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Young smokers’ views of genetic susceptibility testing for lung cancer risk: minding unintended consequences

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Abstract

Assessment of smokers’ responses to individualized feedback of genetic susceptibility has shown little or no influence on smoking cessation outcomes. One explanation is that smokers may be having unintended responses that undermine the feedback’s motivational impact (e.g., fatalism or downplaying risk). In preparation for a large randomized trial with college smokers, we conducted a qualitative pilot study to explore smokers’ motives for genetic testing and how these motives might influence interpretation of genetic risk feedback. Prior to reviewing informational materials describing a test for the glutathione S-transferase M1 gene, 33 college smokers (18 to 21 years) participated in a 30-min, semistructured, open-ended interview regarding their attitudes on health risks, genetic testing in general, genetic testing for lung cancer risk, and informational needs regarding genetics and genetic testing for lung cancer risk. Two central themes emerged from an analysis of the interviews: general impressions of genetic testing and perceived value of genetic testing. Prominent in the second theme was the finding that genetic risk feedback may be unsuccessful in motivating quitting (a) due to skepticism about genetic tests, (b) participants dismissing genetic feedback as personally irrelevant, and (c) participants receiving low-risk results justifying continued smoking in light of public health messages that “it’s never too late to quit.” These findings require careful consideration among health professionals looking to genetic risk feedback as a vehicle to motivate disease prevention or behavior change.

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References

  • Amos A, Wiltshire S, Haw S, McNeill A (2006) Ambivalence and uncertainty: experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens. Health Edc Res 21(2):181–191

    Article  Google Scholar 

  • Arnett JJ (2000) Optimistic bias in adolescent and adult smokers and nonsmokers. Add Behav 25(4):625–632

    Article  CAS  Google Scholar 

  • ATLAS/ti. Version 5.0. [Computer sofware] (2005) Berlin, Scientific Sofware Development

  • Audrain J, Boyd NR, Roth J, Main D, Caporaso NF, Lerman C (1997) Genetic susceptibility testing in smoking-cessation treatment: one-year outcomes of a randomized trial. Addict Behav 22:741–751

    Article  PubMed  CAS  Google Scholar 

  • Benhamou S, Lee WJ, Alexandrie AK et al (2002) Meta- and pooled analyses of the effects of glutathione S-transferase M1 polymorphisms and smoking on lung cancer risk. Carcinogenesis 23:1343–1350

    Article  PubMed  CAS  Google Scholar 

  • Bloss CS, Ornowski L, Silver E et al (2010) Consumer perceptions of direct-to-consumer personalized genomic risk assessments. Genet Med 12:556–566

    Article  PubMed  Google Scholar 

  • Bloss C, Schork NJ, Topol EJ (2011) Effect of direct-to-consumer genomewide profiling to assess disease risk. NEJ 364:524–534

    Article  CAS  Google Scholar 

  • Carlsten C, Burke W (2006) Potential for genetics to promote public health: genetics research on smoking suggests caution about expectations. JAMA 22:2480–2482

    Article  Google Scholar 

  • Carpenter MJ, Strange C, Jones Y, Dickson MR, Carter C, Moseley MA, Gilbert GE (2007) Does genetic testing result in behavioral health change? Changes in smoking behavior following testing for alpha-1 antitrypsin deficiency. Ann Behav Med 33(1):22–28

    Article  PubMed  Google Scholar 

  • Cohn LD, Macfarlane S, Yanez C, Imai WK (1995) Risk-perception: differences between adolescents and adults. Health Psychol 14:217–222

    Article  PubMed  CAS  Google Scholar 

  • Collins RE, Wright AJ, Marteau TM (2011) Impact of communicating personalized genetic risk information on perceived control over the risk: a systematic review. Genet Med 13(4):273–277

    Article  PubMed  Google Scholar 

  • Guest G, Bunce A, Johnson L (2006) How many interviews are enough?: an experiment with data saturation and variability. Field Methods 18:59–82

    Article  Google Scholar 

  • Henrikson NB, Bowen D, Burke W (2009) Does genomic risk information motivate people to change their behavior? Genome Med 1(4):37

    Article  PubMed  Google Scholar 

  • Heshka JT, Palleschi C, Howley H, Wilson B, Wells PS (2008) A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genet Med 10:19–32

    Article  PubMed  Google Scholar 

  • Hock KT, Christensen KD, Yashar BM, Roberts JS, Gollust SE, Uhlmann WR (2011) Direct-to-consumer genetic testing: an assessment of genetic counselors’ knowledge and beliefs. Gen in Med 13(4):325–332

    Article  Google Scholar 

  • Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288

    Article  PubMed  Google Scholar 

  • Hunter DJ, Khoury MJ, Drazen JD (2008) Letting the genome out of the bottle—will we get our wish? N Engl J Med 358:105–107

