Biomedical subjects

Caryn Lerman

Publications and source records attributed to Caryn Lerman.

At least 37 records · Page 2Linked to original sources

PubMed2005

Increases in hyperactive-impulsive symptoms predict relapse among smokers in nicotine replacement therapy.

Inattention and hyperactive-impulsive symptoms have been associated with nicotine dependence. In an open-label randomized trial (N = 454) of transdermal nicotine versus nicotine nasal spray, we examined whether increases in inattention and hyperactive-impulsive symptoms measured by self-report in the first quit week predicted relapse at the end of 8 weeks of treatment (EOT). During the first quit week, 166 (37%) participants reported an increase whereas 288 (63%) reported no change/decrease in total symptoms; changes were not influenced by treatment type. In a logistic regression model of abstinence, an increase in total symptoms in the first quit week significantly reduced odds of abstinence at EOT (continuous change score: OR = 0.94, 95% CI = 0.91-0.98, p = .002; dichotomized change score: OR = 0.57, 95% CI = 0.37-0.87, p = .009). Early increases in inattention and hyperactive-impulsive symptoms following quit date during nicotine replacement therapy predicted relapse to smoking, suggesting that treatments targeting these symptoms in the first quit week may facilitate abstinence.

Adult↗

PubMed2005

The use of race variables in genetic studies of complex traits and the goal of reducing health disparities: a transdisciplinary perspective.

The use of racial variables in genetic studies has become a matter of intense public debate, with implications for research design and translation into practice. Using research on smoking as a springboard, the authors examine the history of racial categories, current research practices, and arguments for and against using race variables in genetic analyses. The authors argue that the sociopolitical constructs appropriate for monitoring health disparities are not appropriate for use in genetic studies investigating the etiology of complex diseases. More powerful methods for addressing population structure exist, and race variables are unacceptable as gross proxies for numerous social/environmental factors that disproportionately affect minority populations. The authors conclude with recommendations for genetic researchers and policymakers, aimed at facilitating better science and producing new knowledge useful for reducing health disparities.

Health Status↗

PubMed2005

Recurrent event analysis of lapse and recovery in a smoking cessation clinical trial using bupropion.

We report a reanalysis of data from a prior study describing the event history of quitting smoking aided by bupropion, using recurrent-event models to determine the effect of the drug on occurrence of lapses and recoveries from lapse (resumption of abstinence). Data were collected on 1,070 subjects across two similar double-blind randomized clinical trials of bupropion versus placebo and fitted with separate Cox regression models for lapse and recovery. Analyses were split using discrete time-varying covariates between the treatment (weeks 1-10) and follow-up phases (end of treatment to 12 months). Bupropion was associated with slower lapse during treatment for both sexes, and being female was associated with faster lapse across both phases. Drug did not affect time to recovery for males but was associated with faster recovery among females, allowing women to recover as quickly as men. High levels of nicotine dependence did not affect time to lapse but were associated with slower recovery from lapse across treatment and follow-up phases. During the treatment phase, higher levels of baseline depression symptoms had no effect on time to lapse but were associated with slower recovery from lapse. Results highlight the asymmetry in factors preventing lapse versus promoting recovery. Specifically, dependence, depression symptoms, and a sex x drug interaction were found to affect recovery but not lapse. Further research disentangling lapse and recovery events from summary abstinence measures is needed to help us develop interventions that take advantage of bupropion at its best and that compensate where it is weak.

Adult↗

PubMed2005

The types of regular cigarette smokers: a latent class analysis.

