Article Text

Personal beliefs, experiences, and emotions influenced smokers’ perceptions of their cancer risk
  1. Dawn Dowding, RN, PhD
  1. University of York
 York, UK

    Statistics from

 Q How do the personal beliefs, experiences, and emotions of smokers influence their perceptions of cancer risk?


    Qualitative study using grounded theory analysis.


    A university dental clinic in New York, New York, USA.


    15 smokers who were 18–79 years of age (67% men, 47% white), were fluent in English, and had no cancer history. 9 participants smoked ⩽1 pack daily, and 6 smoked >1 pack daily. 12 participants had previously tried to stop smoking.


    Participants were interviewed for 45 minutes. They were asked to describe behaviours, thoughts, and feelings that arose when they heard about a famous person’s death from cancer, a family member’s diagnosis, a media report about a cause of cancer, or discussion about a recent situation pertaining to cancer. Participants were also asked to think aloud while looking at 10 established cancer risk perception questions to give insight into how participants thought about risk perceptions. Interviews were audiotaped, transcribed, and analysed using grounded theory methods.


    2 processes characterised perceptions of cancer risk. (1) Central processing of cancer risk perception. Participants gleaned cancer risk related knowledge from the media, health professionals, friends, and family. Participants had various stances toward these sources of information: receptiveness, scepticism, or neutrality. Participants were particularly attentive to whether smoking had a role in another person’s diagnosis. Moreover, their knowledge of cancer risk factors often overlapped with the personal salience of these risk factors. Participants used their knowledge of these risk factors to shape their perceptions of risk factors that they felt increased or decreased their personal cancer risk. They formed an overall perception of their cancer risk by combining these factors. (2) Affective and attitudinal process of cancer risk perception. Participants’ perceptions of risk were influenced by their personal beliefs and emotions. (a) Philosophies about cancer risk. Participants’ beliefs sometimes downplayed the role of smoking (eg, cancer can happen to anyone), increased their perception of risk (eg, cancer is inevitable), decreased their perception of risk (eg, a relationship with God protected them), or avoided the issue (eg, cancer risk is unknowable). (b) The power of thought. Participants also had superstitious-like beliefs about cancer risk. Some people thought that thinking their risk was high would encourage illness, so they downplayed their risk. Others thought they would incur cancer if they were confident of having a low risk, so they increased their risk perceptions. Some people thought that any extreme thought about risk was dangerous, and they gave mid-range answers. Participants also had beliefs about the value of positive thoughts. Some thought their risk of cancer would be low because of their positive outlook. Some people also expressed a desire to think positively, although they were aware that the risk from smoking could not be completely offset by positive thoughts. Often perceptions of risk were expressed in terms of hope (eg, I hope my chances of getting cancer are slim). (c) Emotions/affect related to cancer risk. Discussing cancer risk evoked a range of emotions—fear, sadness, and depression being the most prevalent. Participants expressed dread of a diagnosis of cancer. They also expressed emotion when thinking about their risk of cancer. These emotions related to how other people would feel, what it would be like to confront mortality, and how they understood the severity of cancer. (d) Reactions to the risk perception scales. Participants felt uncomfortable with the risk scales used; they felt they were difficult to use, impersonal, too abstract, and “dishonest.” Most people expressed a discomfort with numbers. Some people had idiosyncratic ways of increasing the relevance of the numbers and making them more personal (eg, assigning an increase in risk of 10% for each decade of life or decreasing risk by 10% for each cessation attempt). Some participants gave contradictory answers. For example, one woman reported believing that both of the following statements were true: her risk of cancer was 80% because of poor nutrition and drug use, and her cancer risk was 0.1% because she was changing her habits.


    Smokers used personal beliefs, emotions, and experiences to shape their perceptions of cancer risk.


    The study by Hay et al provides some interesting insights into how people think about their own risk of developing cancer in relation to several health behaviours including smoking. It adds to the body of evidence that suggests that how people perceive risk may be related to their emotional reaction to that information.1 It also provides insight into possible reasons why people appear to react differently when faced with numerical information about risk as opposed to more general information,2 and why the order in which information about the risks/benefits of different treatments is presented influences health choices.3

    The authors provide a clear account of how they collected and analysed the data. However, the participants were recruited from a dental clinic in the US and may not, therefore, represent patients seen by nurses in other healthcare settings. Also, it is unclear whether all participants showed all of the different thought processes that were reported to characterise perceptions of cancer risk.

    The literature on presenting risks and probabilities in decision making suggests that most people make sense of uncertainty better when risks are presented as natural frequencies (eg, 8 of 100 women will stop smoking) rather than the probabilities or percentages that research uses to represent uncertainty (eg, the probability of women stopping smoking is 0.08 or 8%).4 The study by Hay et al suggests that although numeracy is a feature of patients’ understanding of risks, the emotional aspects of communication can still influence the ability of professionals to use solutions or decision aids.

    Practitioners who provide smoking cessation advice to patients may find the results of this study useful. They should be aware that how people react emotionally to risk information may influence their perceptions of that information and, subsequently, their behaviour.


    View Abstract


    • For correspondence: Dr J L Hay, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. hayj{at}

    • Source of funding: National Institutes of Health.

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