title: Changes in Physical Activity Following a Genetic-Based Internet-Delivered Personalized Intervention: Randomized Controlled Trial (Food4Me) Does genetic testing result in behavioral health change? Changes in smoking behavior following testing for alpha-1 antitrypsin deficiency Effects of a Web-Based Personalized Intervention on Physical Activity in European Adults: A Randomized Controlled Trial Impact of direct-to-consumer genomic testing at long term follow-up Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income. Evaluating Changes in Omega-3 Fatty Acid Intake after Receiving Personal FADS1 Genetic Information: A Randomized Nutrigenetic Intervention Disclosure of Genetic Information and Change in Dietary Intake: A Randomized Controlled Trial Genetic Susceptibility Testing and Readiness to Control Weight: Results from a Randomized Controlled Trial Risky Business: Risk Perception and the Use of Medical Services among Customers of DTC Personal Genetic Testing Effect of Alzheimer disease genetic risk disclosure on dietary supplement use. Is Information on Genetic Determinants of Obesity Helpful or Harmful for Obese People?—A Randomized Clinical Trial Psychological impact of genetic testing for familial hypercholesterolemia within a previously aware population: A randomized controlled trial Does Type 2 Diabetes Genetic Testing and Counseling Reduce Modifiable Risk Factors? A Randomized Controlled Trial of Veterans Efficacy of genotype notification to Japanese smokers on smoking cessation--an intervention study at workplace. Changes in Diet and Physical Activity Following BRCA1/2 Testing Health Behavior Changes After Genetic Risk Assessment for Alzheimer Disease: The REVEAL Study An intervention study of smoking cessation with feedback on genetic cancer susceptibility in Japan. Effect of communicating DNA based risk assessments for Crohn’s disease on smoking cessation: randomised controlled trial Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Psychological and Behavioural Impact of Genetic Testing Smokers for Lung Cancer Risk Genetic susceptibility testing in smoking-cessation treatment: one-year outcomes of a randomized trial. The theory of planned behaviour: Reactions and reflections
abstract: Background There is evidence that  physical activity ( PA )  can attenuate the influence of the fat mass- and obesity-associated ( FTO ) genotype on the risk to develop obesity . However , whether providing personalized information on FTO genotype leads to changes in PA is unknown . Objective The purpose of this study was to determine if disclosing FTO risk had an impact on change in PA following a 6-month intervention . Methods The single nucleotide polymorphism ( SNP ) rs9939609 in the FTO gene was genotyped in 1279 participants of the Food4Me study , a four-arm , Web-based r and omized controlled trial ( RCT ) in 7 European countries on the effects of personalized advice on nutrition and PA . PA  was measured objective ly using a TracmorD accelerometer and was self-reported using the Baecke question naire at baseline and 6 months . Differences in baseline PA variables between risk ( AA and AT genotypes ) and nonrisk ( TT genotype ) carriers were tested using multiple linear regression . Impact of FTO risk disclosure on PA change at 6 months was assessed among participants with inadequate PA , by including an interaction term in the model : disclosure ( yes/no ) × FTO risk ( yes/no ) . Results At baseline , data on PA were available for 874 and 405 participants with the risk and nonrisk FTO genotypes , respectively . There were no significant differences in objective ly measured or self-reported baseline PA between risk and nonrisk carriers . A total of 807 ( 72.05 % ) of the participants out of 1120 in the personalized groups were encouraged to increase PA at baseline . Knowledge of FTO risk had no impact on PA in either risk or nonrisk carriers after the 6-month intervention . Attrition was higher in nonrisk participants for whom genotype was disclosed ( P=.01 ) compared with their at-risk counterparts . Conclusions No association between baseline PA and FTO risk genotype was observed . There was no added benefit of disclosing FTO risk on changes in PA in this personalized intervention . Further RCT studies are warranted to confirm whether disclosure of nonrisk genetic test results has adverse effects on engagement in behavior change . Trial Registration Clinical Trials.gov NCT01530139 ; http:// clinical trials.gov/show/NCT01530139 ( Archived by WebCite at : http://www.webcitation.org/6XII1QwHz Background : As genetic testing for health risk becomes increasingly available , it becomes important to study the prospect i ve impact of testing on modifiable health behavior . Purpose : This study examines the impact of genetic testing for alpha-1 antitrypsin ( AAT ) deficiency , a condition that usually results in emphysema in individuals exposed to cigarette smoke . We evaluated whether AAT testing , performed in the home and with minimal contact ( reading material s including advice on cessation ) , results in quit attempts and abstinence . Methods : Identified smokers ( N=199 ) from a larger study of genetic testing were surveyed 3 months following receipt of their AAT genotype . The primary endpoint was the incidence of quit attempts . Results : Smokers who tested severely AAT deficient were significantly more likely to report a 24-hr quit attempt ( 59 % ) than were those who tested normal ( 26 % ) . Carriers had a 34 % quit attempt rate . Severely AAT deficient smokers were more likely than both carriers and normals to seek information on treatment , use pharmacotherapy for smoking cessation , and report greater reductions in their smoking . There were no group differences in 3-month abstinence rates . Conclusions : Knowledge of severe AAT deficiency , but not carrier status , may motivate smokers toward cessation . The AAT testing experience may have consequences for outcomes of other genetic conditions with modifiable health behaviors Background The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity ( PA ) . There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults . Objective It is hypothesized that providing personalized advice based on PA measured objective ly alongside diet , phenotype , or genotype information would lead to larger and more sustained changes in PA , compared with nonpersonalized advice . Methods A total of 1607 adults in seven European countries were r and omized to either a control group ( nonpersonalized advice , Level 0 , L0 ) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet ( Level 1 , L1 ) , PA plus diet and phenotype ( Level 2 , L2 ) , or PA plus diet , phenotype , and genotype ( Level 3 , L3 ) .  PA  was measured for 6 months using triaxial accelerometers , and self-reported using the  Baecke question naire . Outcomes were objective and self-reported PA after 3 and 6 months . Results While 1270 participants ( 85.81 % of 1480 actual starters ) completed the 6-month trial , 1233 ( 83.31 % ) self-reported PA at both baseline and month 6 , but only 730 ( 49.32 % ) had sufficient objective PA data at both time points . For the total cohort after 6 months , a greater improvement in self-reported total PA ( P=.02 ) and PA during leisure ( nonsport ) ( P=.03 ) was observed in personalized groups compared with the control group . For individuals advised to increase PA , we also observed greater improvements in those two self-reported indices ( P=.006 and P=.008 , respectively ) with increased personalization of the advice ( L2 and L3 vs L1 ) . However , there were no significant differences in accelerometer results between personalized and control groups , and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6 . After 6 months , there were small but significant improvements in the objective ly measured physical activity level ( P<.05 ) , moderate PA ( P<.01 ) , and sedentary time ( P<.001 ) for individuals advised to increase PA , but these changes were similar across all groups . Conclusions Different levels of personalization produced similar small changes in objective PA . We found no evidence that personalized advice is more effective than conventional “ one size fits all ” guidelines to promote changes in PA in our Web-based intervention when PA was measured objective ly . Based on self-reports , PA increased to a greater extent with more personalized advice . Thus , it is crucial to measure PA objective ly in any PA intervention study . Trial Registration Clinical Trials.gov NCT01530139 ; http:// clinical trials.gov/show/NCT01530139 ( Archived by WebCite at : http://www.webcitation.org/6XII1QwHz Background There are few empirical data to inform the debate surrounding the use and regulation of direct-to-consumer ( DTC ) genome-wide disease risk tests . This study aim ed to determine the long term psychological , behavioural , and clinical impacts of genomic risk testing for common disease . Methods The Scripps Genomic Health Initiative is a prospect i ve longitudinal cohort study of adults who purchased the Navigenics Health Compass , a commercially available genomic test . Web based assessment s were administered at baseline , short ( 3 months ) , and long term ( 1 year ) follow-up . Results 2240 participants completed either or both follow-ups and a subset of 1325 completed long term follow-up . There were no significant differences from baseline in anxiety ( p=0.50 ) , fat intake ( p=0.34 ) , or exercise ( p=0.39 ) at