The present study sought to refine cigarette smoking exposure by examining whether individuals with a history of regular cigarette smoking could be classified into meaningful subgroups based on their smoking habits, nicotine dependence, and quit attempts. Data were obtained from 3,025 male and female twins aged 22-59 years who participated in two longitudinal studies based on the Virginia Twin Registry. Latent class analysis was used to identify the number and nature of subgroups of smokers reporting similar smoking habits based on 18 characteristics. Estimates of prevalence for different classes of smoking were obtained along with expected frequencies of endorsements for each smoking behavior by class. Distributions of demographic characteristics, psychopathology, and personality were examined as external validators. The results demonstrated considerable heterogeneity and revealed eight classes of smokers who differed in their degree of nicotine dependence, cessation attempts, and ability to quit smoking. Smoking classes ranged from individuals who were all former smokers with low nicotine dependence who attempted to quit once and were successful, to individuals who were all current smokers with little desire to quit, to individuals with high nicotine dependence with multiple quit attempts, only a subset of which were successful. Estimates of prevalence for each class were 9%-20%. Our findings support the idea that regular cigarette smokers are highly heterogeneous and highlight the need for smoking exposure refinement in future studies. Acknowledging the complexity of cigarette smoking and classifying smokers into more specific subgroups based on their smoking behavior in future studies will enable more accurate evaluation of disease etiology and risk and could lead to more appropriate smoking cessation interventions.

Adult↗

PubMed2005

Association of catechol-O-methyltransferase with smoking cessation in two independent studies of women.

OBJECTIVES AND METHODS: The Val108/158Met polymorphism in the gene that encodes COMT, a dopamine metabolizing enzyme, results in a three- to four-fold reduction in COMT activity. To determine if the lower activity Met allele of COMT was associated with smoking cessation in women, we used two independent studies: a population-based case--control study and a nicotine replacement clinical trial. RESULTS: In the case--control study, women with two Met alleles were significantly more likely to be ex-smokers than current smokers [OR=1.82, 95% CI (1.05, 3.17), P=0.03]. In the nicotine replacement clinical trial, among women, the Met/Met genotype was associated with a higher probability of smoking cessation based on both point prevalence and prolonged abstinence outcomes [OR=2.96, 95% CI (1.07, 8.14), P=0.04; OR=3.23, 95% CI (1.13, 9.20), P=0.03, respectively]. CONCLUSIONS: This first report of a significant association between COMT Val108/158Met and smoking cessation suggests that COMT variation has an effect on smoking behavior in women.

Aged↗

PubMed2005

Barriers to translating emerging genetic research on smoking into clinical practice. Perspectives of primary care physicians.

OBJECTIVE: Smoking remains the leading cause of preventable death nationally. Emerging research may lead to improved smoking cessation treatment options, including tailoring treatment by genotype. Our objective was to assess primary care physicians' attitudes toward new genetic-based approaches to smoking treatment. DESIGN AND SETTING: A 2002 national survey of primary care physicians. Respondents were randomly assigned a survey including 1 of 2 scenarios: a scenario in which a new test to tailor smoking treatment was described as a "genetic" test or one in which the new test was described as a "serum protein" test. PARTICIPANTS: The study sample was randomly drawn from all U.S. primary care physicians in the American Medical Association Masterfile (e.g., those with a primary specialty of internal medicine, family practice, or general practice). Of 2,000 sampled physicians, 1,120 responded, yielding a response rate of 62.3%. MEASUREMENTS AND MAIN RESULTS: Controlling for physician and practice characteristics, describing a new test as "genetic" resulted in a regression-adjusted mean adoption score of 73.5, compared to a score of 82.5 for a nongenetic test, reflecting an 11% reduction in physicians' likelihood of offering such a test to their patients. CONCLUSIONS: Merely describing a new test to tailor smoking treatment as "genetic" poses a significant barrier to physician adoption. Considering national estimates of those who smoke on a daily basis, this 11% reduction in adoption scores would translate into 3.9 million smokers who would not be offered a new genetic-based treatment for smoking. While emerging genetic research may lead to improved smoking treatment, the potential of novel interventions will likely go unrealized unless barriers to clinical integration are addressed.

Adult↗

PubMed2005

Utilization of BRCA1/BRCA2 mutation testing in newly diagnosed breast cancer patients.

BACKGROUND: Among newly diagnosed breast cancer patients who are at risk for carrying a BRCA1 or BRCA2 mutation, knowledge of mutation status can influence local breast cancer treatment decisions. Thus, genetic testing at the time of diagnosis is increasingly considered an option for such patients. In this study, we evaluated factors associated with the decision to undergo BRCA1/BRCA2 gene testing at the time of initial breast cancer diagnosis. METHODS: Participants were newly diagnosed breast cancer patients who had not yet received definitive local breast cancer treatment and who had a family history consistent with hereditary breast cancer. Participants were offered genetic counseling and BRCA1/BRCA2 testing with results in 2 to 3 weeks. RESULTS: Of 231 patients who referred to the study, 20 (9%) declined the baseline interview, 34 (15%) completed a baseline interview but declined genetic testing, and 177 (76%) underwent BRCA1/BRCA2 testing. Physician recommendation for BRCA1/BRCA2 testing and indecision about definitive local treatment were both associated with undergoing testing. Among patients who were tested, 38 (21%) proceeded with definitive local treatment before receiving test results. Delay in the availability of test results and low levels of anxiety were associated with the decision to proceed with definitive local treatment before receiving test results. CONCLUSIONS: These results suggest that if rapid testing is available and genetic referrals are made for appropriate patients, a high proportion are likely to opt for such testing. In particular, patients who have not yet reached a decision about definitive local treatment may benefit from a genetic referral.

Adult↗

PubMed2005

Catechol-O-methyl-transferase functional polymorphism and nicotine dependence: an evaluation of nonreplicated results.

Review articles have focused attention on and cited possible reasons for the nonreplication of genetic association studies. Herein, we illustrate how one might work through these possible reasons to make a judgment about the most plausible reason(s) when faced with two or more studies which yield seemingly inconsistent results. In the first study, 342 treatment-seeking smokers were genotyped for the Val108Met polymorphism in the functional catechol-O-methyl-transferase (COMT) locus. Alleles coding Val at codon 108 are denoted as H and those coding Met are denoted as L. An association between presence of the "H" (high activity) allele and pretreatment level of nicotine dependence level using the Fagerstrom Test for Nicotine Dependence was detected (P = 0.0072), after controlling for baseline body mass index (BMI, kg/m2), depression symptoms, and age. To validate this initial finding, 443 treatment-seeking smokers from an independent smoking cessation clinical trial were genotyped for the COMT polymorphism. Within the second study, no association between presence of the "H" allele and nicotine dependence was detected (P = 0.6418) after controlling for baseline BMI, depression symptoms, and age. We critically reviewed both studies with regard to often cited reasons for nonreplication, including type I error, population stratification, low statistical power, and imprecise measures of phenotype. Although in our opinion the failure to replicate the initial association in the second study is likely either the result of low statistical power to detect a small effect or effect heterogeneity, thorough analyses failed to definitively identify the reason for nonreplication.

Adult↗

PubMed2005

Behavioral consequences of testing for obesity risk.

OBJECTIVE: There is considerable hope that genetic susceptibility testing will motivate behavior that can prevent or reduce the risk of complex conditions such as obesity. This study examined potential behavioral consequences of such testing. METHODS: Participants (n = 249) were randomly assigned to review one of four vignettes that asked them to imagine that they had been tested for their risk of becoming overweight or obese. The experimental factors were test type (genetic versus hormone test) and risk level (increased versus average risk for obesity). Study measures included behavioral intentions and perceived behavioral control related to eating a healthy diet, as well as weight locus of control. RESULTS: Participants assigned to the increased risk conditions indicated greater intentions to eat a healthy diet compared with participants assigned to the average risk conditions (P < 0.02). There were significant interaction effects of risk x perceived behavioral control (P < 0.02) and risk x weight locus of control (P < 0.003) on dietary intentions. Individuals with low perceived behavioral control or an external weight locus of control who were told to imagine they were at average risk expressed significantly lower intentions to eat a healthy diet. A three-way interaction of body mass index, family history of overweight/obesity, and assigned risk level found the greatest effects of risk feedback among those who either had a family history or a higher body mass index (P < 0.007). CONCLUSION: This study provides preliminary evidence that testing for susceptibility to obesity may motivate healthier behavior. However, some individuals may be susceptible to a false reassurance effect after receiving test results indicating a lack of increased risk.

