Ancestry-Specific Hypothetical Genetic Feedback About Lung Cancer Risk in African American Individuals Who Smoke: Cognitive, Emotional, and Motivational Effects on Cessation

Genetic factors play an important role in the risk of developing lung cancer, a disease that disproportionately affects African American (AA) individuals who smoke. Accumulating evidence suggests that specific ancestry-informative genetic markers are predictive of lung cancer risk in AA individuals who smoke. Although testing for, and communication of, genetic risk to patients should impact health and screening, results are mixed. The goal of this study was to evaluate the effects of genetic risk communication that also included ancestry-specific risk information among African American individuals who smoke. Using an experimental design, African American individuals who smoke (n = 166) were assigned randomly to receive hypothetical genetic test results that indicated (1) low vs. high genetic risk for lung cancer (“Risk”) and (2) European vs. African Ancestry (“Ancestry”). We hypothesized that participants who had been told that they were both at high risk for lung cancer based on genetic markers prominent in African persons at risk of lung cancer, and that they have African ancestry, would exhibit increases in cognitive (perceived lung cancer risk), emotional (cancer worry and psychological distress), and motivational (motivation to quit smoking) factors shown to predict longer-term health behavior change. Results revealed significant and moderate-to-large effects of Risk for all outcomes. There was also a significant Ancestry effect on perceived lung cancer risk: increased risk perceptions among participants who learned that they have high African genetic heritage. Path analytic modeling revealed that cognitive and emotional factors mediated the effects of both Risk and Ancestry feedback on motivation to quit smoking. Findings further highlight the importance of incorporating ancestry-specific genetic risk information into genetic counseling sessions, especially in underserved populations, as doing so may impact key cognitive, emotional, and motivational factors critical to behavior change.

Duke Scholars

Author Isaac Marcelo Lipkus School of Nursing