RESUMEN
INTRODUCTION: Cigarette smokers experience higher levels of depressive symptoms and are more likely to be diagnosed with depressive disorders than nonsmokers. To date, the nature of the smoking-depression relationship has not been adequately studied among heavy smokers, a group at elevated risk for poor health outcomes. In this study, we examined depressive symptom expression among heavy smokers while considering the moderating roles of smoking status, gender, and race. We also explored whether amount of tobacco usually consumed had an impact. METHODS: We extracted data from a large, highly nicotine-dependent, nontreatment cigarette smoking study sample (N = 6,158). Participants who consented were screened for major exclusions, and they completed questionnaires. RESULTS: Smokers reported a higher, clinically meaningful level of depressive symptoms relative to nonsmokers (27.3% of smokers vs. 12.5% of nonsmokers) scored above the clinical cutoff on the Center for Epidemiological Studies Depression (CES-D) scale (p < .001), which differed among race × gender subgroups. Further, amount of daily intake was inversely associated with self-report of depressive symptoms. For every 10-cigarette increment, the likelihood of scoring above the CES-D clinical cutoff decreased by 62% (p < .0001). CONCLUSIONS: These findings improve our understanding of tobacco's influence on depressive symptom expression among heavy smokers, with implications for tailoring evidence-based tobacco treatments.
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Depresión/epidemiología , Depresión/etiología , Fumar/epidemiología , Fumar/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
OBJECTIVES: We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit. METHODS: We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group. RESULTS: We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence (F(1,12) = 6.84; P < .05) and prolonged abstinence (F(1,12) = 14.62; P < .01) than did those in the usual care group. CONCLUSIONS: The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans.
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Odontología Comunitaria , Nicotina/uso terapéutico , Agonistas Nicotínicos/uso terapéutico , Educación del Paciente como Asunto , Cese del Hábito de Fumar/métodos , Adulto , Clínicas Odontológicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mississippi , New York , OregonRESUMEN
Dentists with tobacco cessation training perform more interventions, report increased self-efficacy, preparedness and fewer barriers than those without training. The aim of this study was to assess changes in knowledge, attitudes and behavior of dentists (CE group) at six months following presentation of a standardized tobacco cessation lecture module. These data were compared to those from age and gender-matched controls who did not receive training. The CE group was more likely to feel cessation was very important, score higher on knowledge questions, update tobacco use of continuing patients, ask former smokers about relapse and ask about daily consumption. The CE group was also more likely to discuss the personal relevance of quitting, roadblocks and setting quit dates, identify triggers, discuss pharmacotherapy and provide follow-up. These results suggest that group education appears to be a cost-efficient and effective method of teaching dentists about the latest methods of tobacco cessation.
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Actitud del Personal de Salud , Educación en Odontología/métodos , Conocimientos, Actitudes y Práctica en Salud , Prevención del Hábito de Fumar , Enseñanza , Cese del Uso de Tabaco , Humanos , AutoeficaciaRESUMEN
Intensive tobacco treatment programs offer many advantages relative to other treatment options, particularly for more complex patients, e.g., highly nicotine dependent, or those with medical and psychiatric symptoms and disorders. Efforts to better understand those who choose to enroll in these programs, particularly regarding the characteristics they possess known to mediate outcomes, are important considerations in tailoring available services. In this study, we examined how participants differed on key descriptive and tobacco use variables within race (i.e., African-American, Caucasian) and sex subgroups. Baseline characteristics from a large group of consecutive program enrollees were examined across targeted subgroups. Strong racial effects and some sex effects were noted for marital status, education, employment and health insurance status, alcohol consumption, presence of medical and psychiatric disorders, as well as participant tobacco use patterns and tobacco use rates of family, friends and coworkers. The differences in participant tobacco use measures across race and sex factors remained significant after adjusting for the confounding effects of all other covariates. These findings have implications for characterizing key patient subgroups who present at tobacco treatment clinics. Such information may contribute to options for tailoring treatment regimens.