    Article  PubMed  CAS  Google Scholar 

  • Ito H, Matsuo K, Wakai K et al (2006) An intervention study of smoking cessation with feedback on genetic cancer susceptibility in Japan. Prev Med 42(2):102–108

    Article  PubMed  Google Scholar 

  • Janz NK, Becker MH (1984) The health belief model: a decade later. Health Educ Q 11(1):1–47

    PubMed  CAS  Google Scholar 

  • Koury M (2003) Genetics and genomics in practice: the continuum from genetic disease to genetic information in health and disease. Genet Med 5:261–268

    Article  Google Scholar 

  • Kunda Z (1987) Motivated inference: self-serving generation and evaluation of causal theories. J Pers Soc Psychol 53(4):636–647

    Article  Google Scholar 

  • Lerman CE, Munafò MR (2007) Genetics and smoking cessation improving outcomes in smokers at risk. Am J Prev Med 33(6 Suppl):S398–S405

    Article  PubMed  Google Scholar 

  • Lerman C, Gold K, Audrain J et al (1997) Incorporating biomarkers of exposure and genetic susceptibility into smoking cessation treatment: effects on smoking-related cognitions, emotions, and behavior change. Health Psychol 16(1):87–99

    Article  PubMed  CAS  Google Scholar 

  • Marteau TM, French DP, Griffin SJ, Prevost AT, Sutton S, Watkinson C, Attwood S, Hollands GJ (2010) Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours. Cochrane Database Syst Rev 6(10):CD007275, Review

    Google Scholar 

  • McBride CM, Halabi S, Bepler G, Lyna P, McIntyre L, Lipkus I, Albright J, O’Briant K (2000) Maximizing the motivational impact of feedback of lung cancer susceptibility on smokers’ desire to quit. J Heal Commun 5:229–241

    Article  CAS  Google Scholar 

  • McBride CM, Bepler G, Lipkus IM et al (2002) Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income. Cancer Epidemiol Biomarkers Prev 11:521–528

    PubMed  Google Scholar 

  • McBride CM, Koehly LM, Sanderson SC, Kaphingst KA (2010) The behavioral response to personalized genetic information: will genetic risk profiles motivate individuals and families to choose more healthful behaviors? Annu Rev Public Health 21(31):89–103

    Article  Google Scholar 

  • McCoy SB, Gibbons FX, Reis TJ, Gerrard M, Luus CA, Sufka AV (1992) Perceptions of smoking risk as a function of smoking status. J Behav Med 15(5):469–488

    Article  PubMed  CAS  Google Scholar 

  • Mogilner A, Otten M, Cunningham JD, Brower ST (1998) Awareness and attitudes concerning BRCA gene testing. Ann Surg Oncol 5(7):607–612

    Article  PubMed  CAS  Google Scholar 

  • O’Neill SC, Luta G, Peshkin BN, Abraham A, Walker LR, Tercyak KP (2009) Adolescent medical providers’ willingness to recommend genetic susceptibility testing for nicotine addiction and lung cancer risk to adolescents. J Pediatr Psychol 34(6):617–626

    Article  PubMed  Google Scholar 

  • Patton M (2002) Qualitative research and evaluation methods, 3rd edn. Sage, Thousand Oaks

    Google Scholar 

  • Perez GK, Cruess DG, Cruess S, Brewer M, Stroop J, Schwartz R, Greenstein R (2011) Attitudes toward direct-to-consumer advertisements and online genetic testing among high-risk women participating in a hereditary cancer clinic. J Health Commun 22:1–22

    Google Scholar 

  • Pollack A (2010) Start-up may sell genetic tests in stores. New York Times. May 11, 2010:B2

  • Sandelowski M (2000) What ever happened to qualitative description? Res Nurs Health 23:334–340

    Article  PubMed  CAS  Google Scholar 

  • Sanderson SC, Hubbart C, Hughes E, Jarvis MJ, Wardle J (2008) Psychological and behavioral impact of genetic testing smokers for lung cancer risk: a phase II exploratory trial. J Health Psychol 13(4):481–494

    Article  PubMed  Google Scholar 

  • Sanderson SC, O’Neill SC, White DB et al (2009) Responses to online GSTM1 genetic test results among smokers related to patients with lung cancer: a pilot study. Cancer Epidemiol Biomarkers Prev 18:1953–1961

    Article  PubMed  CAS  Google Scholar 

  • Sanderson SC, O’Neill SC, Bastian LA, Bepler G, McBride CM (2010) What can interest tell us about uptake of genetic testing? intention and behavior amongst smokers related to patients with lung cancer. Public Health Genomics 13(2):116–124

    Article  PubMed  CAS  Google Scholar 

  • Sobti RC, Kaur P, Kaur S et al (2008) Combined effect of GSTM1, GSTT1 and GSTP1 polymorphisms on histological subtypes of lung cancer. Biomarkers 13:282–295