long term follow-up , and 96.8 % of the sample had no test related distress . Longitudinal linear mixed model analyses were consistent with results of cross-sectional analyses . Screening test completion was associated with sharing genomic test results with a physician ( 36.0 % shared ; p<0.001 ) and perceived utility of the test ( 61.5 % high perceived utility ; p=0.002 ) , but was not associated with the genomic risk estimate values themselves . Conclusions Over a third of DTC genomic test recipients shared their results with their own physician during an approximate 1 year follow-up period , and this sharing was associated with higher screening test completion . Genomic testing was not associated with long term psychological risks , and most participants reportedly perceived the test to be of high personal utility PURPOSE Markers of genetic susceptibility to tobacco-related cancers could personalize harms of smoking and motivate cessation . Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a st and ard cessation intervention . EXPERIMENTAL DESIGN Our design was a two-arm trial with eligible smokers r and omized in a 1:2 ratio to Enhanced Usual Care or Biomarker Feedback ( BF ) .  Surveys were conducted at baseline , 6 , and 12 months later . The setting was an inner city community health clinic . African-American patients who were current smokers ( n = 557 ) were identified by chart abstract ion and provider referral . All smokers received a self-help manual and , if appropriate , nicotine patches . Smokers in the BF arm also were offered a blood test for genotyping the GST(3 ) gene ( GSTM1 ) , sent a test result booklet , and called up to four times by a health educator . Prevalent abstinence was assessed by self-report of having smoked no cigarettes in the prior 7 days at the 6- and 12-month follow-ups and sustained abstinence , i.e. , not smoking at either follow-up or in-between . RESULTS Smoking cessation was greater for the BF arm than the Enhanced Usual Care arm ( 19 % versus 10 % , respectively ; P < 0.006 ) at 6 months but not at 12 months . CONCLUSIONS Smokers agreed to genetic feedback as part of a multicomponent cessation program . Although the program increased short-term cessation rates compared with st and ard intervention , genetic feedback of susceptibility may not benefit smokers with high baseline risk perceptions Nutrigenetics research is anticipated to lay the foundation for personalized dietary recommendations ; however , it remains unclear if providing individuals with their personal genetic information changes dietary behaviors . Our objective was to evaluate if providing information for a common variant in the fatty acid desaturase 1 ( FADS1 ) gene changed omega-3 fatty acid ( FA ) intake and blood levels in young female adults ( 18–25 years ) . Participants were r and omized into Genetic ( intervention ) and Non-Genetic ( control ) groups , with measurements taken at Baseline and Final ( 12 weeks ) . Dietary intake of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) was assessed using an omega-3 food frequency question naire .  Red blood cell ( RBC ) FA content was quantified by gas chromatography . Implication s of participation in a nutrigenetics study and awareness of omega-3 FAs were assessed with online question naires . Upon completion of the study , EPA and DHA intake increased significantly ( p = 1.0 × 10−4 ) in all participants . This change was reflected by small increases in RBC % EPA . Participants in the Genetic group showed increased awareness of omega-3 terminology by the end of the study , reported that the dietary recommendations were more useful , and rated cost as a barrier to omega-3 consumption less often than those in the Non-Genetic group . Providing participants FADS1 genetic information did not appear to influence omega-3 intake during the 12 weeks , but did change perceptions and behaviors related to omega-3 FAs in this timeframe Background Proponents of consumer genetic tests cl aim that the information can positively impact health behaviors and aid in chronic disease prevention . However , the effects of disclosing genetic information on dietary intake behavior are not clear . Methods A double-blinded , parallel group , 2∶1 online r and omized controlled trial was conducted to determine the short- and long-term effects of disclosing nutrition-related genetic information for personalized nutrition on dietary intakes of caffeine , vitamin C , added sugars , and sodium . Participants were healthy men and women aged 20–35 years ( n = 138 ) . The intervention group ( n = 92 ) received personalized DNA-based dietary advice for 12-months and the control group ( n = 46 ) received general dietary recommendations with no genetic information for 12-months .  