title: A qualitative study of lung cancer risk perceptions and smoking beliefs among national lung screening trial participants.
abstract: BACKGROUND
  The National Comprehensive Cancer Network and the American Cancer Society recently released lung screening guidelines that include smoking cessation counseling for smokers undergoing screening. Previous work indicates that smoking behaviors and risk perceptions of the National Lung Screening Trial (NLST) participants were relatively unchanged. We explored American College of Radiology Imaging Network (ACRIN)/NLST former and current smokers' risk perceptions specifically to (a) determine whether lung screening is a cue for behavior change, (b) elucidate risk perceptions for lung cancer and smoking-related diseases, and (c) explore postscreening behavioral intentions and changes.
  
  
  METHODS
  A random sample of 35 participants from 4 ACRIN sites were qualitatively interviewed 1-2 years postscreen. We used a structured interview guide based on Health Belief Model and Self-Regulation Model constructs. Content analyses were conducted with NVivo 8.
  
  
  RESULTS
  Most participants endorsed high-risk perceptions for lung cancer and smoking-related diseases, but heightened concern about these risks did not appear to motivate participants to seek screening. Risk perceptions were mostly attributed to participants' heavy smoking histories; former smokers expressed greatly reduced risk. Lung cancer and smoking-related diseases were perceived as very severe although participants endorsed low worry. Current smokers had low confidence in their ability to quit, and none reported quitting following their initial screen.
  
  
  CONCLUSIONS
  Lung screening did not appear to be a behavior change cue to action, and high-risk perceptions did not translate into quitting behaviors. Cognitive and emotional dissonance and avoidance strategies may deter engagement in smoking behavior change. Smoking cessation and prevention interventions during lung screening should explore risk perceptions, emotions, and quit confidence.
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA;
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Streck
authors.forename: Ilana F
authors.initials: IF
authors.lastname: Gareen
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Ostroff
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Hyland
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.forename: Hannah
authors.initials: H
authors.lastname: Pajolek
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008297:Male; D008400:Mass Chest X-Ray / Q000523:psychology; D008403:Mass Screening / Q000523:psychology*; D008404:Massachusetts; D008875:Middle Aged; D010465:Perception; D010865:Pilot Projects; D036301:Qualitative Research; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology; D012927:Social Control, Informal; D011795:Surveys and Questionnaires