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BACKGROUND: Oral and maxillofacial surgeons (OMS) treat oral disease attributable to and/or complicated by tobacco use and have unique opportunities to treat patients with tobacco dependence. This study assessed the tobacco-use-related knowledge, attitudes and intervention behaviors of OMS in the United States. METHODS: The authors mailed a 38-item survey to members of the American Association of Oral and Maxillofacial Surgeons (N = 5,234). RESULTS: More than one-half (52.4 percent) of recipients responded; 21.9 percent reported that they assisted tobacco-using patients most of the time; 14.5 percent reported having an awareness of the U.S. Public Health Service Clinical Practice Guideline; and 8.7 percent had received training in treating tobacco dependence. Most respondents (90.1 percent) identified tobacco users and 63.3 percent advised tobacco users to quit; less than 15 percent assisted most patients with various interventions. Most respondents did not view providing tobacco treatment as their professional responsibility. Self-efficacy ratings were low, as was perceived treatment effectiveness. Providers with training performed more interventions, perceived interventions to be more effective, reported greater self-efficacy and perceived fewer barriers than did those without training. Most respondents (71.4 percent) were interested in improving their skills in this area. Being female and having received training in treating patients with tobacco dependence predicted a higher frequency of providing interventions. Current tobacco use by providers predicted a lower frequency of providing interventions. CONCLUSIONS: OMS provide interventions for tobacco use at an unacceptably low rate but report that they desire to improve their skills in this area. Training is associated with a higher frequency of intervention behaviors. PRACTICE IMPLICATIONS: Training is likely to be well-received and to increase the frequency with which dentists provide treatment for tobacco dependence.
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Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Especialidades Quirúrgicas , Cirugía Bucal , Estados UnidosRESUMEN
BACKGROUND: The gene encoding neurotrophic tyrosine kinase receptor 2 (NTRK2) has been localized to a region on chromosome 9q22-q23 that showed a "suggestive" linkage to nicotine dependence (ND) in our previous linkage analyses. However, no association of NTRK2 with ND has been identified. METHODS: Family-based association analyses of 2037 participants (1366 African Americans [AA], 671 European Americans [EA]) representing 602 nuclear families were performed to evaluate association of nine single nucleotide polymorphisms (SNPs) within NTRK2 with ND. RESULTS: Individual SNP-based association analysis indicated that in the EA sample, SNPs rs1659400 and rs1187272 were significantly associated with at least one adjusted ND measure. Haplotype analysis revealed that even after Bonferroni correction, the haplotype T-T-A of rs1659400-rs1187272-rs1122530 had a highly significant positive association, with adjusted ND measures in the EA sample (max Z = 3.78; p = .0001, frequency 59.9%). We further identified a major haplotype, T-G-C-A-A (26%), formed by rs993315-rs736744-rs920776-rs4075274-rs729560, which showed a significant positive association (max Z = 2.97, p = .003) with adjusted ND measures in the AA sample. CONCLUSIONS: These results strongly suggest that NTRK2 is a susceptibility gene for ND. These findings imply that NTRK2 plays a role in the etiology of ND and represents an important biological candidate for further investigation.
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Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido Simple , Receptor trkB/genética , Tabaquismo/genética , Adulto , Negro o Afroamericano , Cromosomas Humanos Par 9 , Femenino , Frecuencia de los Genes , Haplotipos , Humanos , Desequilibrio de Ligamiento , Masculino , Persona de Mediana Edad , Núcleo Familiar , Tabaquismo/etnología , Población BlancaRESUMEN
AIMS: The primary aim of our randomised control trial (RCT) was to evaluate the relative efficacy of two dental office based interventions compared to usual care. One intervention consisted of a combination of dental practitioner advice to quit and proactive telephone counselling (3A's), and the other arm consisted of a dental practitioner delivered intervention based on the 5A's of the Clinical Practice Guideline (5A's). METHOD: 2177 tobacco using patients were enrolled from 68 dental practices in Mississippi. We collected 3-month outcome data from 76% (n = 1652) of participants. RESULTS: Smokers in the two intervention conditions quit at a higher rate than those in usual care; chi2 (1, n = 1381) = 3.10, p<0.05. Although not significant, more patients in the 5A's condition quit than those in the 3A's. Of patients in the 3A's Condition, 50% reported being asked by their dentist or hygienists about fax referral to the quitline, and 35% were referred. Quitline counsellors contacted 143 (70%) referred participants. CONCLUSION: These results suggest that there are both advantages and disadvantages to the use of quitlines as an adjunct to brief counselling provided by dental practitioners. Patients receiving quitline counselling quit at higher rates than those who did not; however, only a small percentage of patients received counselling from the quitline. Therefore, it appears that dental professionals may be most effective in helping their patients to quit by regularly providing the 5A's plus proactively referring only those patients who are highly motivated to a quitline for more intensive counselling.
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Consejo/métodos , Odontología/métodos , Líneas Directas , Cese del Hábito de Fumar/métodos , Femenino , Humanos , Masculino , Mississippi , Guías de Práctica Clínica como Asunto , Práctica Privada , Derivación y Consulta/organización & administración , Resultado del TratamientoRESUMEN
The purpose of this study was to explore perceptions of the roles and responsibilities of dental education in serving the public good, and the extent to which they are being met, from the vantage point of leaders at the university and state level. Five questions were developed to gather views on dental education's success in meeting the expectations and needs of the public. Fifty-one interviews were conducted with leaders at seven institutions and with public officials in six states. Overall, dental education was perceived as fulfilling its public purpose in promoting oral health, providing access to care, and conducting relevant research. However, significant areas for improvement were noted including better communication of accomplishments to key stakeholders, graduating a more socially aware, culturally sensitive, and community-oriented dental practitioner, and being a committed partner with other community leaders in improving access to care for all citizens. Current programs aimed at addressing these gaps (e.g., Pipeline, Profession, and Practice program) are discussed. Dental education can address these perceptions only by producing graduates who desire to fulfill their obligations to society and serve the public good.
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Atención a la Salud/tendencias , Servicios de Salud Dental/tendencias , Educación en Odontología/tendencias , Promoción de la Salud , Odontología en Salud Pública/tendencias , Docentes de Odontología , Predicción , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Opinión Pública , Facultades de Odontología/organización & administración , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Although many years of genetic epidemiological studies have demonstrated that genetics plays a significant role in determining smoking behavior, little information is available on genomic loci or genes affecting nicotine dependence. Several susceptibility chromosomal regions for nicotine dependence have been reported, but few have received independent confirmation. To identify susceptibility loci for nicotine dependence, 313 extended pedigrees selected from the Framingham Heart Study population were analyzed by both the GENEHUNTER and S.A.G.E. programs. RESULTS: After performing linkage analyses on the 313 extended Framingham Heart Study families, the EM Haseman-Elston method implemented in GENEHUNTER provided evidence for significant linkage of smoking rate to chromosome 11 and suggestive linkage to chromosomes 9, 14, and 17. Multipoint sib-pair regression analysis using the SIBPAL program of S.A.G.E. on 1389 sib pairs that were split from the 313 extended families identified suggestive linkage of smoking rate to chromosomes 4, 7, and 17. Of these identified positive regions for nicotine dependence, loci on chromosomes 7, 11, and 17 were identified by both GENEHUNTER and S.A.G.E. programs. CONCLUSION: Our genome-wide scan results on the Framingham Heart Study data provide evidence for significant linkage of smoking rate to chromosome 11 and suggestive linkage to chromosomes 4, 7, 9, 14, and 17. These findings suggest that some of these regions may harbor susceptibility loci for nicotine dependence, and warrant further investigation in this and other populations.
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Marcadores Genéticos/genética , Pruebas Genéticas/estadística & datos numéricos , Genoma Humano , Fumar/epidemiología , Fumar/genética , Adulto , Hijos Adultos , Mapeo Cromosómico/estadística & datos numéricos , Cromosomas Humanos Par 11/genética , Cromosomas Humanos Par 17/genética , Cromosomas Humanos Par 7/genética , Estudios de Cohortes , Femenino , Predisposición Genética a la Enfermedad/epidemiología , Predisposición Genética a la Enfermedad/genética , Genética de Población/estadística & datos numéricos , Humanos , Masculino , Linaje , Programas Informáticos/estadística & datos numéricos , Tabaquismo/epidemiología , Tabaquismo/genéticaRESUMEN
Despite wide distribution of an evidence-based clinical practice guideline, the provision of treatment for tobacco use has been weak. The primary care setting is an ideal environment in which to implement the tobacco clinical practice guideline. It has been suggested that implementation of the guideline may be enhanced by adapting guideline recommendations into a stepped-care plus treatment-matching model; however, this model has yet to be tested. This article describes an ongoing investigation designed to evaluate (1) the feasibility of implementing this treatment model in a primary care environment, (2) efforts on identifying reasonable assessment methods, (3) primary care providers' use of assessment data, and (4) the relationships between predictors and outcomes under differing treatment "step" conditions in primary care settings. Six primary care clinics are participating in this study comparing usual care, brief clinical intervention, and enhanced clinical intervention conditions. The last of these conditions is hypothesized to produce the best and most cost-effective outcomes. Recruitment is expected to continue until January 2004, being 65% complete as of this writing. Follow-up contacts will continue until April 2005. Results should provide information that will contribute to the ongoing development of primary care-based tobacco intervention approaches.
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Atención Primaria de Salud , Investigación , Cese del Hábito de Fumar , Humanos , Mississippi , Guías de Práctica Clínica como Asunto , Cese del Hábito de Fumar/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES/HYPOTHESIS: Although one in five U.S. adults continue to smoke, healthcare providers often fail to provide basic, effective interventions. This is particularly true for physician specialists. This study sought to investigate perceived role, self-efficacy, practice behaviors, and attitudes among otolaryngologists as they relate to the delivery of tobacco treatment services. STUDY DESIGN: This study involved a single administration of a survey questionnaire to current members of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). METHODS: A questionnaire was mailed up to three times to active members. RESULTS: Survey response rate was 39% (N = 2127). Based on an evaluation of treatment factors categorized according to the National Cancer Institute's 5A's approach, trained providers generally rated themselves consistently higher than untrained providers across areas of clinical activity. Minimal differences were noted for Ask and Advise, moderate for Assess, and the greatest for Assist and Arrange. Trained providers also indicated more positive attitudes towards treatment. CONCLUSIONS: While the level of performance was reasonable for otolaryngologists relative to other specialists in the published literature, overall tobacco treatment activity remains unacceptably low. This study suggests the positive impact of training and the potential value of making such experiences widely available.
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Competencia Clínica , Atención a la Salud/normas , Educación Médica Continua/métodos , Otolaringología/educación , Tabaquismo/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care. METHODS: The authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants. RESULTS: At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F(1,66) = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F(1,66) = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies. CONCLUSIONS: The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office-based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling. CLINICAL IMPLICATIONS: The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.
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Consultorios Odontológicos , Líneas Directas , Derivación y Consulta , Telefacsímil , Cese del Uso de Tabaco/métodos , Adulto , Actitud Frente a la Salud , Estimulantes del Sistema Nervioso Central/uso terapéutico , Consejo , Relaciones Dentista-Paciente , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Humanos , Masculino , Nicotina/análogos & derivados , Agonistas Nicotínicos/uso terapéutico , Salud Bucal , Cese del Hábito de Fumar/métodos , Tabaco sin Humo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION AND AIMS: Dentists and dental hygienists are in a unique position to motivate and assist their patients to quit smoking and using smokeless tobacco, and there is ample evidence that they can be effective. Tobacco plays a major role in the development and treatment of many oral diseases, and the repeated nature of dental treatment provides multiple opportunities for information, advice and brief counselling. However, dentists and dental hygienists in practice report lack of training in effective tobacco cessation skills as a significant barrier to incorporating these behaviours into routine care. DESIGN AND METHODS: In this paper, we summarise the rationale for addressing tobacco use within dentistry and dental hygiene, review the extant policies regarding provision of tobacco-related education, and make recommendations for the content and format of tobacco dependence treatment training in undergraduate curricula and continuing education courses. RESULTS: Although worldwide dental education organisations have policies encouraging their members to provide tobacco cessation services to their patients, there are no national standards for tobacco cessation curriculum in US dental schools. In addition, tobacco cessation is not considered a clinical competency. DISCUSSION AND CONCLUSIONS: For dental professionals to systematically assist their patients to quit tobacco, changes must be made to the ways treatment of tobacco dependence is viewed within dentistry and taught at the undergraduate and post-graduate levels. Until that time, the dental profession will continue to fall short of the Clinical Practice Guidelines and the policies set out by its professional organisations.
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Odontología/métodos , Educación en Odontología/métodos , Higiene Bucal/educación , Cese del Uso de Tabaco/métodos , Relaciones Dentista-Paciente , Educación Continua en Odontología/métodos , Humanos , Higiene Bucal/métodos , Tabaquismo/prevención & control , Tabaquismo/terapiaRESUMEN
RATIONALE: Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi. METHODS: The Provider Attitude Survey, an 85-item measure of tobacco-related knowledge, attitudes and intervention behaviours was mailed to all members of Mississippi's Family Medicine, Dentistry and Nurse Practitioner professional organizations (N=2043). RESULTS: Over one-third (n=802, 39.2%) of eligible providers responded. Just 24.3% had received training in tobacco cessation and 33.7% were aware of the Public Health Service clinical practice guideline. Over 90% indicated that it was their role to prevent tobacco use; felt rewarded when they helped patients quit; and were bothered and upset by the health effects of tobacco. Doctors assisted more patients than nurses or dentists. Doctors and nurses reported more self-efficacy, motivation and preparedness for treating tobacco use than dentists. Providers with training performed more interventions and reported more self-efficacy, preparedness and fewer barriers than those without training. Training was associated with greater increases in self-efficacy, preparedness and intervention behaviours for dentists than for the other groups. CONCLUSIONS: Despite a high prevalence of tobacco use and tobacco-related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.
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Conocimientos, Actitudes y Práctica en Salud , Rol del Médico , Médicos de Familia , Prevención del Hábito de Fumar , Competencia Clínica , Odontólogos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mississippi , Motivación , Médicos Osteopáticos , Guías de Práctica Clínica como Asunto , Práctica de Salud Pública , Autoeficacia , Cese del Hábito de FumarRESUMEN
Epidemiological studies have demonstrated that genetic factors account for at least 50% of the liability for nicotine dependence (ND). Although several linkage studies have been conducted, all samples to date were primarily of European origin. In this study, we conducted a genomewide scan of 1,261 individuals, representing 402 nuclear families, of African American (AA) origin. We examined 385 autosomal microsatellite markers for ND, which was assessed by smoking quantity (SQ), the Heaviness of Smoking Index (HSI), and the Fagerstrom Test for ND (FTND). After performing linkage analyses using various methods implemented in the GENEHUNTER and S.A.G.E. programs, we found a region near marker D10S1432 on chromosome 10q22 that showed a significant linkage to indexed SQ, with a maximum LOD score of 4.17 at 92 cM and suggestive linkage to HSI, SQ, and log-transformed SQ. Additionally, we identified three regions that met the criteria for suggestive linkage to at least one ND measure: on chromosomes 9q31 at marker D9S1825, 11p11 between markers D11S1993 and D11S1344, and 13q13 between markers D13S325 and D13S788. Other locations on chromosomes 15p11, 17q25, and 18q12 exhibited some evidence of linkage for ND (LOD >1.44). The four regions with significant or suggestive linkage were positive for multiple ND measures by multiple statistical methods. Some of these regions have been linked to smoking behavior at nominally significant levels in other studies, which provides independent replication of the regions for ND in different cohorts. In summary, we found significant linkage on chromosome 10q22 and suggestive linkage on chromosomes 9, 11, and 13 for major genetic determinants of ND in an AA sample. Further analysis of these positive regions by fine mapping and/or association analysis is thus warranted. To our knowledge, this study represents the first genomewide linkage scan of ND in an AA sample.
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Negro o Afroamericano/genética , Cromosomas Humanos Par 10 , Tabaquismo/genética , Adolescente , Adulto , Femenino , Genoma Humano , Humanos , Escala de Lod , Masculino , Repeticiones de Microsatélite , Nicotina/metabolismo , Núcleo FamiliarRESUMEN
Twelve single-nucleotide polymorphisms (SNPs) in the human gamma-aminobutyric acid type B (GABA(B)) receptor subunit 2 gene (GABAB2) were tested for association with nicotine dependence (ND) in an extensively phenotyped cohort of 1,276 smokers and nonsmokers, representing approximately 404 nuclear families of African American (AA) or European American (EA) origin. The GABAB2 gene encodes a subunit of the GABA(B) receptor for GABA, an inhibitory neurotransmitter involved in the regulation of many physiological and psychological processes in the brain. The gene is located within a region of chromosome 9q22 that showed a "suggestive" linkage to ND. Individual SNP analysis performed using the PBAT-GEE program indicated that two SNPs in the AAs and four SNPs in the EAs were significantly associated with ND. Haplotype analysis using the Family-Based Association Test revealed that, even after Bonferroni correction, the haplotype C-C-G of rs2491397-rs2184026-rs3750344 had a significant positive association with ND in both the pooled and the AA samples. In the EAs, we identified two haplotypes, C-A-C-A and T-A-T-A, formed by SNPs rs1435252-rs378042-rs2779562-rs3750344, that showed a highly significant negative and positive association with ND, respectively. In summary, our findings provide evidence of a significant association of GABAB2 variants with ND, implying that this gene plays an important role in the etiology of this drug addiction.
