Skip to main content
SpringerLink
Log in

Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Previous work suggests that, compared to white adults, black adults have lower perceived risk for smoking-related diseases (SRDs), which may influence cessation behavior and health outcomes; however, racial differences in SRD risk perceptions among high-risk patients (i.e., a group that exhibits elevated risk for SRDs) following lung screening remain unknown. This paper thus examined differences in risk perceptions for lung cancer and other SRDs among black and white National Lung Screening Trial (NLST) participants. We administered a 10-item measure of perceived lifetime risk of lung cancer and other SRD (Smoking Risk Perceptions Scale; SRPS) to NLST participants at 1 year following lung screening to (1) establish the internal consistency of the SRPS for both black and white participants, (2) compare smoking-related disease risk perceptions between black and white participants, and (3) identify predictors of risk perceptions for black and white participants using multivariable linear regression models. We determined the SRPS items loaded onto two factors (personal and comparative risks; Cronbach’s alpha = 0.93 and 0.95 for 1743 white and 194 black participants, respectively), thus demonstrating high internal consistency for both black and white adults. Compared to white participants, black adults demonstrated lower SRD risk perceptions (SRPS range = 10–50, mean difference = 2.55, SE = 0.50, p < 0.001), even after adjusting for smoking status and sociodemographics. Younger age, female gender, higher education, white race, and current smoking status were independently associated with high risk perceptions. Sociodemographic factors associated with lower risk perceptions resemble factors related to continued smoking. Findings suggest current and former black smokers are at risk of having lower risk perceptions for lung cancer and SRDs than white adults following lung cancer screening; these differences may explain observed racial differences in cessation outcomes. Although similar factors influence black and white adults’ beliefs, risk perceptions may differentially impact smoking behavior among these groups. Behavior change models that guide tobacco treatment approaches, particularly for high-risk black smokers, should consider the influence of cultural factors on risk perceptions and cessation efforts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;34(16):1198–205. https://doi.org/10.1056/NEJM199910143411606.

    Article  Google Scholar 

  2. Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med. 2001;345(3):181–8. https://doi.org/10.1056/NEJM200107193450306.

    Article  CAS  PubMed  Google Scholar 

  3. Lathan CS, Neville BA, Earle CC. The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol. 2006;24(3):413–8. https://doi.org/10.1200/JCO.2005.02.1758.

    Article  PubMed  Google Scholar 

  4. Lathan CS, Neville BA, Earle CC. Racial composition of hospitals: effects on surgery for early-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(26):4347–52. https://doi.org/10.1200/JCO.2007.15.5291.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Earle C, Venditti LN, Nuemann PJ, et al. Who gets chemotherapy for metastatic lung cancer? Chest. 2000;117(5):1239–46. https://doi.org/10.1378/chest.117.5.1239.

    Article  CAS  PubMed  Google Scholar 

  6. Earle CC, Venditti L, Neumann, et al. Impact of referral patterns on the use of chemotherapy for lung cancer. J Clin Oncol. 2000;117(5):1239–46. https://doi.org/10.1200/JCO.2002.07.142.

    Article  CAS  Google Scholar 

  7. Stewart J. Lung carcinoma in African Americans: a review of the current literature. Cancer. 2001;91(12):2476–81. https://doi.org/10.1002/1097-0142(20010615)91:12<2476::AID-CNCR1283>3.0.CO;2-Z.

    Article  PubMed  Google Scholar 

  8. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15. https://doi.org/10.7326/0003-4819-139-11-200312020-00009.

    Article  PubMed  Google Scholar 

  9. American Cancer Society. Cancer Facts & Figures. Atlanta: American Cancer Society; 2017.

    Google Scholar 

  10. Park ER, Japuntich SJ, Traeger L, et al. Disparities between blacks and whites in tobacco and lung cancer treatment. Oncologist. 2011;16(10):1428–34. https://doi.org/10.1634/theoncologist.2011-0114.

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Dios MA, Anderson BJ, Stanton C, Audet DA, Stein M. Project Impact: a pharmacotherapy pilot trial investigating the abstinence and treatment adherence of Latino light smokers. J Subst Abus Treat. 2012;43(3):322–30. https://doi.org/10.1016/j.stat.2012.01.004.

    Article  Google Scholar 

  12. Landrine H, Corral I, Campbell KM. Racial disparities in healthcare provider advice to quit smoking. Prev Med Rep. 2018;10:172–5. https://doi.org/10.1016/j.pmedr.2018.03.003.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jones MR, Joshu CE, Navas-Acien A, Platz EA. Racial/ethnic differences in duration of smoking among former smokers in the National Health and Nutrition Examination Surveys. Nicotine Tob Res. 2018;20(3):303–11. https://doi.org/10.1093/ntr/ntw326.

