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Ayanian JZ, Cleary PD. Perceived Risks of Heart Disease and Cancer Among Cigarette Smokers. JAMA. 1999;281(11):1019–1021. doi:10.1001/jama.281.11.1019
Author Affiliations: Section on Health Services and Policy Research, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital (Dr Ayanian), and the Department of Health Care Policy (Drs Ayanian and Cleary), Harvard Medical School, Boston, Mass. Dr Ayanian is a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation.
Context Cigarette smoking causes more preventable deaths from
cardiovascular disease and cancer than any other modifiable risk
factor, but smokers may discount the increased personal risk they face
from continued smoking.
Objective To assess smokers' perceptions of their risks of heart
disease and cancer.
Design and Setting Telephone and self-administered survey in 1995
of a probability sample of US households with telephones.
Participants A total of 3031 adults aged 25 to 74 years, including
737 current smokers (24.3%).
Main Outcome Measures Respondents with no history of myocardial
infarction (MI) (96.2%) or cancer (92.9%) assessed their risk of
these conditions relative to other people of the same age and sex.
Among current smokers, perceived risks were analyzed by demographic and
clinical factors using logistic regression.
Results Only 29% and 40% of current smokers believed they have a
higher-than-average risk of MI or cancer, respectively, and only 39%
and 49% of heavy smokers (≥40 cigarettes per day) acknowledged these
risks. Even among smokers with hypertension, angina, or a family
history of MI, 48%, 49%, and 39%, respectively, perceived their risk
of MI as higher than average. In multivariate analyses, older (≥65
years), less educated (< high school graduate), and light smokers
(1-19 cigarettes per day) were less likely than younger, more educated,
and heavy smokers to perceive an increased personal risk of MI or
Conclusions Most smokers do not view themselves at increased risk
of heart disease or cancer. As part of multifaceted approaches to
smoking cessation, physicians and public health professionals should
identify and educate smokers who are not aware of smoking-related
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