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
This is a preview of subscription content, log in to check access.
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.
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.
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar