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John Z. Ayanian, MD, MPP; Paul D. Cleary, PhD

JAMA. 1999;281:1019-1021.

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.

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.

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