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Predisposición Genética a la Enfermedad , Variación Genética , Receptores de GABA-B/genética , Tabaquismo/genética , Adulto , Negro o Afroamericano/genética , Alelos , Estudios de Cohortes , Femenino , Haplotipos , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Población Blanca/genéticaRESUMEN
We tested six single nucleotide polymorphisms (SNPs) in the alpha4 subunit gene (CHRNA4) and four SNPs in the beta2 subunit gene (CHRNB2) of nicotinic acetylcholine receptors (nAChRs) for association with nicotine dependence (ND), which was assessed by smoking quantity (SQ), the heaviness of smoking index (HSI) and the Fagerstrom test for ND (FTND) in 2037 subjects from 602 nuclear families of either European-American (EA) or African-American (AA) ancestry. Analysis of the six SNPs within CHRNA4 demonstrated that in the EA sample SNPs rs2273504 and rs1044396 are significantly associated with the adjusted SQ and FTND score, respectively. In the AA samples, SNPs rs3787137 and rs2236196 are each significantly associated with at least two adjusted ND measures. Association of rs2236196 with the adjusted HSI and FTND scores in the AA samples remained significant after correction for multiple testing. Furthermore, analysis revealed gender- and ethnic-specific associations for several SNPs with ND measures in both ethnic samples; however, only the association of SNP rs2236196 with the three adjusted ND measures remained significant after correcting for multiple testing in the AA female samples. Haplotype analysis of rs2273505-rs2273504-rs2236196 showed significant association after Bonferroni correction of a C-G-G haplotype (53.4%) with three adjusted ND measures in samples from the AA females. A similar analysis for the four SNPs within CHRNB2 did not reveal significant association with the three ND measures. In summary, our findings provide convincing evidence for the involvement of the nAChR alpha4 subunit, but not of the nAChR beta2 subunit, in nicotine addiction.
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Población Negra/genética , Receptores Nicotínicos/genética , Caracteres Sexuales , Tabaquismo/genética , Población Blanca/genética , Femenino , Predisposición Genética a la Enfermedad , Haplotipos , Humanos , Masculino , Modelos Genéticos , Polimorfismo de Nucleótido Simple , Fumar/genéticaRESUMEN
Brain-derived neurotrophic factor (BDNF) influences dopamine and serotonin neurotransmission in the brain, both of which are involved in the reward system of addiction. The BDNF gene is located in a genomic region on chromosome 11p where we and others have found 'significant' linkage to nicotine dependence (ND). We tested the potential role of variants within BDNF in vulnerability to ND, which was assessed by Smoking Quantity (SQ), the Heaviness of Smoking Index (HSI), and the Fagerström Test for ND (FTND). Six single nucleotide polymorphisms (SNPs) in BDNF were analyzed in an extensively phenotyped cohort of 602 nuclear families with smokers and non-smokers of African-American (AA) or European-American (EA) ancestry. Individual SNP analysis revealed that two SNPs in the pooled male and three SNPs in the EA male samples were significantly associated with at least one adjusted ND measure. However, none of these associations remained significant after correction for multiple testing. Haplotype analysis of rs6484320-rs988748-rs2030324-rs7934165 revealed that a major T-C-T-G haplotype was significantly associated, even after Bonferroni correction, with the three ND measures in the pooled and EA male samples (maximum Z = 3.00, P = 0.002 and maximum Z = 3.13, P = 0.0009 for SQ, respectively). No significant association of a major haplotype with ND was found in the AA or EA female smokers. The significant association of BDNF variants with ND implies that this gene plays a role in the etiology of ND in EAs and that its involvement is gender specific. BDNF may warrant further investigation in ND.