SHORT REPORT
"Risk homeostasis"or "teachable moment"? the interaction between smoking behavior and lung cancer screening in the Mayo Lung Project
Lu Shi 1  
,  
 
 
More details
Hide details
1
Department of Health Services, 650 Charles E. Young Drive S. 61-253 CHS, Los Angeles, CA 90099, USA
2
UCLA School of Public Health, 650 Charles E. Young Drive S. 46-081C CHS Los Angeles, CA 90099 USA
CORRESPONDING AUTHOR
Lu Shi   

Department of Health Services, 650 Charles E. Young Drive S. 61-253 CHS, Los Angeles, CA 90099, USA
Publish date: 2011-01-24
 
Tobacco Induced Diseases 2011;9(January):2
KEYWORDS
ABSTRACT
The chest X-ray lung cancer screening program of Mayo Lung Project (MLP) yielded mixed results of improved lung case survival but no improvement in lung cancer mortality. This paper analyzes the smoking patterns of study participants in order to examine possible behavioral ramifications of periodic lung cancer screening. Using a longitudinal difference-of-difference model, we compared the smoking behavior, in terms of current smoker status among all subjects and the intensity of smoking among those continuing smokers, between those who received periodic lung cancer screening and those who received usual-care. In both arms of this lung cancer screening trial, there was a sizable decline in cigarette smoking one year after participants received baseline prevalence screening. There was no significant difference in current smoker status between the intervention group receiving periodic Xray screening and the control group receiving usual care. While we detect that the continuing smokers in the intervention group smoked more than their counterparts in the control group, the magnitude of the difference is not sufficient to explain a substantial difference in lung cancer incidence between the two groups. Our study shows that periodic lung screening in MLP did not decrease smoking behavior beyond the observed decline following the initial prevalence screening conducted at baseline for both the intervention and control groups. Our results also indicate, paradoxically, that participants assigned to the intervention group smoked more cigarettes per day on average than those in the control group. Lung cancer screening programs need additional cessation components to sustain the abstinence effect typically observed following initial lung screening.
 
REFERENCES (28)
1.
Fontana RS: The Mayo Lung Project. Cancer. 2000, 89 (S11): 2352-2355. 10.1002/1097-0142(20001201)89:11+<2352::AID-CNCR7>3.0.CO;2-5.
 
2.
Flehinger BJ, Kimmel M, Polyak T, Melamed MR: Screening for lung cancer: The Mayo lung project revisited. Cancer. 1993, 72 (5): 1573-1580. 10.1002/1097-0142(19930901)72:5<1573::AID-CNCR2820720514>3.0.CO;2-9.
 
3.
Marcus PM, Bergstralh EJ, Zweig MH, Harris A, Offord KP, Fontana RS: Extended Lung Cancer Incidence Follow-up in the Mayo Lung Project and Overdiagnosis. J Natl Cancer Inst. 2006, 98 (11): 748-756. 10.1093/jnci/djj207.
 
4.
Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R: Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. British Medical Journal. 2000, 321 (7257): 323-329. 10.1136/bmj.321.7257.323.
 
5.
Sanderson Cox L, Patten CA, Ebbert JO, Drews AA, Croghan GA, Clark MM, Wolter TD, Decker PA, Hurt RD: Tobacco use outcomes among patients with lung cancer treated for nicotine dependence. Journal Of Clinical Oncology. 2002, 20 (16): 3461-3469. 10.1200/JCO.2002.10.085.
 
6.
Taylor KL, Cox LS, Zincke N, Mehta L, McGuire C, Gelmann E: Lung cancer screening as a teachable moment for smoking cessation. Lung Cancer. 2007, 56 (1): 125-134. 10.1016/j.lungcan.2006.11.015.
 
7.
Stevens VJ, Severson H, Lichtenstein E, Little SJ, Leben J: Making the most of a teachable moment: a smokeless-tobacco cessation intervention in the dental office. Am J Public Health. 1995, 85: 231-5. 10.2105/AJPH.85.2.231.
 
8.
Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP: Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer. 2006, 106: 17-27. 10.1002/cncr.21598.
 
9.
Everett KD, Gage J, Bullock L, Longo DR, Geden E, Madsen RW: A pilot study of smoking and associated behaviors of low-income expectant fathers. Nicotine & Tobacco Research. 2005, 7 (2): 269-276.
 
10.
Bypass Angioplasty Revascularization Investigation (BARI) Investigators: Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease - A multicenter randomized trial. Journal of the American Medical Association. 1997, 277 (9): 715-721. 10.1001/jama.277.9.715.
 
11.
Ostroff JS, Buckshee N, Mancuso CA, Yankelevitz DF, Henschke CI: Smoking cessation following CT screening for early detection of lung cancer. Preventive Medicine. 2001, 33 (6): 613-621. 10.1006/pmed.2001.0935.
 
12.
Townsend CO, Clark MM, Jett JR, Patten CA, Schroeder DR, Nirelli LM, Swensen SJ, Hurt RD: Relation between smoking cessation and receiving results from three annual spiral chest computed tomography scans for lung carcinoma screening. Cancer. 2005, 103 (10): 2154-2162. 10.1002/cncr.21045.
 
13.
Cox LS, Clark MM, Jett JR, Patten CA, Schroeder DR, Nirelli LM, Swensen SJ, Hurt RD: Change in smoking status after spiral chest computed tomography scan screening. Cancer. 2003, 98 (11): 2495-2501. 10.1002/cncr.11813.
 