    Article  PubMed  Google Scholar 

  14. Bacio GA, Guzman IY, Shapiro JR, Ray LA. Differences in quit attempts between non-Hispanic black and white daily smokers: the role or smoking motives. Addict Behav. 2015;39(12):1769–72. https://doi.org/10.1016/j.addbeh.2014.07.001.

    Article  Google Scholar 

  15. Johnson L, Hartz S, Bierut L. Different trajectories of smoking behaviors across racial groups. Drug Alcohol Depend. 2017;171:e96–7.

    Google Scholar 

  16. Max W, Sung HY, Tucker LY, Stark B. Disproportionate cost of smoking for African Americans in California. Am J Public Health. 2010;100(1):152–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lyna P, McBride C, Samsa G, Pollak KI. Exploring the association between perceived risks of smoking and benefits to quitting: who does not see the link? Addict Behav. 2002;27(2):293–307. https://doi.org/10.1016/S0306-4603(01)00175-7.

    Article  PubMed  Google Scholar 

  18. Lathan CS, Okechukwu C, Drake B, et al. Racial differences in the perception of lung cancer: the 2005 Health Information National Trends Survey. Cancer. 2010;116(8):1981–6. https://doi.org/10.1002/cncr.24923.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marshall HM, Bowman RV, Yang IA, Fong, et al. Screening for lung cancer with low-dose computed tomography: a review of current status. J Thorac Dis. 2013;5(Suppl 5):S524–39. https://doi.org/10.3978/j.issn.2072-1439.2013.09.06.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Final Update Summary: Lung Cancer: Screening. U.S. Preventive Services Task Force. July 2015. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening

  21. Taylor KL, Cox LS, Zincke N, et al. Lung cancer screening as a teachable moment for smoking cessation. Lung Cancer. 2007;56:125–34. https://doi.org/10.1001/jamainternmed.2015.3558.

    Article  PubMed  Google Scholar 

  22. Park ER, Kleimann S, Youatt EJ, Lockhart A, Campbell EG, Levy DE, et al. Black and white adults' perspectives on the genetics of nicotine addiction susceptibility. Addict Behav. 2011;36(7):769–72. https://doi.org/10.1016/j.addbeh.2011.02.007.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Park ER, Ostroff JS, Rakowski W, et al. Risk perceptions among participants undergoing lung cancer screening: Baseline results from the National Lung Screening Trial. Ann Behav Med. 2009;37(3):268–79. https://doi.org/10.1007/s12160-009-9112-9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Park ER, Streck JM, Gareen IF, Ostroff JS, Hyland KA, Rigotti NA, et al. A qualitative study of lung cancer risk perceptions and smoking beliefs among national lung screening trial participants. Nicotine Tob Res. 2014;16(2):166–73. https://doi.org/10.1093/ntr/ntt133.

    Article  PubMed  Google Scholar 

  25. Soulakova JN, Hartman AM, Liu B, Willis GB, Augustine S. Reliability of adult self-reported smoking history: data from the tobacco use supplement to the current population survey 2002-2003 cohort. Nicotine Tob Res. 2012;14(18):952–60. https://doi.org/10.1093/ntr/ntr313.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Soulakova JN, Huang H, Crockett LJ. Racial/ethnic disparities in consistent reporting of smoking-related behaviors. J Addict Behav Ther Rehabil. 2015; 4(4). https://doi.org/10.4172/2324-9005.1000147.

  27. Ramo DE, Hall SM, Prochaska JJ. Reliability and validity of self-reported smoking in an anonymous online survey with young adults. Health Psychol. 2011;30(6):693–701. https://doi.org/10.1037/a0023443.

    Article  PubMed  PubMed Central  Google Scholar 

  28. American College of Radiology Imaging Network. American College of Radiology Imaging Network Protocol 6654 data forms. 2011.

  29. Weinstein ND, Marcus SE, Moser RP. Smokers’ unrealistic optimism about their risk. Tob Control. 2005;14(1):55–9. https://doi.org/10.1136/tc.2004.008375.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Borrelli B, Hayes RB, Dunsiger S, et al. Risk perception and smoking behavior in medically ill smokers: a prospective study. Addiction. 2010;105(6):1100–8. https://doi.org/10.1111/j.1360-0443.2010.02900.x.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Orom H, O'Quin KE, Reilly S, Kiviniemi MT. Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood. Ethn Health. 2015;20(6):543–56. https://doi.org/10.1080/13557858.2014.950197.