Food frequency question naires were collected at baseline and 3- and 12-months after the intervention to assess dietary intakes . General linear models were used to compare changes in intakes between those receiving general dietary advice and those receiving DNA-based dietary advice . Results Compared to the control group , no significant changes to dietary intakes of the nutrients were observed at 3-months . At 12-months , participants in the intervention group who possessed a risk version of the ACE gene , and were advised to limit their sodium intake , significantly reduced their sodium intake ( mg/day ) compared to the control group ( −287.3±114.1 vs. 129.8±118.2 , p = 0.008 ) . Those who had the non-risk version of ACE did not significantly change their sodium intake compared to the control group ( 12-months : −244.2±150.2 , p = 0.11 ) . Among those with the risk version of the ACE gene , the proportion who met the targeted recommendation of 1500 mg/day increased from 19 % at baseline to 34 % after 12 months ( p = 0.06 ) . Conclusions These findings demonstrate that disclosing genetic information for personalized nutrition results in greater changes in intake for some dietary components compared to general population -based dietary advice . Trial Registration Clinical Trials.gov Objective To test the hypothesis that adding obesity gene feedback ( FTO ) to simple weight control advice at a life stage with raised risk of weight gain ( university ) increases readiness to control weight . Methods Individually r and omized controlled trial comparing the effect of : ( i ) simple weight control advice plus FTO feedback ( FA ) and ( ii ) simple weight control advice only ( AO ) on readiness to engage with weight control . Differences in stage of change by genotype and differential weight control behaviors were secondary outcomes . Results Of 1,016 participants r and omized , only 279 completed follow-up , yielding 90 % power to detect a small effect for readiness to control weight . As predicted , FA participants were more likely to be in the contemplation stage than AO participants ( P = 0.023 ) . Participants receiving higher-risk genetic results were at a higher stage of change than controls ( P = 0.003 ) , with a trend toward a higher stage of change than those getting lower-risk results ( P = 0.051 ) . Lower-risk results did not decrease weight control intentions compared with controls ( P = 0.55 ) . There were no group differences in adherence to recommended weight control behaviors ( P = 0.87 ) . Conclusions Adding FTO feedback to weight control advice enhanced readiness to control weight , without evidence for genetic determinism , but had no more effect on behavior than weight control advice alone Direct-to-consumer  genetic testing has generated speculation about how customers will interpret results and how these interpretations will influence healthcare use and behavior ; however , few empirical data on these topics exist . We conducted an online survey of DTC customers of 23 and Me , deCODEme , and Navigenics to begin to address these questions . R and om sample s of U.S. DTC customers were invited to participate . Survey topics included demographics , perceptions of two sample DTC results , and health behaviors following DTC testing .  Of 3,167 DTC customers invited , 33 % ( n = 1,048 ) completed the survey . Forty-three percent of respondents had sought additional information about a health condition tested ; 28 % had discussed their results with a healthcare professional ; and 9 % had followed up with additional lab tests . Sixteen percent of respondents had changed a medication or supplement regimen , and one-third said they were being more careful about their diet . Many of these health-related behaviors were significantly associated with responses to a question that asked how participants would perceive their colon cancer risk ( as low , moderate , or high ) if they received a test result showing an 11 % lifetime risk , as compared to 5 % risk in the general population . Respondents who would consider themselves to be at high risk for colon cancer were significantly more likely to have sought information about a disease ( p = 0.03 ) , discussed results with a physician ( p = 0.05 ) , changed their diet ( p = 0.02 ) , and started exercising more ( p = 0.01 ) . Participants ’ personal health context s — including personal and family history of disease and quality of self-perceived health — were also associated with health-related behaviors after testing . Subjective interpretations of genetic risk data and personal context appear to be related to health behaviors among DTC customers . Sharing DTC test results with healthcare professionals may add