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Pereira S, Apodaca C, Slominski K, Lipsky RK, Coarfa C, Walker CL, McGuire AL, Steele L, Helmer DA. "Holy Cow, Where do I Sign up?" Attitudes of Military Veterans Toward Epigenomic Biomarker Toxic Exposure Testing. Mil Med 2024:usae454. [PMID: 39313279 DOI: 10.1093/milmed/usae454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION After the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Promise to Address Comprehensive Toxics (PACT) Act in 2022, there has been a great interest in studying toxic exposures encountered during military service. Development of epigenomic biomarkers for exposures could facilitate understanding of exposure-related health effects, but such testing could also provide unwanted information. MATERIALS AND METHODS We explored attitudes toward epigenomic biomarker research and the potential to test for past exposures using semistructured interviews with Veterans (n = 22) who experienced potentially harmful exposures. RESULTS Twenty Veterans said they would hypothetically want to receive epigenomic information related to their toxic exposures and potential health impacts as part of a research study. Veterans identified 9 potential benefits, including promoting insights concerning intergenerational health, identification of early health interventions, and additional knowledge or explanation for their experiences. Sixteen participants noted potential risks, including psychological distress, receiving nonactionable, uncertain, or inaccurate results, and privacy and discrimination risks. Ten participants identified at least 1 condition in their children that they thought could be related to their exposure and most said they would be interested in receiving research results related to their children's and grandchildren's risk. CONCLUSION Results suggest that Veterans might welcome benefits of epigenomic research related to military exposures, yet have some concerns about potential negative impacts.
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Affiliation(s)
- Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77063, USA
| | - Calvin Apodaca
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77063, USA
| | - Kyle Slominski
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77063, USA
| | - Rachele K Lipsky
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77063, USA
- Duke University School of Nursing, Durham, NC 27710, USA
| | - Cristian Coarfa
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77063, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77063, USA
| | - Cheryl L Walker
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77063, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77063, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77063, USA
| | - Lea Steele
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77063, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77063, USA
| | - Drew A Helmer
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77063, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77063, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77063, USA
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Pereira S, Apodaca C, Slominski K, Lipsky RK, Coarfa C, Walker CL, McGuire AL, Steele L, Helmer DA. "Holy cow, where do I sign up?" Attitudes of Military Veterans toward Epigenomic Biomarker Toxic Exposure Testing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305554. [PMID: 38699358 PMCID: PMC11065004 DOI: 10.1101/2024.04.09.24305554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background With the signing of the PACT Act in 2022, there is great interest and investment in studying toxic exposures encountered during military service. One way to address this is through the identification of epigenomic biomarkers associated with exposures. There is increasing evidence suggesting that exposure to toxic substances may result in alterations to DNA methylation and resultant gene expression. These epigenomic changes may lead to adverse health effects for exposed individuals and their offspring. While the development of epigenomic biomarkers for exposures could facilitate understanding of these exposure-related health effects, such testing could also provide unwanted information. Objectives Explore Veterans' attitudes toward epigenomic biomarker research and the potential to test for past exposures that could pose intergenerational risk. Methods Semi-structured interviews with Veterans (n=22) who experienced potentially harmful exposures during their military service. Results Twenty Veterans said they would hypothetically want to receive epigenomic information related to their toxic exposures and potential health impacts as part of a research study. Veterans identified nine potential benefits of this research, including promoting insights concerning intergenerational health, identification of early health interventions to mitigate the impact of exposures, and additional knowledge or explanation for their experiences. At the same time, 16 participants noted potential risks, including psychological distress in response to results, concerns about receiving non-actionable, uncertain, or inaccurate results, and issues related to privacy and discrimination. Ten participants also identified at least one condition in their children that they thought could be related to their exposure and most said they would be interested in receiving research results related to their children's and grandchildren's risk of developing a health condition associated with their exposure. Discussion Results suggest that Veterans might welcome benefits of epigenomic research related to military exposures yet have some concerns about potential negative impacts.
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Fox BM, Martschenko DO. Placing Publics in Public Health Genomics. Public Health Genomics 2023; 27:23-29. [PMID: 38128495 PMCID: PMC11007191 DOI: 10.1159/000535942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Brandy M. Fox
- Center for Biomedical Ethics, Department of Pediatrics, Stanford Medicine, Stanford, CA
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Boscarino JA, Adams RE, Urosevich TG, Hoffman SN, Kirchner HL, Chu X, Shi W, Boscarino JJ, Dugan RJ, Withey CA, Figley CR. Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine. Pharmgenomics Pers Med 2022; 15:17-27. [PMID: 35058707 PMCID: PMC8765536 DOI: 10.2147/pgpm.s338244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/24/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. Methods For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0–8, mean=3.6, SD=1.4). Results Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. Discussion In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.
