title: Effect of communicating DNA based risk assessments for Crohn's disease on smoking cessation: randomised controlled trial.
abstract: 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.
  
  
  METHODS
  Parallel group, cluster randomised controlled trial.
  
  
  METHODS
  Families with Crohn's disease in the United Kingdom.
  
  
  METHODS
  497 smokers (mean age 42.6 (SD 14.4) years) who were first degree relatives of probands with Crohn's disease, with outcomes assessed on 209/251 (based on DNA analysis) and 217/246 (standard risk assessment).
  
  
  METHODS
  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 standard smoking cessation intervention. Calls were tape recorded and a random subsample selected to assess fidelity to the clinical protocol.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  Among relatives of patients with Crohn's disease, feedback of DNA based risk assessments does not motivate behaviour change to reduce risk any more or less than standard risk assessment. These findings accord with those across a range of populations 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.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN21633644.
authors: Department of Psychology at Guy's, Section of Health Psychology, King's College London, London SE1 9RT, UK.
authors: Gareth J
authors: GJ
authors: Hollands
authors: Sophia C L
authors: SC
authors: Whitwell
authors: Richard A
authors: RA
authors: Parker
authors: Natalie J
authors: NJ
authors: Prescott
authors: Alastair
authors: A
authors: Forbes
authors: Jeremy
authors: J
authors: Sanderson
authors: Christopher G
authors: CG
authors: Mathew
authors: Cathryn M
authors: CM
authors: Lewis
authors: Sally
authors: S
authors: Watts
authors: Stephen
authors: S
authors: Sutton
authors: David
authors: D
authors: Armstrong
authors: Ann Louise
authors: AL
authors: Kinmonth
authors: A Toby
authors: AT
authors: Prevost
authors: Theresa M
authors: TM
authors: Marteau
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003424:Crohn Disease / Q000235:genetics* / Q000517:prevention & control; D004252:DNA Mutational Analysis; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D005820:Genetic Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment / Q000379:methods; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D006113:United Kingdom
chemical_list: D053473:Nod2 Signaling Adaptor Protein