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

  • Giselle K. PerezEmail author
  • Ilana F. Gareen
  • JoRean Sicks
  • Christopher Lathan
  • Alaina Carr
  • Pallavi Kumar
  • Colin Ponzani
  • Kelly Hyland
  • Elyse R. Park


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.


Smoking cessation Racial disparities Lung cancer Screening 


Funding Information

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).

Compliance with Ethical Standards

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.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of PsychiatryMassachusetts General Hospital & Harvard Medical SchoolBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of EpidemiologyBrown University School of Public HealthProvidenceUSA
  4. 4.Center for Statistical SciencesBrown University School of Public HealthProvidenceUSA
  5. 5.Division of Population Sciences, Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  6. 6.Abramsom Cancer Center, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.University of South Florida and Moffitt Cancer CenterTampaUSA

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