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Affiliation(s)
- Joseph A Boscarino
- Department Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
- Correspondence: Joseph A Boscarino Department Population Health Sciences, Geisinger Clinic, 100 N. Academy Ave., 44-00, Danville, PA, 17822, USATel +1 570-214-9825 Email
| | - Richard E Adams
- Department Sociology, Kent State University, Kent, OH, 44242, USA
| | | | - Stuart N Hoffman
- Department Sleep Medicine, Geisinger Clinic, Danville, PA, 17822, USA
| | - H Lester Kirchner
- Department Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Xin Chu
- Obesity Institute, Geisinger Clinic, Danville, PA, 17822, USA
| | - Weixing Shi
- Obesity Institute, Geisinger Clinic, Danville, PA, 17822, USA
| | - Joseph J Boscarino
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, STC 7, Tampa, FL, 33606, USA
| | - Ryan J Dugan
- Department Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Carrie A Withey
- Department Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, 70112, USA
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Morosoli JJ, Colodro-Conde L, Barlow FK, Medland SE. Investigating perceived heritability of mental health disorders and attitudes toward genetic testing in the United States, United Kingdom, and Australia. Am J Med Genet B Neuropsychiatr Genet 2021; 186:341-352. [PMID: 34562071 DOI: 10.1002/ajmg.b.32875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/12/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
Our beliefs about the heritability of psychiatric traits may influence how we respond to the use of genetic information in this area. In the present study, we aim to inform future education campaigns as well as genetic counseling interventions by exploring common fears and misunderstandings associated with learning about genetic predispositions for mental health disorders. We surveyed 3,646 genetic research participants from Australia, and 960 members of the public from the United Kingdom, and the United States, and evaluated attitudes toward psychiatric genetic testing. Participants were asked hypothetical questions about their interest in psychiatric genetic testing, perceived usefulness of psychiatric genetic testing, and beliefs about malleability of behavior, among others. We also asked them to estimate the heritability of alcohol dependence, schizophrenia, and major depression. We found a high interest in psychiatric genetic testing. In most cases, more than a third of the participants showed serious concerns related to learning about personal genetic predisposition, such as not wanting to have children if they knew they had a high genetic predisposition, or not wanting to choose a partner with a high genetic predisposition for a mental health problem. Finally, we found a significant association between most participants' attitudes and their lay estimates of heritability, which highlights the complexity of educating the public about genetics.
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Affiliation(s)
- José Juan Morosoli
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Lucía Colodro-Conde
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Fiona Kate Barlow
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah E Medland
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
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Wang Q, Pang C, Meng L, Wang G. Public perceived knowledge of, attitude toward, and use of genetic testing in urban China. J Genet Couns 2021; 30:1629-1639. [PMID: 33942946 DOI: 10.1002/jgc4.1428] [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: 04/09/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
Because most research about laypeople and genetic testing (GT) has been conducted in other nations than China, we conducted a study in urban China (a) to determine the perceived knowledge of, attitude toward, and use of GT there; (b) to identify influencing factors associated with the public's perceived knowledge, attitudes, and use of GT; and (c) to explore the relationship among public knowledge of, attitude toward, and use of GT. Our data came from a community-based survey in urban Dalian of 868 individuals. We used generalized ordered logit and logit models to examine factors associated with perceived knowledge of, attitude toward, and use of GT. We found that 67% of community members knew about GT, that 45% had a positive opinion of GT, and that only 4% accessed GT. Older people were more likely to have less perceived knowledge of GT and less likely to have a negative attitude toward it; these relationships were especially stronger among those aged ≥60 years. We also found that socially disadvantaged people were more likely to have less perceived knowledge of GT and more likely to have a negative opinion of it. Having a greater level of perceived knowledge was significantly correlated with increased odds of having a more positive or neutral attitude toward GT and of being more likely to access GT. Our findings may help policy makers design effective action plans and regulations regarding GT and genetic counseling services for laypersons in China.