Adult↗

PubMed2005

A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients.

BACKGROUND: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking. PURPOSE: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation. METHODS: Cancer patients (N=109) were randomized to either the theoretically based CBT intervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy. RESULTS: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either a 1-month (44.9 vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation. CONCLUSIONS: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions for future research in this area.

Cognitive Behavioral Therapy↗

PubMed2005

Pharmacogenetics and nicotine addiction treatment.

This review focuses on the current status of, and future directions for, pharmacogenetic research on nicotine dependence and smoking cessation treatment. Pharmacological treatment involving nicotine replacement therapy and bupropion for nicotine addiction and smoking cessation has been shown to be efficacious when provided in combination with behavioral support. Cessation rates remain somewhat modest, however, and one possibility is that success rates may be enhanced by offering treatments tailored to an individual's genotype. Nonetheless, research on this issue remains in its infancy, and although the scope for individualized treatment tailored to genotype is promising, there are substantial practical, ethical and social considerations that must be addressed before such research is translated into clinical practice.

Bupropion↗

PubMed2005

Smoking cessation treatment: pharmacogenetic assessment.

This review focuses on the current status and future directions of pharmacogenetics research into responses to treatments for nicotine dependence and smoking cessation. Research remains in its infancy and, although the potential for individualized treatment tailored to genotype is promising, there are practical, ethical and social considerations that must be addressed before such research is translated into clinical practice. In particular, future studies that need to be conducted before such research is translated into clinical practice and potential limitations and barriers to this translation are described.

Genotype↗

PubMed2004

BRCA1/2 testing in hereditary breast and ovarian cancer families: effectiveness of problem-solving training as a counseling intervention.

It remains uncertain whether members of hereditary breast and ovarian cancer (HBOC) families experience psychological distress with genetic testing and whether pre-test counseling can have a moderating effect on client well-being. One purpose of this study was to assess change in psychological well-being from baseline to 6-9 months follow-up and the effect of a problem-solving training (PST) intervention on psychological well-being. Two hundred and twelve members of 13 HBOC families were offered BRCA1/2 testing for a previously identified family mutation. Participants received education and were randomized to one of two counseling interventions; PST or client-centered counseling. Psychological well-being was assessed at baseline and again at 6-9 months following the receipt of test results, or at the equivalent time for those participants who chose not to undergo testing. Well-being was assessed using measures of depressive symptoms (CESD), intrusive thoughts (IES), cancer worries, and self-esteem. Comparisons were made between those who chose testing and those who did not as well as between those who received positive and negative test results. One hundred eighty one participants elected to undergo genetic testing (85%) and 47 of these (26%) were identified as BRCA1/2 mutation carriers. Breast and ovarian cancer worries decreased significantly (p = 0.007 and 0.008, respectively) in those who tested negative while there was no appreciable change in psychological well-being from baseline to follow-up in either those who tested positive or in non-testers. Among all participants, particularly testers, those randomized to PST had a greater reduction in depressive symptoms than those randomized to client-centered counseling (p < 0.05 and p = 0.02, respectively). Regardless of the decision to test, individuals with a personal history of cancer (n = 22) were more likely to have an increase in breast cancer worries compared to those who had never been diagnosed with cancer (p < 0.001). Results suggest that a problem-solving counseling intervention may help to enhance psychological well-being following testing and that a personal history of cancer may increase psychological distress associated with genetic testing.

Adult↗

PubMed2004

Colon cancer screening practices following genetic testing for hereditary nonpolyposis colon cancer (HNPCC) mutations.

