Skip to main content


Log in

Perceptions of Risk Factors for Colorectal Cancer and Colorectal Cancer Risk-Related Behaviors Among Current, ex-, and Nonsmokers

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript


Smoking significantly increases risk for colorectal cancer (CRC). We examined smokers’ and nonsmokers’ perceptions of behavioral factors for the increased risk of CRC and evaluated how these related to CRC screening. Self-reported questionnaire data were obtained from a random, average CRC risk sample of women and men (aged 50–75 years) during 2004. Smokers less frequently reported recent CRC screening than nonsmokers (p = 0.03). Smokers not adherent to screening less frequently agreed that smoking and alcohol consumption (both strongly linked to CRC) increased the risk for CRC (p values < 0.05) than nonsmokers. Notably, the number of concurrent CRC risk behaviors reported by smokers not adherent to CRC screening increased with the number of cigarettes smoked per day, identifying heavy smokers who do not screen as a subgroup most in need of intervention. Findings extend current understanding on processes underlying smokers’ perceptions of risk for CRC and how these relate to screening utilization, which can guide provider efforts to improve CRC screening among smokers and reduce their CRC risk-related behaviors.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others


  1. American Cancer Society (2011) Colorectal cancer facts & figures 2011–2013. American Cancer Society, Atlanta

    Google Scholar 

  2. Rex DK, Johnson DA, Anderson JC et al (2008) American college of gastroenterology guidelines for colorectal cancer screening. Am J Gastroenterol 2009:739–750

    Google Scholar 

  3. Beydoun HA, Beydoun MA (2008) Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control 19:339–359

    Article  PubMed  Google Scholar 

  4. Neider AM, John S, Messina CR et al (2006) Are patients aware of the association between smoking and bladder cancer? J Urol 176:2405–2408

    Article  Google Scholar 

  5. Festinger L (1957) A theory of cognitive dissonance. Stanford University Press, Evanston

    Google Scholar 

  6. Weinstein ND (1998) Accuracy of smoker’s risk perceptions. Ann Behav Med 20:135–140

    Article  PubMed  CAS  Google Scholar 

  7. Peretti-Watel P, Constance J, Guilbert P et al (2007) Smoking too few cigarettes to be at risk? Smokers’ perceptions of risk and risk denial, a French study. Tob Control 16:351–356

    Article  PubMed  Google Scholar 

  8. Cummings KM, Hyland A, Giovino GA et al (2004) Are smokers adequately informed about the health risks of smoking and medicinal nicotine? NicotineTob Res Supp3:S333–S340

    Article  Google Scholar 

  9. Messina CR, Lane DS, Grimson R (2005) Colorectal cancer-screening attitudes and practices: preferences for decision-making. Am J Prev Med 28:439–446

    Article  PubMed  Google Scholar 

  10. Messina CR, Lane DS, Colson RC (2009) Colorectal cancer screening among users of county health centers and users of private physician practices. Public Health Rep 124:568–578

    PubMed  Google Scholar 

  11. American Cancer Society (2005) Colorectal cancer facts & figures. Special edition 2005. American Cancer Society, Atlanta

    Google Scholar 

  12. Muscat JE, Wynder E (1994) The consumption of well-done meat and the risk of colorectal cancer. Am J Public Health 84:856–858

    Article  PubMed  CAS  Google Scholar 

  13. Giovannucci E (2002) Epidemiologic studies of folate and colorectal neoplasia: A review. J Nutr 132:2350S–2355S

    PubMed  CAS  Google Scholar 

  14. Byers T, Levin B, Rothenberger D et al (1997) American cancer society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: Update 1997. CA Cancer J Clin 47:154–160

    Article  PubMed  CAS  Google Scholar 

  15. Winawer SJ, Fletcher RH, Miller L et al (1997) Colorectal cancer screening: Clinical guidelines and rational. Gastroenterol 112:594–642

    Article  CAS  Google Scholar 

  16. Pignone M, Rich M, Teutsch SM et al (2002) Screening for colorectal cancer in adults at average risk: A summary of the evidence for the U.S. preventive services task force. Ann Intern Med 137:132–141

    Article  PubMed  Google Scholar 

  17. Chao A, Thun MJ, Jacobs EJ, Henley SJ, Rodriguez C, Calle EE (2000) Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. JNCI 92:1888–1896

    Article  PubMed  CAS  Google Scholar 

  18. Yabroff KR (2008) Interventions to improve cancer screening: Commentary from a health services research perspective. Am J Prev Med 35(1S):S6–S9

    Article  PubMed  Google Scholar 

  19. Emmons KM, McBride CM, Puleo E et al (2005) Project PREVENT: A randomized trial to reduce multiple behavioral risk factors for colorectal cancer. Cancer Epidemiol Biomarkers Prev 14:1453–149

    Article  PubMed  Google Scholar 

  20. Everson-Hock ES, Taylor AH, Ussher M (2010) Readiness to use physical activity as a smoking cessation aid: A multiple behavior change application of the transtheoretical model among quitters attending stop smoking clinics. Patient Educ Couns 79:156–159

    Article  PubMed  Google Scholar 

  21. Hay J, Shuk E, Cruz G et al (2005) Thinking through cancer risk: characterizing smokers’ process of risk determination. Qual Health Res 15:1074–1085

    Article  PubMed  Google Scholar 

  22. Hettema JE, Hendricks PS (2010) Motivational interviewing for smoking cessation: A meta-analytic review. J Consult Clinical Psychol 78:868–884

    Article  Google Scholar 

  23. Guassora AD, Gannik D (2010) Developing and maintaining patients’ trust during general practice consultations: The case for smoking cessation advice. Patient Educ Couns 78:46–52

    Article  PubMed  Google Scholar 

  24. Brigham J, Lessov-Schlagger CN, Javitz HS et al (2010) Validity of recall of tobacco use in two prospective cohorts. Am J Epidemiol 172:828–835

    Article  PubMed  Google Scholar 

  25. Jones RM, Mongin SJ, Lazovich D et al (2008) Validity of four self-reported colorectal cancer screening modalities in a general population: Differences over time and by intervention assignment. Cancer Epidemiol Biomarkers Prev 17:777–784

    Article  PubMed  Google Scholar 

Download references


This work was supported by the National Cancer Institute at the National Institutes of Health [R01 CA1010206-1-10435].

Conflict of interest

All authors have no conflicts of interest to declare.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Catherine R. Messina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Messina, C.R., Lane, D.S. & Anderson, J.C. Perceptions of Risk Factors for Colorectal Cancer and Colorectal Cancer Risk-Related Behaviors Among Current, ex-, and Nonsmokers. J Canc Educ 28, 444–453 (2013).

Download citation

  • Published:

  • Issue Date:

  • DOI: