvard Medical School, EC Alumnae Hall, Suite 301, 41 Avenue Louis Pasteur, Boston, MA 02115-5727, USA
| | - Robert C Green
- Department of Medicine, Division of Genetics, Brigham & Women's Hospital & Harvard Medical School, EC Alumnae Hall, Suite 301, 41 Avenue Louis Pasteur, Boston, MA 02115-5727, USA
- Partners Healthcare Center for Personalized Genetic Medicine, Boston, MA, USA
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