Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
J Racial Ethn Health Disparities. 2019 Aug;6(4):676-685. doi: 10.1007/s40615-019-00566-z. Epub 2019 Feb 8.
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.
先前的研究表明，与白人成年人相比，黑人成年人对与吸烟相关的疾病（SRD）的感知风险较低，这可能会影响戒烟行为和健康结果；然而，在肺癌筛查后，高危患者（即具有较高 SRD 风险的人群）中 SRD 风险感知的种族差异仍不清楚。因此，本文研究了在接受国家肺癌筛查试验（NLST）的黑人和白人参与者中，对肺癌和其他 SRD 的风险感知差异。我们在 NLST 参与者接受肺癌筛查后的 1 年内，使用 10 项终生患肺癌和其他 SRD 的感知风险的测量工具（吸烟风险感知量表；SRPS）对其进行了调查，目的是：（1）为黑人和白人参与者建立 SRPS 的内部一致性；（2）比较黑人和白人参与者的吸烟相关疾病风险感知；（3）使用多变量线性回归模型，确定黑人和白人参与者风险感知的预测因素。我们确定 SRPS 项目加载到两个因素（个人和比较风险；对 1743 名白人参与者和 194 名黑人参与者，Cronbach's alpha 分别为 0.93 和 0.95），因此两个群体的内部一致性都很高。与白人参与者相比，黑人参与者表现出较低的 SRD 风险感知（SRPS 范围为 10-50，平均差异为 2.55，SE 为 0.50，p<0.001），即使在调整了吸烟状况和社会人口统计学因素后也是如此。较年轻的年龄、女性性别、较高的教育程度、白人种族和当前的吸烟状况与高风险感知独立相关。与较低风险感知相关的社会人口统计学因素与继续吸烟的因素相似。研究结果表明，在接受肺癌筛查后，目前和以前的黑人吸烟者可能对肺癌和 SRD 的风险感知低于白人成年人；这些差异可能解释了在戒烟结果方面观察到的种族差异。尽管相似的因素影响黑人和白人成年人的信念，但风险感知可能会对这些群体的吸烟行为产生不同的影响。指导烟草治疗方法的行为改变模型，特别是针对高危黑人吸烟者，应考虑文化因素对风险感知和戒烟努力的影响。
