Salma K. Marani

Psychological impact of genetic testing for hereditary nonpolyposis colorectal cancer

PURPOSE This study examines the impact of hereditary nonpolyposis colorectal cancer (HNPCC) genetic test results on psychological outcomes among cancer-affected and -unaffected participants up to 1 year after results disclosure. PATIENTS AND METHODS A total of 155 persons completed study measures before HNPCC genetic testing, and at 2 weeks and 6 and 12 months after disclosure of test results. RESULTS Mean scores on all outcome measures remained stable and within normal limits for cancer-affected participants, regardless of mutation status. Among unaffected carriers of HNPCC-predisposing mutations, mean depression, state anxiety, and cancer worries scores increased from baseline to 2 weeks postdisclosure and decreased from 2 weeks to 6 months postdisclosure. Among unaffected noncarriers, mean depression and anxiety scores did not differ, but cancer worries scores decreased during the same time period. Affected and unaffected carriers had higher mean test-specific distress scores at 2 weeks postdisclosure compared with noncarriers in their respective groups; scores decreased for affected carriers and all unaffected participants from 2 weeks to 12 months postdisclosure. Classification of participants into high- versus low-distress clusters using mean scores on baseline psychological measures predicted significantly higher or lower follow-up scores, respectively, on depression, state anxiety, quality of life, and test-specific distress measures, regardless of mutation status. CONCLUSION Although HNPCC genetic testing does not result in long-term adverse psychological outcomes, unaffected mutation carriers may experience increased distress during the immediate postdisclosure time period. Furthermore, those with higher levels of baseline mood disturbance, lower quality of life, and lower social support may be at risk for both short- and long-term increased distress.

Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students.

Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institutes Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIREs effects on cessation.

Developing mobile phone text messages for tobacco risk communication among college students: a mixed methods study

BackgroundEngaging young adults for the purpose of communicating health risks associated with nicotine and tobacco use can be challenging since they comprise a population heavily targeted with appealing marketing by the evolving tobacco industry. The Food and Drug Administration seeks novel ways to effectively communicate risks to warn about using these products. This paper describes the first step in developing a text messaging program delivered by smartphones that manipulate three messaging characteristics (i.e., depth, framing, and appeal).MethodsPerceptions of community college students were described after previewing text messages designed to inform about risks of using conventional and new tobacco products. Thirty-one tobacco users and nonusers, aged 18–25 participated in five focus discussions held on two community college campuses. Attendees reviewed prototype messages and contributed feedback about text message structure and content. Qualitative data were coded and analyzed using NVivo Version 10.ResultsMost participants were female and two-thirds were ethnic minorities. A variety of conventional and new tobacco products in the past month were used by a third of participants. Three identified domains were derived from the qualitative data. These included perceived risks of using tobacco products, receptivity to message content, and logistical feedback regarding the future message campaign.ConclusionOverall, participants found the messages to be interesting and appropriate. A gap in awareness of the risks of using new tobacco products was revealed. Feedback on the prototype messages was incorporated into message revisions. These findings provided preliminary confirmation that the forthcoming messaging program will be appealing to young adults.

Cognitive impairment in men with testicular cancer prior to adjuvant therapy.

Cognitive dysfunction experienced by individuals with cancer represents an important survivorship issue because of its potential to affect occupational, scholastic, and social activities. Whereas early efforts to characterize cognitive dysfunction primarily focused on the effects of chemotherapy, more recent evidence indicates that impairment may exist before systemic treatment. This study characterized cognitive dysfunction before adjuvant chemotherapy in a sample of men diagnosed with nonseminomatous germ cell tumors (NSGCT) of the testis.

Psychological functioning in persons considering genetic counseling and testing for Li-Fraumeni syndrome

Objective: Li–Fraumeni syndrome (LFS) confers an increased risk of multiple types of cancer in both children and adults. Clinical genetic testing for deleterious germline p53 gene mutations can identify most LFS‐affected families. We evaluated factors associated with cancer‐specific distress and perceived self‐efficacy in coping with a positive genetic test result among persons at risk of having deleterious p53 mutations.

A prospective study of cognitive function in men with non‐seminomatous germ cell tumors

Longitudinal neuropsychological assessments were performed to determine if adjuvant chemotherapy was associated with cognitive dysfunction in men with non‐seminomatous germ cell tumors (NSGCT).

Evaluation of a decision aid for families considering p53 genetic counseling and testing.

Purpose: Li-Fraumeni syndrome (LFS) is associated with p53 germline mutations, and carriers are at increased risk for multiple primary cancers. We evaluated outcomes following the administration of a video-based decision aid (DA) prior to clinical p53 genetic counseling and testing among persons who had previously participated in cancer genetics research.Methods: Fifty-seven individuals at risk for a known p53 mutation completed baseline and post-DA measures of psychological outcomes, plus knowledge and attitudes regarding p53 genetic testing. Counseling and testing uptake also was recorded.Results: At baseline, multivariate analysis showed that greater testing intention was associated with lower decisional conflict (P < 0.01). Compared with baseline data, multivariate analyses of post-DA outcomes showed that knowledge about LFS and genetic testing increased and decisional conflict related to testing decreased (P < 0.001). Mean cancer worries scores decreased among all participants (P < 0.001), and mean depression scores decreased for males (P < 0.05). Thirty-nine (68%) completed pre-test genetic counseling and 23 (40%) subsequently gave a blood sample for clinical genetic testing.Conclusion: This intervention was useful as an initial outreach and educational method for families considering p53 genetic testing, and may improve knowledge about LFS as well as psychological outcomes.

Self-Efficacy Mediates the Effect of Depression on Smoking Susceptibility in Adolescents

INTRODUCTION Research indicates that negative affect and/or depression is associated with increased prevalence for smoking and higher levels of nicotine dependence in adults and adolescents. A previous study with adult smokers attempting to quit indicated that low levels of self-efficacy partially mediated depressions adverse effect on posttreatment cessation. METHOD The current study attempted to test self-efficacy as a potential mediator between depressive symptoms and smoking susceptibility in adolescents. One thousand and ninety-three nonsmoking high-school students who were part of a large clinical trial evaluating an interactive CD-ROM-based smoking prevention/cessation curriculum (project ASPIRE) were included in this analysis. These students completed an extensive battery before treatment and 18 months after treatment, which included measures of depression, self-efficacy, smoking status, and smoking susceptibility. RESULTS Results indicated that self-efficacy partially mediated the positive relationship between baseline depressive symptoms and susceptibility to smoke at 18 months, accounting for approximately 27% of the variance. CONCLUSIONS Perhaps future interventions to prevent smoking in adolescents can target self-efficacy potentially resulting in more effective outcomes, particularly in adolescents with current depressive symptoms or who may be at risk for future depression.

A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION

BackgroundDespite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods), is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches) and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities.Methods/DesignWe are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1) Standard Care - brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help materials; 2) Enhanced Care - standard care components plus a cell phone-delivered text/graphical messaging component; and 3) Intensive Care - enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups). At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking cessation intervention treatment groups.DiscussionIt is hypothesized that the intensive care approach will most successfully address the needs of the target population and result in the highest smoking cessation rates. In addition to increasing cessation rates, the intervention offers several features (including neighborhood outreach and use of mHealth technology) that are likely to reduce treatment barriers while enhancing participant engagement and retention to treatment.Trial registrationThis randomized controlled trial is registered with clinicaltrials.gov registration number NCT00948129.

Changes in screening behaviors and attitudes toward screening from pre-test genetic counseling to post-disclosure in Lynch syndrome families

The purpose of this study was to examine colonoscopy adherence and attitudes toward colorectal cancer (CRC) screening in individuals who underwent Lynch syndrome genetic counseling and testing. We evaluated changes in colonoscopy adherence and CRC screening attitudes in 78 cancer‐unaffected relatives of Lynch syndrome mutation carriers before pre‐test genetic counseling (baseline) and at 6 and 12 months post‐disclosure of test results (52 mutation negative and 26 mutation positive). While both groups were similar at baseline, at 12 months post‐disclosure, a greater number of mutation‐positive individuals had had a colonoscopy compared with mutation‐negative individuals. From baseline to 12 months post‐disclosure, the mutation‐positive group demonstrated an increase in mean scores on measures of colonoscopy commitment, self‐efficacy, and perceived benefits of CRC screening, and a decrease in mean scores for perceived barriers to CRC screening. Mean scores on colonoscopy commitment decreased from baseline to 6 months in the mutation‐negative group. To conclude, adherence to risk‐appropriate guidelines for CRC surveillance improved after genetic counseling and testing for Lynch syndrome. Mutation‐positive individuals reported increasingly positive attitudes toward CRC screening after receiving genetic test results, potentially reinforcing longer term colonoscopy adherence.