Perceived Risks of Heart Disease and Cancer Among Cigarette Smokers | Lifestyle Behaviors | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Centers for Disease Control and Prevention.  Cigarette smoking-attributable mortality and years of potential life lost—United States, 1990.  MMWR Morb Mortal Wkly Rep.1993;42:645-649.Google Scholar
US Department of Health and Human Services.  Reducing the Health Consequences of Smoking: 25 Years of Progress. Rockville, Md: US Dept of Health and Human Services, Public Health Service; 1989. DHHS publication (CDC) 89-8411.
National Cancer Institute.  Changes in Cigarette-Related Disease Risks and Their Implication for Prevention and ControlBethesda, Md: National Cancer Institute; 1997. Smoking and Tobacco Control Series, No. 8. NIH publication 97-4213.
US Department of Health and Human Services.  The Health Benefits of Smoking CessationRockville, Md: US Dept of Health and Human Services, Public Health Service; 1990. DHHS publication (CDC) 90-8416.
Centers for Disease Control and Prevention.  Cigarette smoking among adults—United States, 1994.  MMWR Morb Mortal Wkly Rep.1996;45:588-590.Google Scholar
Weinstein ND. Unrealistic optimism about illness susceptibility: conclusions from a community-wide sample.  J Behav Med.1987;10:481-500.Google Scholar
Centers for Disease Control and Prevention.  Physician and other health-care professional counseling of smokers to quit—United States, 1991.  MMWR Morb Mortal Wkly Rep.1993;42:854-857.Google Scholar
Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians.  JAMA.1998;279:604-608.Google Scholar
Leventhal H, Cleary PD. The smoking problem: a review of the research and theory in behavioral risk modification.  Psychol Bull.1980;88:370-405.Google Scholar
Weinstein ND. The precaution adoption process.  Health Psychol.1988;7:355-386.Google Scholar
Weinstein ND. Accuracy of smokers' risk perceptions.  Ann Behav Med.1998;20:135-140.Google Scholar
Marmot MG, Fuhrer R, Ettner SL, Marks NF, Bumpass LL, Ryff CD. Contribution of psychosocial factors to socioeconomic differences in health.  Milbank Q.1998;76:403-448.Google Scholar
Avis NE, Smith KW, McKinlay JB. Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed?  Am J Public Health.1989;17:1608-1612.Google Scholar
Levy PS, Lemeshow S. Sampling of Populations: Methods and Applications. New York, NY: John Wiley & Sons Inc; 1991.
Leventhal H, Glynn K, Fleming R. Is the smoking decision an "informed choice"? effect of smoking risk factors on smoking beliefs.  JAMA.1987;257:3373-3376.Google Scholar
Brownson RC, Jackson-Thompson J, Wilkerson JC, Davis JR, Owens NW, Fisher EB. Demographic and socioeconomic differences in beliefs about the health effects of smoking.  Am J Public Health.1992;82:99-103.Google Scholar
McCoy SB, Gibbons FX, Reis TJ, Gerrard M, Luus CA, Sufka AV. Perceptions of smoking risk as a function of smoking status.  J Behav Med.1992;15:469-488.Google Scholar
Strecher VJ, Kreuter MW, Kobrin SC. Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks?  J Behav Med.1995;18:45-54.Google Scholar
Schoenbaum M. Do smokers understand the mortality effects of smoking? evidence from the Health and Retirement Survey.  Am J Public Health.1997;87:755-759.Google Scholar
Gibbons FX, Eggleston TJ, Benthin AC. Cognitive reactions to smoking relapse: the reciprocal relation between dissonance and self-esteem.  J Pers Soc Psychol.1997;72:184-195.Google Scholar
The Smoking Cessation Clinical Practice Guideline Panel and Staff.  The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline.  JAMA.1996;275:1270-1280.Google Scholar
Glynn TJ, Manley MW. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for PhysiciansBethesda, Md: National Cancer Institute; 1997. NIH publication 97-3064.
Cummings SR, Rubin SM, Oster G. The cost-effectiveness of counseling smokers to quit.  JAMA.1989;261:75-79.Google Scholar
Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation.  JAMA.1997;278:1759-1766.Google Scholar
Viscusi WK. Smoking: Making the Risky Decision. New York, NY: Oxford University Press; 1992.
Brief Report
March 17, 1999

Perceived Risks of Heart Disease and Cancer Among Cigarette Smokers

Author Affiliations

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.

JAMA. 1999;281(11):1019-1021. doi:10.1001/jama.281.11.1019

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 cancer.

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 health risks.