BACKGROUND: Although increased colonoscopic surveillance is recommended for hereditary nonpolyposis colon cancer (HNPCC) mutation carriers, limited information is available on adherence to colorectal cancer screening recommendations. This study investigated colonoscopy practices following genetic testing for HNPCC mutations. METHODS: This prospective cohort study was conducted between May 22, 1996, and November 13, 1999. Participants were 98 men and women without a personal history of colon cancer or colectomy who were identified from 11 extended HNPCC families. Colonoscopy use was evaluated by telephone before genetic counseling and was reassessed 1, 6, and 12 months following test results disclosure. RESULTS: During the 12 months following genetic counseling and testing, 73% (16/22) of HNPCC mutation carriers, 16% (8/49) of noncarriers, and 22% (6/27) of decliners reported having a colonoscopy (chi(2) = 23.97, P<.001). After controlling for clinical factors and pretest screening practices, HNPCC mutation carriers were significantly more likely than test decliners to have a colonoscopy (odds ratio [OR], 12.12; 95% confidence interval [CI], 3.42-42.96; P<.001). There were no differences in colonoscopy use between noncarriers and decliners (OR, 0.60; 95% CI, 0.28-1.29; P =.19). Perceived control over developing colon cancer also had a significant effect on posttest colonoscopy use (OR, 2.19; 95% CI, 1.22-3.94; P =.01). CONCLUSIONS: Genetic testing may motivate increased colonoscopic screening among HNPCC mutation carriers. Increased efforts may be needed to assess patients' family histories of colon cancer and provide appropriate referrals for genetic counseling and testing to target colonoscopic screening to high-risk individuals.

Adult↗

PubMed2004

Changes in food reward following smoking cessation: a pharmacogenetic investigation.

RATIONALE: Despite the high prevalence and public health significance of weight gain following smoking cessation, little is known about the underlying bio-behavioral mechanisms or effective therapies. OBJECTIVES: We evaluated the effects of bupropion on food reward following smoking abstinence and the moderating influence of genotype. METHODS: Seventy-one smokers of European ancestry were genotyped for the dopamine D2 receptor ( DRD2) Taq1 polymorphism and randomized to treatment with bupropion (300 mg) or placebo for smoking cessation. Subjects participated in two behavioral laboratory sessions during which the rewarding value of food was assessed using a behavioral economics measure: session 1 occurred prior to medication and before cessation of smoking; session 2 occurred following 3 weeks of medication and 1 week of sustained abstinence. RESULTS: Carriers of the DRD2 A1 minor allele exhibited significant increases in the rewarding value of food following abstinence from smoking, and these effects were attenuated by bupropion treatment ( P=0.03 for medication by genotype interaction). Further, higher levels of food reward at session 2 (post-quit) predicted a significant increase in weight by 6-month follow-up in the placebo group, but not in the bupropion-treated group ( P=0.006 for medication by food reward interaction). CONCLUSIONS: These results provide new evidence that the increase in body weight that occurs following smoking cessation is related to increases in food reward, and that food reward is partly determined by genetic factors. Bupropion's efficacy in attenuating abstinence-induced weight gain may be attributable, in part, to decreasing food reward.

Adult↗

PubMed2004

Impact of BRCA1/BRCA2 counseling and testing on newly diagnosed breast cancer patients.

