Attitudes toward Precision Treatment of Smoking in the Southern Community Cohort Study

Abstract

Background: Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smokingrelated 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 ¼ strongly agree/4 ¼ agree) versus less favorable (1 ¼ strongly disagree/2 ¼ disagree/ 3 ¼ 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) ¼ 2.10, 95% confidence interval (CI), 1.36-3.25, P ¼ 0.001; preparation vs. precontemplation:

Utility of incorporating a gene-based lung cancer risk test on uptake and adherence in a community-based lung cancer screening pilot study

“…This result is very similar to the results we obtained in a sub-study of the NLST where a 10 SNP panel reassigned risk in 26–31% of participants in the NLST using net reclassification improvement index (NRI) analyses ( Young et al, 2014 ). We conclude from these results that SNP data provides a useful addition to clinical variables in assigning risk and that this may have utility in engaging smokers in CT screening ( Patel et al, 2012 , Senft et al, 2019 , Young and Hopkins, 2013 ). In the current study, 98% (154/157 high risk smokers) of those deemed eligible for screening actually attended to undergo CT screening.…”

“…This denial is reinforced by a smoker’s lack of motivational tension, a state reflective of their fear of suffering a fatal complication of smoking such as lung cancer ( Weinstein et al, 2005 ). Not surprisingly, the tendency to high levels of unrealistic optimism (denial) and low levels of motivational tension (fear) determines a smoker’s interest, and ultimately participating, in risk mitigating activities such as smoking cessation ( Nichols et al, 2017 , Senft et al, 2019 ) and CT screening for early detection of lung cancer ( Hahn et al, 2006 , Weinstein et al, 2005 , Young and Hopkins, 2012 , Griffiths et al, 2012 , Silvestri et al, 2007 , Kim et al, 2008 ). In addition to uptake for lung cancer screening, there has been growing interest in adherence to screening following the baseline scan ( Spiro, 2007 , Park et al, 2013 , Montes et al, 2007 , Zahnd and Eberth, 2019 , Richards et al, 2020 , Fedewa et al, 2020 , Kim et al, 2008 , Schnoll et al, 2003 , Hahn et al, 2006 ).…”

In-vivo design feedback and perceived utility of a genetically-informed smoking risk tool among current smokers in the community

“…The in-vivo approach used in the current study extends prior research that examined participants’ attitudes about receiving and using both hypothetical [ 19 , 23 , 41 , 42 , 60 , 27 , 47 ] and personalized [ 7 , 10 – 18 , 28 – 38 , 47 , 2 ] genetic information for various purposes by analyzing participants’ feedback about the RiskProfile concurrently with its delivery. This study capitalized on the opportunity to engage participants using qualitative and user-centered design methods to gain a deep understanding of their motivations, perceived utility, concerns, recommended improvements, and positive aspects of the RiskProfile .…”

“…There is now a growing body of work on the impact of genetic information about smoking and smoking-related disorders (e.g., nicotine addiction, lung cancer). These studies have informed current smokers’ perceptions about hypothetical and actual genetic results [ 41 , 42 , 43 ] and have assessed behavior change, decision making, motivation, and other related outcomes subsequent to return of personalized genetic results [ 7 , 44 – 46 , 11 , 12 , 17 , 18 , 47 ]. Despite these studies providing a wealth of important findings, no known studies have solicited user-centered design feedback of a genetic risk communication tool concurrent with the return of smoking-related genetic results.…”

Evidence-based smoking cessation treatment: a comparison by healthcare system

“…Some services, including a bidirectional e-referral to the state tobacco quitline and automated telephone follow-up encounters, are intended to maximize the service’s reach [ 21 ]. Other smoking cessation-related activities, including one-on-one phone counseling with certified smoking cessation treatment specialists, free FDA-approved smoking cessation medication to eligible smokers, and precision care based on nicotine metabolism, are intended to augment personalized tobacco treatment [ 37 , 38 ].…”