There is little consistency across risk perception measures in tobacco research. There may be value in developing and disseminating best practices for assessing tobacco risk perceptions. A set of risk perception consensus measures may also benefit researchers in the field to help them consistently apply measurement recommendations.
Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoking behaviors. To understand optimal methods of assessing adults’ cigarette smoking risk perceptions (among both smokers and nonsmokers), we reviewed best practices from the tobacco control literature, and where gaps were identified, we looked more broadly to the research on risk perceptions in other health domains. Based on this review, we suggest assessments of risk perceptions (1) about multiple smoking-related health harms, (2) about harms over a specific timeframe, and (3) for the person affected by the harm. For the measurement of perceived likelihood in particular (ie, the perceived chance of harm from smoking based largely on deliberative thought), we suggest including (4) unconditional and conditional items (stipulating smoking behavior) and (5) absolute and comparative items and including (6) comparisons to specific populations through (7) direct and indirect assessments. We also suggest including (8) experiential (ostensibly automatic, somatic perceptions of vulnerability to a harm) and affective (emotional reactions to a potential harm) risk perception items. We also offer suggestions for (9) response options and (10) the assessment of risk perception at multiple time points. Researchers can use this resource to inform the selection, use, and future development of smoking risk perception measures. Implications Incorporating the measurement suggestions for cigarette smoking risk perceptions that are presented will help researchers select items most appropriate for their research questions and will contribute to greater consistency in the assessment of smoking risk perceptions among adults.
(1) This study suggests that moderate drinking may influence the quit smoking process. Further study is needed to better understand the implications of moderate drinking for smoking cessation. (2) Providing information alone may not be effective in helping people abstain from drinking during smoking cessation, especially if moderate drinkers do not perceive their behavior as reducing their chance for a successful quit attempt. Tailoring smoking cessation interventions to include strategies to reduce moderate-to-heavy alcohol consumption may improve smoking cessation outcomes among alcohol users attempting to quit smoking.
Introduction Nondaily smoking has become increasingly common among cigarette smokers. Our objective was to determine whether current daily versus nondaily smoking differed by tobacco-related risk perceptions (TRRPs), demographic factors, and cancer history. Methods Participants were all adult current smokers in three consecutive years (Waves 1–3) of the longitudinal cohort Population Assessment of Tobacco and Health Study (N=8,307). The primary analysis was weighted logistic regression of daily versus nondaily smoking at Wave 3. TRRP measures were cigarette harm perception, worry that tobacco products will damage one’s health, belief that smoking cigarettes causes [lung/bladder/mouth/liver] cancer, and nondaily cigarette harm perception (Likert-type scale). Other measures included demographic factors, other tobacco product use, minor at time of first cigarette, and cancer survivor status (yes/no). Results Among current smokers, daily versus nondaily smoking was significantly associated with being a minor at time of first cigarette (OR=1.54, p<.001), TRRPs (OR=0.83, p<.001; OR=1.40, p<.001; and OR=1.17, p=.009 [harm perception, worry, and nondaily cigarette harm perception, respectively]), and interaction between cancer survivor status and belief that smoking causes cancer (p<.001). TRRPs among current smokers did not differ significantly between cancer survivors and respondents without a cancer history. Conclusions Respondents with lower harm perception, higher worry, and higher nondaily cigarette harm perception were more likely to be daily versus nondaily smokers. Respondents with higher belief that smoking causes cancer or who were cancer survivors were less likely to be daily (versus nondaily) smokers compared to respondents with low belief and no cancer history. Implications This study is unique in that it examined associations of smoking cigarettes daily versus nondaily with tobacco-related risk perceptions and cancer survivorship—comparing cancer survivors to those without a cancer history. Given the increasing prevalence of nondaily smoking as compared with daily smoking in the general population, and the prognostic significance of smoking after cancer diagnosis, these findings fill a clinically important gap in the literature and provide a foundation for further research.
Understanding hospital culture is important to effectively manage patient flow. The purpose of this study was to develop a survey instrument that can assess a hospital's culture related to in-hospital transitions in care. Key transition themes were identified using a multidisciplinary team of experts from 3 health care systems. Candidate items were rigorously evaluated using a modified Delphi technique. Findings indicate 8 themes associated with hospital culture-mediating transitions. Forty-four items reflect the themes.
Background To understand the state of tobacco control efforts across Africa, a first-ever survey was implemented to assess the nature and activities of tobacco control stakeholders across the African continent. Methods A survey in English, Arabic, and French was made available to individuals and organizations to assess the types and scope of tobacco control efforts and experience with tobacco control programs based on FCTC articles/MPOWER components. Results There were 219 respondents from 32 African and 6 non-African countries. Research and advocacy were the most reported activities, and several organizations emerged as network nodes for connecting tobacco control efforts across multiple African countries. The most common FCTC articles/MPOWER components worked on were (W) warning about the dangers of tobacco (58%), (M) monitor tobacco use and policies (49%), and (P) protection against secondhand smoke exposure (47%). Significant between-country differences were also found on some FCTC articles/MPOWER components: (1) (R) price and tax measures [Articles 6 and 15] (F=1.57, p=0.048), (2) industry interference [Article 5.3] (F=1.62, p=0.038), and (3) economically viable alternatives to tobacco growing [Article 17] (F=1.94, p=0.007). Discussion This study found a broad and robust tobacco control network across Africa, with multiple organizations serving those networks and having overlapping collaborations. There is considerable variability in tobacco control priorities and networking, and multiple barriers were identified to expanding the network and to fostering increased tobacco control efforts. The results point to important directions for increasing collaboration across FCTC articles/MPOWER components to improve tobacco control efforts; potential research opportunities, including an analysis of tobacco industry activities, an exploration of ways to help people quit tobacco, and approaches to elevate the cost of tobacco; and a solid tobacco control network foundation on which to build. However, exploring creative approaches to increase research most relevant to specific countries and their cultural characteristics is essential.
Background: Little is known about how cancer diagnosis and tobacco-related risk perceptions are associated with smoking behavior. Methods: We used data from Waves (W) 1–3 (2013–2016) of the Population Assessment of Tobacco and Health Study to analyze longitudinal smoking behavior among adults who were current smokers and not previously diagnosed with cancer at baseline (W1; N=7,829). The outcome was smoking cessation as of follow-up (W3). Explanatory variables were sociodemographics, other tobacco product use, adult at first cigarette, tobacco dependence, cancer diagnosis after baseline, and tobacco-related risk perceptions (cigarette harm perception, worry that tobacco products will damage one’s health [“worry”], belief that smoking causes cancer [“belief”], and nondaily smoking harm perception). Results: Cessation was significantly associated with baseline worry (odds ratio [OR]=1.26; 95% confidence interval 1.13–1.40), follow-up cigarette harm perception (OR=2.01 [1.77–2.29]), and follow-up belief (OR=1.40 [1.20–1.63]). Cessation was inversely associated with follow-up (W3) worry, and this association was stronger among those without a cancer diagnosis (OR=0.37 without cancer; OR=.76 among individuals diagnosed with cancer; interaction p=0.001). Conclusions: Cessation is associated with tobacco-related risk perceptions, with different perceptions contributing in unique ways. Cessation is predicted by baseline worry but is inversely associated with worry at follow-up, suggesting that perhaps cessation has alleviated worry. The latter finding was stronger among respondents not diagnosed with cancer. Impact: Associations between cancer diagnosis, tobacco-related risk perceptions and smoking behavior may inform the development of evidence-based smoking cessation interventions.
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