Tobacco use and perceived risk of lung cancer in a safety-net population

Under-represented populations may have higher smoking rates and face greater risk of lung cancer. We examined perceptions of lung cancer risk and smoking behaviors in an urban safety-net lung cancer screening (LCS) population.

We conducted surveys of English- and Spanish-speaking individuals undergoing first-time low-dose computed tomography (LDCT). Current smoking was defined as one or more cigarettes within the past month. We characterized smoking behavior according to the transtheoretical model of health behavior change. Results were analyzed by Chi-square test, Fisher's exact test, and multivariable logistic regression models.

Among 447 invited individuals, 411 (92%) participated in the survey, of whom 53% were Black, 18% were Hispanic, 56% reported income below the federal poverty level, 62% had graduated high school, and 79% were current smokers. Seventy percent reported some degree of worry about developing lung cancer, with 40% perceiving they were at risk in the next 10 years. In multivariable analysis, recent quit attempts were significantly associated with older age, Black race, perceived lung cancer risk in the next ten years, and level of worry about developing lung cancer. Specifically, individuals perceiving personal lung cancer risk were less likely to have made a recent quit attempt (OR 0.47; P = 0.04), while those reporting a lot of worry about developing lung cancer were more likely to have attempted to quit in the prior 12 months (OR 3.81; P = 0.001). Men (OR 1.71; P = 0.03) and Hispanic individuals (OR 3.87 compared to Black individuals; P < 0.001) were more likely to perceive personal risk of lung cancer. When grouped according to health behavior change (precontemplation/contemplation, preparation, action, maintenance), smoking behavior was not associated with level of worry about lung cancer (P = 0.46).

In an urban, safety-net LCS population, current smoking rates are high and perceived lung cancer risk varies by numerous demographic characteristics. While most individuals reported worry about lung cancer, which correlated with past quit attempts, this concern is not associated with overall current smoking behavior. Given disparities in smoking rates and lung cancer risk, a nuanced understanding of factors affecting smoking behaviors may optimize cessation interventions in under-represented populations.