perceived utility to the tests BACKGROUND Genetic susceptibility testing for Alzheimer disease ( AD ) with APOE genotype disclosure is not recommended for clinical use but is available through direct-to-consumer ( DTC ) genetic testing companies . Little is known about whether APOE genotype disclosure would actually prompt changes in nutrition behaviors among at-risk individuals . OBJECTIVE We studied the effect of APOE genotype disclosure for AD risk assessment on dietary supplement use in adults with a family history of AD . DESIGN As part of a secondary analysis of data from the second Risk Evaluation and Education for Alzheimer 's Disease Study , we examined the effect of genotype disclosure on health-behavior changes among 272 unaffected first-degree relatives of persons with AD . RESULTS Overall , 16 % of all participants reported a change in dietary supplement use after AD risk assessment . Participants who learned that they had at least one copy of the risk-increasing epsilon4 allele ( epsilon4 + ) had 4.75 times the odds of reporting a change in dietary supplement use than did their counterparts who had an absence of the risk-increasing epsilon4 allele ( epsilon4- ) ( 95 % CI : 2.23 , 10.10 ; P < 0.0001 ) after adjustment for age , sex , race , baseline supplement use , r and omization arm , and educational level . There were no significant differences between APOE epsilon4 + and epsilon4- participants in changes in overall diet , exercise , or medications . CONCLUSIONS In this sample of first-degree relatives receiving genetic susceptibility testing for AD , an APOE epsilon4 + genotype status was positively associated with dietary supplement use after risk disclosure . Such changes occurred despite the absence of evidence that supplement use reduces the risk of AD . Given the expansion of DTC genetic tests , this study highlights the need for future studies in disease risk communication Background and Objectives Although more and more genetic information is available , it is unclear whether this information is helpful for patients . Therefore , we assessed the positive and negative effects of informing obese people about the genetic etiology of being overweight . Design , Participants Two hundred ninety-four obese people were r and omized to 2 interventions ( a 1-session consultation for obese people on how to manage obesity either including genetic information or not ) ; their results were compared to a control group ( 116 ) . Subjects were assessed before and after consultation and 6 months later . Measurements Weight , scales on feeling guilty for being overweight , self-control , negative mood ( primary endpoint ) , body acceptance , restraint eating . Results Both types of consultations were considered helpful by the participants , and had comparable effects on body weight . The consultation with genetic information was rated superior in terms of leading to new insights ( advantage for consultation with genetic information , even 6 months later ; p = 0.046 ) . No negative effects ( e.g. , loss of self-efficacy/self-control , increase of body weight ; all p > 0.20 for interaction consultation × time ) were observed for informing obese people about the genetic etiology of being overweight . The consultation result ed in long-term improvement of negative mood if it included genetic information in the case of participants with a family history of obesity and if it included no genetic information in the case of obese people without a family history of obesity ( p = 0.03 for interaction of group , intervention , and time ) . Conclusions Consultations in obesity can be helpful in general . These consultations should include genetic information if people have a family history of obesity This trial tests the hypothesis that confirming a clinical diagnosis of familial hypercholesterolemia ( FH ) by finding a genetic mutation reduces patients ' perceptions of control over the disease and adherence to risk‐reducing behaviors . Three hundred forty‐one families , comprising 341 hypercholesterolemia prob and s and 128 adult relatives , were r and omized to one of two groups : ( a ) routine clinical diagnosis ; ( b ) routine clinical diagnosis plus genetic testing ( mutation search ing in prob and s and direct gene testing in relatives ) . The main outcome measures were perceptions of control over hypercholesterolemia , adherence to cholesterol‐lowering medication , diet , physical activity , and smoking .  