    Article  PubMed  CAS  Google Scholar 

  • Sussner KM, Jandorf L, Thompson HS, Valdimarsdottir HB (2010) Interest and beliefs about BRCA genetic counseling among at-risk Latinas in New York City. J Genet Couns 19(3):255–268

    Article  PubMed  Google Scholar 

  • Tucker JS, Ellickson PL, Klein DJ (2002) Smoking cessation during the transition from adolescence to young adulthood. Nicotine Tob Res 4:321–322

    Article  PubMed  Google Scholar 

  • Vineis P, Anttila S, Benhamou S et al (2007) Evidence of gene gene interactions in lung carcinogenesis in a large pooled analysis. Carcinogenesis 28(9):1902–1905

    Article  PubMed  CAS  Google Scholar 

  • Weiner BJ, Amick HR, Lund JL et al (2011) Review: use of qualitative methods in published health services and management research: a 10-year review. Med Care Res Rev 68:3–33

    Article  PubMed  Google Scholar 

  • Westmaas JL, Woicik PB (2005) Dispositional motivations and genetic risk feedback. Addic Behav 30:1524–1534

    Article  Google Scholar 

  • Wiltshire S, Amos A, Haw S, McNeill A (2005) Image, context and transition: smoking in mid-to-late adolescence. J Adolesc 28(5):603–617

    Article  PubMed  Google Scholar 

  • Wright AJ AJ, Weinman J, Marteau TM (2003) The impact of learning of a genetic predisposition to nicotine dependence: an analogue study. Tob Control 12:227–230

    Article  PubMed  Google Scholar 

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Financial relationships

The authors do not have a financial relationship with the funding agency (National Cancer Institute), and the authors declare that they have no conflict of interest.

Funding

This study was supported by the NIH/NCI grant R01CA121922 (PI: Isaac M. Lipkus) and an IPA from NIH/NCI to James A. Shepperd.

Author information

Authors and Affiliations

  1. Duke University School of Nursing, DUMC 3322, Durham, NC, 27710, USA

    Sharron L. Docherty & Isaac M. Lipkus

  2. Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA

    Colleen M. McBride

  3. Mount Sinai School of Medicine, New York, NY, USA

    Saskia C. Sanderson

  4. Georgetown University, Washington, DC, USA

    Suzanne C. O’Neill

  5. University of Florida, Gainesville, FL, USA

    James A. Shepperd

Authors
  1. Sharron L. Docherty
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  2. Colleen M. McBride
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  3. Saskia C. Sanderson
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  4. Suzanne C. O’Neill
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  5. James A. Shepperd
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  6. Isaac M. Lipkus
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Corresponding author

Correspondence to Sharron L. Docherty.

Appendix

Appendix

Semistructured Interview Guide

  1. 1.

    Tell me why you were interested in enrolling in this study.

    Prompts: What is your understanding of what this study is about?

  2. 2.

    What health risks do you worry about?

    Why?

  3. 3.

    When someone says they desire to undergo genetic testing, what comes to mind?

    What does genetic testing mean to you?

  4. 4.

    What do you think about genetic testing for diseases in general?

    Prompts: Do you think that it is useful for people to know what diseases they may genetically be at risk for getting? Why?

  5. 5.

    Would you be interested in having a test that would give you information on your potential risk for lung cancer? Why or why not?

    How would the information be personally relevant to you?

    How do you think you would make use of the information (i.e., test result)?

  6. 6.

    What do you think are the advantages/disadvantages of genetic testing for lung cancer?

  7. 7.

    What do you think has influenced your feelings about genetic testing for lung cancer?

    Prompts: Family, friends, movies, stories?

  8. 8.

    What would you want to know about a specific genetic test for lung cancer when making a decision about whether or not to be tested?

    Why would you want to know these things?

  9. 9.

    What kind of format would you prefer the information to be presented in?

    Probes: Verbal communication? Written communication? Both written and verbal? Electronic presentation?

  10. 10.

    What do you think is involved in genetic testing for lung cancer?

    For example, what type of information to do you expect to get?

    What will you be asked to do? How do you envision the test result to be given to you?

    What, if anything, do you feel you will be asked to do after getting your test result?

  11. 11.

    Tell me what you know about lung cancer, regardless of how trivial this may seem?

    Probes:

    1. (a)

      What do you think are the causes of lung cancer?

    2. (b)

      What are the symptoms of lung cancer?

    3. (c)

      What do you think are the consequences of lung cancer?

    4. (d)

      How do you think it feels to live with lung cancer?

    5. (e)

      What do you think can be done once a person is diagnosed with lung cancer?

    6. (f)

      Do you think lung cancer is curable?

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Docherty, S.L., McBride, C.M., Sanderson, S.C. et al. Young smokers’ views of genetic susceptibility testing for lung cancer risk: minding unintended consequences. J Community Genet 2, 165–172 (2011). https://doi.org/10.1007/s12687-011-0053-1

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  • DOI: https://doi.org/10.1007/s12687-011-0053-1

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