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To the Editor: Drs Ayanian and Cleary¹ concluded that most smokers do not perceive themselves as being at increased risk for heart disease or cancer (71% and 60%, respectively) after being asked: "Do you think your risk of a heart attack (or cancer) is higher, lower, or about the same as other (men/women) your age."² However, their conclusion may be unwarranted based on answers to this question.

First, there is strong evidence that the context of a question (eg, what questions immediately precede it) can have a significant effect on how respondents interpret the question and on what information they use to help them answer.³ Because the questions about risk "were asked separately from questions about smoking,"¹ some smokers may not have included their smoking behavior in their mental representation of themselves while evaluating their risk of disease. Some heavier smokers may have thought about their smoking behavior in judging . . . [Full Text of this Article]