PURPOSE: Approximately 5% to 10% of newly diagnosed breast cancer patients carry a BRCA1 or BRCA2 mutation. Given these patients' high risk for contralateral breast cancer, bilateral mastectomy is increasingly considered a treatment option for newly diagnosed BRCA1/2 carriers. In the present study, we prospectively evaluated the impact on surgical decision-making of pretreatment genetic counseling and BRCA1/BRCA2 testing among breast cancer patients at high-risk for carrying a mutation. PATIENTS AND METHODS: Participants were 194 newly diagnosed breast cancer patients who had not yet received definitive surgical treatment and who had at least a 10% prior probability of carrying a BRCA1/2 mutation. Participants were offered free genetic counseling and rapid BRCA1/2 testing. Primary analyses focused on the impact of BRCA1/2 test result on subsequent breast cancer surgical treatment. RESULTS: Forty-eight percent of patients who were found to carry a BRCA1/2 mutation chose bilateral mastectomy as their definitive breast cancer surgery. In contrast, 24% of patients in whom no mutation was detected and 4% of test decliners opted for bilateral mastectomy. Additional predictors of bilateral mastectomy included patients' self-reports of physician recommendations for BRCA1/2 testing and bilateral mastectomy. CONCLUSION: This study highlights patient interest in and the technical feasibility of offering presurgery BRCA1/2 testing to high-risk patients. Most importantly, these results demonstrate that BRCA1/2 test results significantly affect patients' surgical decision-making. The availability of genetic counseling and testing could serve as a valuable aid to patient decision-making for newly diagnosed breast cancer patients at high-risk for carrying a mutation.

Adult↗

PubMed2004

Individualizing nicotine replacement therapy for the treatment of tobacco dependence: a randomized trial.

BACKGROUND: Despite the well-documented efficacy and different pharmacokinetic and pharmacodynamic properties of different forms of nicotine replacement therapy, empirical data are insufficient to guide practitioners in selecting a particular form of treatment for individual patients with tobacco dependence. OBJECTIVE: To evaluate the comparative efficacy of transdermal nicotine and nicotine nasal spray and identify predictors of treatment outcome. DESIGN: Randomized, open-label clinical trial with a 6-month follow-up period. SETTING: 2 university-based smoking cessation research programs. PARTICIPANTS: 299 treatment-seeking smokers who were followed for 6 months after the target quit date. INTERVENTION: Behavioral group counseling and 8 weeks of therapy with nicotine nasal spray or transdermal nicotine. MEASUREMENTS: Demographic characteristics, smoking history, depression symptoms, and body mass index were measured at baseline. Smoking practices were biochemically verified at the end of treatment and at 6 months after the target quit date. RESULTS: Abstinence rates for the transdermal nicotine and nicotine nasal spray groups were not significantly different at 6-month follow-up (15.0% vs. 12.2%, respectively; P > 0.2). Interactions in abstinence rates for subgroups of smokers were statistically significant (P < 0.05). Smokers who had low to moderate dependence levels, were not obese, and were white achieved higher abstinence rates with transdermal nicotine, whereas smokers who were highly dependent, obese, or members of minority groups achieved higher abstinence rates with nasal spray. LIMITATIONS: The subgroup findings need confirmation in additional large studies before they are routinely applied. CONCLUSIONS: Ethnicity, weight, and level of nicotine dependence may help identify smokers who have greater or lesser abstinence rates with either transdermal or nasal spray nicotine.

Administration, Cutaneous↗

PubMed2004

Comparing cancer patients who enroll in a smoking cessation program at a comprehensive cancer center with those who decline enrollment.

BACKGROUND: Despite the availability of smoking interventions for cancer patients, many eligible patients decline enrollment into such programs. We examined reasons patients provide for declining smoking treatment and compared treatment decliners to enrollees. METHODS: Eligible cancer patients (N = 231) were offered smoking cessation treatment. During recruitment, demographic, medical (eg, cancer stage), and smoking-related behavioral (eg, readiness to quit) data were collected, and decliners stated a reason for refusal. Patients who enrolled in the cessation program (N = 109) were compared with those who declined (N = 122) in terms of recruitment data, and reasons for declining were compiled. RESULTS: Decliners were significantly more likely to: (1) have head and neck cancer (vs lung cancer); (2) exhibit fewer physical symptoms (eg, shortness of breath); (3) report a lower readiness to quit smoking; (4) indicate no intention to quit smoking; and (5) smoke fewer cigarettes. A preference to quit without professional assistance was the most common reason for declining treatment. CONCLUSIONS: Our findings highlight important differences between patients who enroll in a smoking cessation program and those who decline and underscore the need for motivational interventions to facilitate enrollment into smoking interventions for cancer patients.

Attitude to Health↗