Shields Alexandra Elizabeth, Najafzadeh Mehdi, Schachter Anna Boonin
Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Suite 901 Boston, MA 02114, USA ; Department of Medicine, Harvard Medical School, 25 Shattuck St Boston, MA 02115, USA.
Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham & Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA.
Per Med. 2013 Nov 1;10(8):813-825. doi: 10.2217/pme.13.89.
To assess potential barriers to clinical integration of tailored smoking cessation treatment among African American and white smokers in the USA.
A total of 392 smokers (203 white and 189 African American) identified within a national random digit dial survey (response rate: 40.1%; 81.2% among households with whom we were able to make contact) of 1200 African Americans and 1200 white Americans. Respondents answered several closed-ended survey items addressing beliefs regarding what influences a smoker's ability to quit, past pharmacotherapy use, and their willingness to undergo genetic assessment in order to be matched to optimal treatment, among other items.
In this first nationally representative survey of US smokers, 77% of respondents expressed willingness to undergo genetic testing in order to be matched to optimal pharmacotherapy, yet only 18% had ever used pharmacotherapy in a previous quit attempt. Smokers who rated 'medications and counseling' as very important in quitting were significantly more likely to endorse genetic testing (odds ratio [OR]: 8.94; 95% CI: 1.86-43.06), while those rating 'having God's help' as very important were significantly less likely to express willingness to undergo testing (OR: 0.11; 95% CI: 0.02-0.71). African American smokers were more likely than white smokers to express willingness to undergo genetic testing (OR: 3.80; 95% CI: 1.09-13.22), despite lower rates of previous pharmacotherapy use.
While smokers reported high rates of willingness to undergo genetic testing to be matched to optimal treatment, these results suggest that smokers' willingness to use medications indicated by genetic test results may prove a significant barrier to realizing the promise of tailored smoking cessation treatment. The role of spirituality in smokers' willingness to use medication is an area for further study.
评估美国非裔美国人和白人吸烟者在接受定制戒烟治疗的临床整合过程中可能存在的障碍。
在一项针对1200名非裔美国人和1200名白人美国人的全国随机数字拨号调查中（回复率：40.1%；在我们能够联系到的家庭中回复率为81.2%），共识别出392名吸烟者（203名白人，189名非裔美国人）。受访者回答了几个封闭式调查项目，内容涉及对影响吸烟者戒烟能力的因素的看法、过去使用药物治疗的情况，以及他们为了获得最佳治疗而接受基因评估的意愿等。
在这项美国吸烟者的首次全国代表性调查中，77%的受访者表示愿意接受基因检测以获得最佳药物治疗，但只有18%的人在之前的戒烟尝试中使用过药物治疗。认为“药物和咨询”对戒烟非常重要的吸烟者更有可能认可基因检测（优势比[OR]：8.94；95%置信区间：1.86 - 43.06），而认为“得到上帝的帮助”非常重要的吸烟者表示愿意接受检测的可能性显著降低（OR：0.11；95%置信区间：0.02 - 0.71）。尽管非裔美国吸烟者之前使用药物治疗的比例较低，但他们比白人吸烟者更有可能表示愿意接受基因检测（OR：3.80；95%置信区间：1.09 - 13.22）。
虽然吸烟者报告称愿意接受基因检测以获得最佳治疗的比例很高，但这些结果表明，吸烟者使用基因检测结果所指示药物的意愿可能成为实现定制戒烟治疗前景的一个重大障碍。灵性在吸烟者使用药物意愿方面的作用是一个有待进一步研究的领域。