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Affiliation(s)
- Qun Wang
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian, China
| | - Cong Pang
- School of Philosophy, Center for Biomedical Ethics, Fudan University, Shanghai, China
| | - Lingyu Meng
- School of Philosophy, Center for Biomedical Ethics, Fudan University, Shanghai, China
| | - Guoyu Wang
- School of Philosophy, Center for Biomedical Ethics, Fudan University, Shanghai, China
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Boscarino JJ, Figley CR, Adams RE, Urosevich TG, Kirchner HL, Boscarino JA. Mental health status in veterans residing in rural versus non-rural areas: results from the veterans' health study. Mil Med Res 2020; 7:44. [PMID: 32951600 PMCID: PMC7504679 DOI: 10.1186/s40779-020-00272-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
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Affiliation(s)
- Joseph J Boscarino
- Clinical Psychology Department, William James College, Newton, MA, 02459, USA
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, 70112, USA
| | - Richard E Adams
- Department of Sociology, Kent State University, Kent, OH, 44242, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA.
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Public Understanding of Behavioral Genetics: Integrating Heuristic Thinking, Motivated Reasoning and Planned Social Change Theories for Better Communication Strategies. Behav Genet 2019; 49:469-477. [PMID: 31317344 DOI: 10.1007/s10519-019-09964-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The field of behavioral genetics is experiencing a revolution following the development of genome-wide association studies and the availability of large datasets from international consortia. This rapid change could increase the existing gaps between basic research, translation, and public understanding of science. In the present work, we aim to synthesize key explanations of how public understanding of socio-scientific issues develop. We propose that integrating dual-process, motivated reasoning, and change management theories will increase the extent to which we understand, and can change, how people respond to findings from behavior genetics.
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Mental Health Impact of Homecoming Experience Among 1730 Formerly Deployed Veterans From the Vietnam War to Current Conflicts: Results From the Veterans' Health Study. J Nerv Ment Dis 2018; 206:757-764. [PMID: 30273271 PMCID: PMC6171364 DOI: 10.1097/nmd.0000000000000879] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the effects of homecoming support on current mental health among 1730 deployed veterans from Vietnam, Iraq/Afghanistan, Persian Gulf, and other conflicts. The prevalence of current posttraumatic stress disorder (PTSD) was 5.4%, current depression was 8.3%, and 5.4% had suicidal thoughts in the past month. Overall, 26% of veterans had low homecoming support, which was more prevalent among Vietnam veterans (44.3%, p < 0.001). In multivariable logistic regressions, controlling for demographics, combat exposure, number of deployments, trauma history, and operational theater, low postdeployment support was associated with PTSD (odds ratio, 2.13; p = 0.032) and suicidality (odds ratio, 1.91; p < 0.030), but not depression. For suicidality, an interaction was detected for homecoming by theater status, whereby Iraq/Afghanistan veterans with lower homecoming support had a higher probability of suicidal thoughts (p = 0.002). Thus, years after deployment, lower homecoming support was associated with current PTSD and suicidality, regardless of theater and warzone exposures. For suicidality, lower support had a greater impact on Iraq/Afghanistan veterans.
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Predictors of Topiramate Tolerability in Heavy Cannabis-Using Adolescents and Young Adults: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Psychopharmacol 2018; 38:134-137. [PMID: 29424802 PMCID: PMC5825284 DOI: 10.1097/jcp.0000000000000843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE/BACKGROUND Cannabis is the most commonly abused illicit drug and accounts for the greatest number of adolescent substance abuse treatment admissions. Despite urgent need for effective interventions, the best available psychosocial treatment options yield only modest effects. Topiramate showed promise as an adjunctive pharmacotherapy to a psychosocial intervention for cannabis misuse among adolescents and young adults in a recent clinical trial, but it was not well tolerated. This study investigated associations between clinical characteristics and side effects and dropout among adolescents and young adults randomized to topiramate. METHODS This study involved secondary data analysis of a randomized placebo-controlled trial of topiramate for treating cannabis misuse (ages, 15-24 years; 50% female). We explored the interaction effects of baseline characteristics and medication condition (topiramate vs placebo) on treatment dropout. We also explored the relationship between side effects and dropout. FINDINGS/RESULTS Higher cannabis problems were significantly associated with reduced hazard of dropout in the topiramate group (P = 0.048) and were nonsignificantly associated with increased hazard of dropout in the placebo group (P = 0.062). Results also showed that memory difficulties were an overwhelming predictor of dropout in the topiramate condition; 42% of participants who dropped out experienced memory difficulties, whereas none of those who remained in the study experienced these effects. IMPLICATIONS/CONCLUSIONS By identifying who may most benefit from and tolerate this medication, treatment for substance use disorders can become more individualized and positive outcomes may be enhanced.
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