    Article  PubMed  Google Scholar 

  32. Scarinci IC, Bandura L, Hidalgo B, Cherrington A. Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping. Health Promot Pract. 2012;13(1):29–40. https://doi.org/10.1177/1524839910366416.

    Article  PubMed  Google Scholar 

  33. Iwelunmor J, Newsome V, Airhihenbuwa CO. Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethn Health. 2014;19(1):20–46. https://doi.org/10.1080/13557858.2013.857768.

    Article  PubMed  Google Scholar 

  34. Blackstone S, Iwelunmor J, Plange-Rhule J, Gyamfi J, Quakyi NK, Ntim M, et al. ‘I believe high blood pressure can kill me:’ Using the PEN-3 cultural model to understand patients’ perceptions of an intervention to control hypertension in Ghana. Ethn Health. 2017;4:1–14. https://doi.org/10.1080/13557858.2017.1346178.

    Article  Google Scholar 

  35. Poss JE. Developing a new model for cross-cultural research: synthesizing the Health Belief Model and the Theory of Reasoned Action. ANS Adv Nurs Sci. 2001;23(4):1–15. https://doi.org/10.1097/00012272-200106000-00002.

    Article  CAS  PubMed  Google Scholar 

  36. Tong EK, Ong MK, Vittinghoff E, Pérez-Stable EJ. Nondaily smokers should be asked and advised to quit. Am J Prev Med. 2006;30(1):23–30. https://doi.org/10.1016/j.amepre.2005.08.048.

    Article  PubMed  Google Scholar 

  37. Kumar P, Gareen IF, Lathan CS, Sicks JD, Perez GK, Hyland KA, et al. Racial differences in tobacco cessation and treatment usage after lung screening: an examination of the National Lung Screening Trial. Oncologist. 2016;21(1):40–9. https://doi.org/10.1634/theoncologist.2015-0325.

    Article  PubMed  Google Scholar 

  38. Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. 1974;2(4):328–34. https://doi.org/10.1177/109019817400200403.

    Article  Google Scholar 

  39. Weinstein ND. The precaution adoption process. Health Psychol. 1988;7(4):355–86. https://doi.org/10.1037/0278-6133.7.4.355.

    Article  CAS  PubMed  Google Scholar 

  40. Soulakova J, Davis WW, Hartman A, Gibson J. The impact of survey and response modes on current smoking prevalence estimates using TUS-CPS: 1992-2003. Surv Res Methods. 2009;3(3):123–37.

    PubMed  PubMed Central  Google Scholar 

  41. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284(20):2606–10. https://doi.org/10.1001/jama.284.20.2606.

    Article  CAS  PubMed  Google Scholar 

  42. Ryan H, Trosclair A, Gfroerer J. Adult current smoking: differences in definitions and prevalence estimates—NHIS and NSDUH, 2008. J Environ Public Health. 2012;2012:1–11. https://doi.org/10.1155/2012/918368.

    Article  Google Scholar 

Download references

Funding

This work was financially supported by the American Cancer Society (grant number MRSG-005-05-CPPB to E.R.P); The National Cancer Institute at the National Institutes of Health (grant numbers U01 CA079778, U01 CA080098, K07 CA211955); and the United States Department of Veterans Affairs (grant number 1IK2CX000918-01A1).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA

    Giselle K. Perez, Alaina Carr, Kelly Hyland & Elyse R. Park

  2. Harvard Medical School, Boston, MA, USA

    Giselle K. Perez, Christopher Lathan, Colin Ponzani & Elyse R. Park

  3. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Ilana F. Gareen

  4. Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA

    Ilana F. Gareen & JoRean Sicks

  5. Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Christopher Lathan

  6. Abramsom Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Pallavi Kumar

  7. University of South Florida and Moffitt Cancer Center, Tampa, FL, USA

    Kelly Hyland

Authors
  1. Giselle K. Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilana F. Gareen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JoRean Sicks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher Lathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alaina Carr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pallavi Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Colin Ponzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kelly Hyland
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elyse R. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giselle K. Perez.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Informed Consent

For this type of study formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perez, G.K., Gareen, I.F., Sicks, J. et al. Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study. J. Racial and Ethnic Health Disparities 6, 676–685 (2019). https://doi.org/10.1007/s40615-019-00566-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-019-00566-z

Keywords

Search

Navigation