The individuals in the study were enrolled in a bupropion double-blind placebo-controlled pharmacogenetic smoking cessation trial conducted by the University of Pennsylvania Transdisciplinary Tobacco Use Research Center. All appropriate IRB approvals were obtained by participating institutions as part of the Pharmacogenetics of Nicotine Addiction and Treatment Consortium. Smokers were recruited from April 1999 to October 2001 at Georgetown University (Washington, DC, USA) and SUNY Buffalo (New York, USA). Details of the eligibility criteria and flow of participants through the enrollment, treatment, and follow-up phases of the trial can be found elsewhere (20 (link)). Briefly, trial participants included 600 smokers who were >18 years of age, and reported smoking more than 10 cigarettes a day for the prior 12 months. Exclusion criteria included pregnancy, a history of DSMIV axis I psychiatric disorder, seizure disorder, and current use of antidepressants or other psychotropic medications. All participants in the trial provided informed consent for both genotyping and treatment; however, at the time of this genotyping analysis, samples remained for 534 subjects. Analyses were limited to individuals of European ancestry with both phenotype and genotype data (n = 412). Although we examine population structure within all 534 individuals of differing self-identified ethnicities, we limit our primary analyses to only those individuals who self-identified as Caucasian because of the potential for differential linkage disequilibrium across ethnic groups to lead to heterogeneity of effect estimates.
Participants from both the sites received identical assessments and treatments. At an initial visit to the smoking clinic, participants provided a 40 mL blood sample and completed a set of standardized self-report questionnaires. Baseline nicotine dependence was assessed via the FTND (64 (link)). All participants received 10 weeks of either placebo or bupropion. Bupropion treatment was delivered according to the standard therapeutic dose (150 mg/day for the first 3 days, followed by 300 mg/day). All participants also received seven sessions of standardized behavioral group counseling, focusing on self-monitoring and behavioral modification approaches. All participants were instructed to quit smoking on a TQD 2 weeks after initiating medication and counseling. Smoking status was assessed by telephone interview at the EOT (8 weeks post-TQD) and at 6 months after the TQD using a validated timeline followback method (65 ). Interviewers were blind to study group assignment. Participants who reported complete abstinence (not even a puff of a cigarette) for at least the 7 days prior to the assessment were asked to complete an in-person visit for biochemical verification of abstinence. Saliva cotinine testing was performed for participants who reported abstinence at a given time-point using a gas–liquid chromatography method (66 (link)). Cotinine is the major proximate metabolite of nicotine and has a much longer half-life than nicotine, making it the preferred biomarker for tobacco use.
Participants from both the sites received identical assessments and treatments. At an initial visit to the smoking clinic, participants provided a 40 mL blood sample and completed a set of standardized self-report questionnaires. Baseline nicotine dependence was assessed via the FTND (64 (link)). All participants received 10 weeks of either placebo or bupropion. Bupropion treatment was delivered according to the standard therapeutic dose (150 mg/day for the first 3 days, followed by 300 mg/day). All participants also received seven sessions of standardized behavioral group counseling, focusing on self-monitoring and behavioral modification approaches. All participants were instructed to quit smoking on a TQD 2 weeks after initiating medication and counseling. Smoking status was assessed by telephone interview at the EOT (8 weeks post-TQD) and at 6 months after the TQD using a validated timeline followback method (65 ). Interviewers were blind to study group assignment. Participants who reported complete abstinence (not even a puff of a cigarette) for at least the 7 days prior to the assessment were asked to complete an in-person visit for biochemical verification of abstinence. Saliva cotinine testing was performed for participants who reported abstinence at a given time-point using a gas–liquid chromatography method (66 (link)). Cotinine is the major proximate metabolite of nicotine and has a much longer half-life than nicotine, making it the preferred biomarker for tobacco use.