摘要：The National Human Genome Research Institute recommends pursuing “genomic information to improve behavior change interventions” as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies. IN ITS RECENTLY PUBLISHED Nature article, “Charting a Course for Genomic Medicine: From Base Pairs to Bedside,” the National Human Genome Research Institute describes research priorities for the coming decade, with the overarching aim of using a genomic understanding of disease to inform improvements in medical care. 1 The breadth of territory covered is impressive, but it precludes precise delineation of the many and diverse directions that could be taken to achieve this vision. Noteworthy for the field of public health is the recommendation for research to pursue applications of “genomic information to improve behavior change interventions.” 1 (p210) Indeed, the fundamental importance of behavior change in any efforts to improve health outcomes is indisputable. Behavioral risk factors (e.g., tobacco use, poor diet, and physical inactivity) are major contributors to the incidence of chronic diseases worldwide. 2 Recognition is increasing that reducing the burden of chronic disease will require researchers to acknowledge the complex interrelationships among behavior, environment (both social and physical), and genetics 3 : the genomic perspective. Nascent research suggests elemental questions and initial hypotheses about how genomic discovery may lead to more effective behavior change interventions. Certain crucial tenets should guide this exploration: (1) current intervention strategies have had limited effect on long-term behavior change and need innovation, (2) standard behavior change recommendations are insensitive to individual variation in intervention response, and (3) understanding the genomics that underlie individual variation could suggest methods for customizing behavior change recommendations to be evaluated in comparative effectiveness trials.
