Research Department, Southcentral Foundation, Anchorage, AK, USA.
Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA.
Nicotine Tob Res. 2024 Jan 1;26(1):79-86. doi: 10.1093/ntr/ntad133.
Alaska Native and American Indian (ANAI) people have a smoking prevalence of 23%. Nicotine metabolite ratio (NMR) and genetic testing may enable tailored selection of tobacco cessation medication.
The purpose of this study was to evaluate the relative contributions of NMR, cessation medication, demographics, and tobacco use history to cessation. Participants were recruited into an observational cohort study consisting of a baseline visit prior to their quit date and 6-week follow-up. Demographic and tobacco use surveys and blood, urine, and breath samples were collected at each visit. Electronic health records were queried for cessation medications. NMR was categorized into slow or normal nicotine metabolism phenotypes (<0.31 and ≥ 0.31, respectively). The main outcome was cessation at 6 weeks. Analyses consisted of descriptive statistics, medication and phenotype concordance, and estimates of relative risk (RR) of quitting.
We enrolled 151 ANAI adults who smoked cigarettes daily. Two-thirds had normal nicotine metabolism phenotype. Retrospective medication and phenotype concordance was 39%. The overall quit rate was 25%. No demographic factors or tobacco use history were associated with quit success. Varenicline and bupropion increased the likelihood of quitting (RR = 2.93 [1.42, 6.03] and RR = 2.52 [1.12, 5.64], respectively) compared to nicotine replacement therapy. Non-optimal medication and phenotype concordance decreased likelihood of quit success (RR = 0.44 [0.22, 0.91]) compared to optimal concordance.
This exploratory study found associations between quit success and tobacco cessation medication as well as medication and phenotype concordance. Additional research is needed to assess use of NMR for treatment selection among ANAI people.
These results broadly support additional community-engaged research to improve medication and phenotype concordance in tribal health settings. Such future research on implementing meditcation and phenotype concordance holds promise to improve expectations, quit success, and health outcomes amongst individuals attempting to quit smoking.
阿拉斯加原住民和美洲印第安人（ANAI）的吸烟率为 23%。尼古丁代谢物比（NMR）和基因检测可以帮助选择更适合的戒烟药物。
本研究旨在评估 NMR、戒烟药物、人口统计学因素和吸烟史对戒烟的相对贡献。参与者被招募到一个观察性队列研究中，该研究包括在戒烟日期前的基线访问和 6 周的随访。在每次访问时收集人口统计学和吸烟史调查以及血液、尿液和呼吸样本。电子健康记录被查询戒烟药物。NMR 分为慢代谢或正常代谢表型（分别为<0.31 和≥0.31）。主要结果是 6 周时的戒烟率。分析包括描述性统计、药物和表型一致性以及戒烟相对风险（RR）的估计。
我们招募了 151 名每天吸烟的 ANAI 成年人。三分之二的人有正常的尼古丁代谢表型。回顾性药物和表型一致性为 39%。总的戒烟率为 25%。没有人口统计学因素或吸烟史与戒烟成功相关。与尼古丁替代疗法相比，伐伦克林和安非他酮增加了戒烟的可能性（RR=2.93[1.42,6.03]和 RR=2.52[1.12,5.64]）。与最佳一致性相比，非最佳药物和表型一致性降低了戒烟成功的可能性（RR=0.44[0.22,0.91]）。
这项探索性研究发现戒烟成功与戒烟药物以及药物和表型一致性之间存在关联。需要进一步的研究来评估在 ANAI 人群中使用 NMR 进行治疗选择。
这些结果广泛支持在部落卫生环境中进一步开展社区参与的研究，以提高药物和表型一致性。在实施药物和表型一致性方面的未来研究有望改善试图戒烟的个体的期望、戒烟成功率和健康结果。