There was no support for the main hypothesis : finding a mutation had no impact on perceived control or adherence to risk‐reducing behavior ( all P‐values > 0.10 ) . While all groups believed that lowering cholesterol was an effective way of reducing the risk of a heart attack , participants in whom a mutation was found believed less strongly in the efficacy of diet in reducing their cholesterol level ( P = 0.02 at 6 months ) and showed a trend in believing more strongly in the efficacy of cholesterol‐lowering medication ( P = 0.06 at 6 months ) . In conclusion , finding a mutation to confirm a clinical diagnosis of FH in a previously aware population does not reduce perceptions of control or adherence to risk‐reducing behaviors . The pattern of findings leads to the new hypothesis that genetic testing does not affect the extent to which people feel they have control over a condition , but does affect their perceptions of how control is most effectively achieved . Further work is needed to determine whether similar results will be obtained in population s with little previous awareness of their risks . © 2004 Wiley‐Liss , Objective We examined the clinical utility of supplementing  type 2 diabetes mellitus ( DM )  risk counseling with DM genetic test results and counseling . Research Design and Methods In this r and omized controlled trial , non-diabetic overweight/obese veteran out patients aged 21 to 65 years received DM risk estimates for lifetime risk , family history , and fasting plasma glucose , followed by either genetic test results ( CR+G ; N = 303 ) or control eye disease counseling ( CR+EYE ; N = 298 ) . All participants received brief lifestyle counseling encouraging weight loss to reduce the risk of DM . Results The mean age was 54 years , 53 % of participants were black , and 80 % were men . There was no difference between arms in weight ( estimated mean difference between CR+G vs. CR+EYE at 3 months = 0.2 kg , 95 % CI : −0.3 to 0.7 ; at 6 months = 0.4 kg , 95 % CI : −0.3 to 1.1 ) , insulin resistance , perceived risk , or physical activity at 3 or 6 months . Calorie and fat intake were lower in the CR+G arm at 3 months ( p ’s ≤ 0.05 ) but not at 6 months ( p ’s > 0.20 ) . Conclusions Providing patients with genetic test results was not more effective in changing patient behavior to reduce the risk of DM compared to conventional risk counseling . Trial registration : Clinical Trials.gov NCT01060540 http:// clinical OBJECTIVES It is well-known that smoking causes many diseases including cancers . Informing smokers of their genotypes associated with the vulnerability to the harms of smoking may be effective measures for smoking cessation . The present study examined the effects of genotype notification of an oncogene ( L-myc ) genotype to smokers on their behavior to quit smoking . METHODS Subjects were 562 employees of a bank who answered to be a smoker for a question naire used at annual health checkup at workplace from July to December 2002 . Those enrolled on August , October , and December were allocated into the genotype notification group ( intervention group ) , and the rest into the controls .  Among 286 smokers allocated into the intervention group , 257 participants ( 89.9 % ) agreed to genotype testing . One year after the enrollment , a follow-up question naire survey was conducted for all smokers including controls . RESULTS Those who stated to have quitted smoking were 22 ( 8.0 % ) among the 276 controls and 15 ( 5.8 % ) among the 257 genotype notified participants , providing that the odds ratio ( OR ) of cessation for the intervention was 0.64 ( 95 % confidence interval , 0.32 - 1.28 ) . No psychological problems associated with genotype notification were observed . CONCLUSION The present study did not show positive effects of genotype notification on smoking cessation rate . To elevate the cessation rate , methods to explain and notify genotypes should be improved ABSTRACT The present study prospect ively examined change in  diet and physical activity behaviors  in 115 women undergoing BRCA1/2 gene testing ( 46 mutation positive , 46 uninformative and 23 definitive negative ) . Participants completed measures of  diet and physical activity  at three time points : prior to genetic testing and 1- and 6-months after receipt of genetic test results . Repeated measures analyses examined between- and within-group differences among participants who received BRCA1/2 positive , uninformative , or definitive negative results . There were no within-group differences across time points or between-group differences at any time point for diet or physical activity . Most participants , overall and within each group , did not meet recommended guidelines for fruit and vegetable and dietary fat consumption . These findings suggest that women do not make spontaneous changes in diet and physical activity following the genetic testing and counseling process . A brief intervention may be necessary for patients who are interested in making changes in modifiable risk factors to complement more definitive risk-reduction strategies Risk information for Alzheimer disease ( AD ) may be communicated through susceptibility gene disclosure , even though this is not currently in clinical use . The REVEAL Study is the first r and omized clinical trial of risk assessment for AD with apolipoprotein E ( APOE ) genotype and numerical risk estimate disclosure . We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors . One hundred sixty-two participants were r and omized to either intervention ( APOE disclosure ) or control ( no genotype disclosure ) groups . Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD . The intervention group received their APOE genotype . Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation . Participants who learned they were ϵ4 positive were significantly more likely than ϵ4 negative participants to report AD-specific health behavior change 1 year after disclosure ( adjusted odds ratio : 2.73 ; 95 % confidence interval : 1.14 , 6.54 ; P=0.02 ) . Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change . Despite lack of preventive measures for AD , knowledge of APOE genotype , numerical lifetime risk , or both , influences health behavior BACKGROUND To evaluate whether feedback of genetic information regarding an L-myc polymorphism , identified as impacting on tobacco-related cancer risk , has an influence on smoking cessation , an intervention study was conducted . METHODS We recruited smokers from first-visit out patients at Aichi Cancer Center Hospital . Six hundred and seventeen participated and were allocated into two groups : the biomarker feedback group ( BF ) and the follow-up smoking status group ( FS ) . The subjects were asked for their smoking status at enrolment and at 3- and 9-month follow-ups . BF subjects were notified about their L-myc genotype . RESULTS The smoking cessation rate at 9-month follow-up was essentially the same for both BF and FS cases , at 18.8 % and 17.0 % , respectively ( P = 0.798 ) . However , a difference in the rate was evident with non-cancer subjects ( 12.7 % and 8.4 % , respectively , P = 0.237 ) , especially in females ( 15.0 % and 4.2 % , respectively , P = 0.024 ) . The non-cancer subjects informed of their genotype were more likely to quit smoking than the FS patients ; particularly in those having a risky genotype , this was significant ( odds ratio : 2.87 , P = 0.003 ) . Again it was most prominent in females . CONCLUSION Feedback regarding an L-myc polymorphism did not impact on smoking cessation overall but appeared to benefit smokers without cancer . In addition , gender could affect the response to the feedback Objective To test the hypothesis that communicating risk of developing Crohn ’s disease based on genotype and that stopping smoking can reduce this risk , motivates behaviour change among smokers at familial risk . Design Parallel group , cluster r and omised controlled trial . Setting Families with Crohn ’s disease in the United Kingdom . Participants 497 smokers ( mean age 42.6 ( SD 14.4 ) years ) who were first degree relatives of prob and s with Crohn ’s disease , with outcomes assessed on 209/251 ( based on DNA analysis ) and 217/246 ( st and ard risk assessment ) . Intervention Communication of risk assessment for Crohn ’s disease by postal booklet based on family history of the disease and smoking status alone , or with additional DNA analysis for the NOD2 genotype . Participants were then telephoned by a National Health Service Stop Smoking counsellor to review the booklet and deliver brief st and ard smoking cessation intervention . Calls were tape recorded and a r and om sub sample selected to assess fidelity to the clinical protocol . Main outcome measure The primary outcome was smoking cessation for 24 hours or longer , assessed at six months . Results The proportion of participants stopping smoking for 24 hours or longer did not differ between arms : 35 % ( 73/209 ) in the DNA arm versus 36 % ( 78/217 ) in the non-DNA arm ( difference −1 % , 95 % confidence interval −10 % to 8 % , P=0.83 ) . The proportion making a quit attempt within the DNA arm did not differ between those who were told they had mutations putting them at increased risk ( 36 % ) , those told they had none ( 35 % ) , and those in the non-DNA arm ( 36 % ) . Conclusion Among relatives of patients with Crohn ’s disease , feedback of DNA based risk assessment s does not motivate behaviour change to reduce risk any more or less than st and ard risk assessment . These findings accord with those across a range of population s and behaviours . They do not support the promulgation of commercial DNA based tests nor the search for gene variants that confer increased risk of common complex diseases on the basis that they effectively motivate health related behaviour change . Trial registration Current Controlled Trials IS RCT N21633644 BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin The behavioural and psychological impact of genetic testing for lung cancer susceptibility was examined among smokers ( N = 61 ) who were r and omly allocated to a GSTM1 genetic testing group ( with GSTM1-missing or GSTM1-present result ) or no-test control group . The GSTM1-missing ( higher risk ) group reported greater motivation to quit smoking , and both genetic testing groups reported lower depression than the control group at one-week follow-up ( p < .05 for all ) . Differences were not significant at two months follow-up . This study indicates the feasibility of much-needed research into the risks and benefits for individuals of emerging lifestyle-related genetic susceptibility tests This study evaluated the long-term impact of genetic susceptibility biomarker feedback on smoking behavior change and symptoms of depression in 426 male and female smokers . Smokers were r and omized to one of three smoking-cessation interventions : minimal contact quit-smoking counseling ( QSC ) , QSC + exposure biomarker feedback ( EBF ) , and QSC + EBF + biomarker feedback about genetic susceptibility to lung cancer ( SBF ) . The logistic regression model for quit attempt revealed a significant main effect for treatment such that participants in the SBF group were more than two times more likely to make a quit attempt than participants in the QSC group . There was not a significant difference between EBF and QSC participants . The results also revealed a significant effect for baseline stage of change . Those smokers in the preparation stage at baseline were more than three times more likely to make a quit attempt over the 12 months following treatment . The models for 30-day cessation and follow-up smoking rate revealed no significant main or interacting effects for treatment . A repeated measures analysis of variance revealed a significant main effect for time , indicating that an initial increase in depression in the genetic susceptibility group was not maintained over time . Genetic susceptibility feedback has the intended effects on motivation to quit , but it may need to be delivered within a more intensive smoking-cessation treatment for the heightened motivation to translate into smoking cessation The seven articles in this issue , and the accompanying meta- analysis in Health Psychology Review [ McEachan , R.R.C. , Conner , M. , Taylor , N. , & Lawton , R.J. ( 2011 ) . Prospect i ve prediction of health-related behaviors with the theory of planned behavior : A meta- analysis . Health Psychology Review , 5 , 97–144 ] , illustrate the wide application of the theory of planned behaviour [ Ajzen , I. ( 1991 ) . The theory of planned behavior . Organizational Behavior and Human Decision Processes , 50 , 179–211 ] in the health domain . In this editorial , Ajzen reflects on some of the issues raised by the different authors . Among the topics addressed are the nature of intentions and the limits of predictive validity ; rationality , affect and emotions ; past behaviour and habit ; the prototype/willingness model ; and the role of such background factors as the big five personality traits and social comparison tendency
target: Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions .
  The most promising lifestyle changes were changes in nutrition .
  Conclusions : It is possible to facilitate behaviour change using genetic testing as the catalyst .
background: Background : Study ing the impact of  genetic testing interventions on lifestyle behaviour change  has been a priority area of research in recent years .
  Substantial heterogeneity exists in the results and conclusions of this literature , which has yet to be explained using vali date d behaviour change theory and an assessment of the quality of genetic interventions .
  The theory of planned behaviour ( TPB ) helps to explain key contributors to behaviour change .
  It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours .
  Purpose : This systematic review provides a detailed , comprehensive identification , assessment , and summary of primary research articles pertaining to  lifestyle behaviour change  ( nutrition , physical activity , sleep , and smoking ) result ing from  genetic testing interventions .
  The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aim ing to determine whether or not genetic testing facilitates changes in lifestyle habits .
  This review is timely in light of a recently published “ call-to-action ” paper , highlighting the need to incorporate the TPB into personalized healthcare behaviour change research .