14.
The International Early Lung Cancer Action Program Investigators: Survival of Patients with Stage I Lung Cancer Detected on CT Screening. New England Journal of Medicine. 2006, 355: 1763-1771. 10.1056/NEJMoa060476. Oct 26, 2006.
 
15.
Kolata G: Study sees gain on lung cancer. New York Times. 2006, [http://www.nytimes.com/2006/10...].
 
16.
Bergstralh E: Notes for Mayo Lung Project Lung Health Questionnaire. Mayo Clinic documents. 1985.
 
17.
Weiss R: Modeling Longitudinal Data. 2005, Springer-Verlag, New York.
 
18.
Lancaster T, Stead LF: Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2005, CD001292.
 
19.
Arnott RJ, Stiglitz JE: The basic analytics of moral hazard. Scandinavian Journal of Economics. 1988, 90: 383-413. 10.2307/3440315.
 
20.
Asch PD, Shea LD, Bodenhorn H: Risk Compensation and the Effectiveness of Safety Belt Use Laws: A Case Study of New Jersey. Policy Sciences. 1991, 24 (2): 181-197. 10.1007/BF00138059.
 
21.
Crandall RW, Graham JD: Automobile Safety Regulation and Offsetting Behaviour: Some New Empirical Estimates. AEA Papers and Proceedings. 1984, 74 (2): 328-331.
 
22.
Manning W, Marquis S: Health insurance: the trade-off between risk pooling and moral hazard. Journal of Health Economics. 1996, 15: 609-639. 10.1016/S0167-6296(96)00497-3.
 
23.
Saffer H, Wakefield M, Terry-McElrath Y: The Effect of Nicotine Replacement Therapy Advertising on Youth Smoking. NBER Working Paper. 2007, No. W12964, [http://ssrn.com/abstract=97159...].
 
24.
Zacny JP, Stitzer ML: Cigarette brand-switching: effects on smoke exposure and smoking behavior. Journal of Pharmacology and Experimental Therapeutics. 1988, 246: 619-627.
 
25.
Wilde GJS: Target Risk 2: A New Psychology of Safety and Health. 2001, Toronto, Canada: PDE Publishing.
 
26.
Wilde GJS: Risk homeostasis theory and traffic accidents: Propositions, deductions and discussion of dissension in recent reactions., Ergonomics. Human behavior and traffic safety. Edited by: Evans L, Schwing RC. 1988, New York: Plenum Press, 31: 441-468. (pp. 193-257).
 
27.
Stead LF, Perera R, Lancaster T: A systematic review of interventions for smokers who contact quitlines. Tobacco Control. 2007, 16 (Suppl 1): i3-i8. 10.1136/tc.2006.019737.
 
28.
Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M, Riedlinger K: The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control. 2007, 16 (Suppl 1): i53-i59. 10.1136/tc.2006.019794.
 
 
CITATIONS (12):
1.
A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants
E. R. Park, J. M. Streck, I. F. Gareen, J. S. Ostroff, K. A. Hyland, N. A. Rigotti, H. Pajolek, M. Nichter
Nicotine & Tobacco Research
 
2.
Predictors of Adverse Smoking Outcomes in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial
S. A. Barry, M. C. Tammemagi, S. Penek, E. C. Kassan, C. S. Dorfman, T. L. Riley, J. Commin, K. L. Taylor
JNCI Journal of the National Cancer Institute
 
3.
Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review
Bárbara Piñeiro, Vani N. Simmons, Amanda M. Palmer, John B. Correa, Thomas H. Brandon
Lung Cancer
 
4.
The Chill of the Moment: Emotions and Proenvironmental Behavior
Daniel Schwartz, George Loewenstein
Journal of Public Policy & Marketing
 
5.
The effectiveness of mindfulness-based stress reduction (MBSR) for survivors of breast cancer: study protocol for a randomized controlled trial
Jiayan Huang, Lu Shi
Trials
 
6.
Impact of Lung Cancer Screening Results on Smoking Cessation
Martin C. Tammemägi, Christine D. Berg, Thomas L. Riley, Christopher R. Cunningham, Kathryn L. Taylor
JNCI: Journal of the National Cancer Institute
 
7.
Effectiveness of advice from physician and nurse on smoking cessation stage in Taiwanese male smokers attending a community-based integrated screening program
Dih-Ling Luh, Sam Li-Sheng Chen, Amy Ming-Fang Yen, Sherry Yueh-Hsia Chiu, Ching-Yuan Fann, Hsiu-Hsi Chen
Tobacco Induced Diseases
 
8.
The explicit and implicit outcome expectancies of Internet games and their relationships with Internet gaming behaviors among college students
Shumeng Hou, Xiaoyi Fang
Computers in Human Behavior
 
9.
Importance of Smoking Cessation in a Lung Cancer Screening Program
Vidit Munshi, Pamela McMahon
Current Surgery Reports
 
10.
Smoke-Free Recovery from Trauma Surgery: A Pilot Trial of an Online Smoking Cessation Program for Orthopaedic Trauma Patients
Sam McCrabb, Amanda Baker, John Attia, Zsolt Balogh, Natalie Lott, Justine Naylor, Ian Harris, Christopher Doran, Johnson George, Luke Wolfenden, Eliza Skelton, Billie Bonevski
International Journal of Environmental Research and Public Health
 
11.
Stages of Change, Determinants, and Mortality for Smoking Cessation in Adult Taiwanese Screenees
Dih-Ling Luh, Hsiu-Hsi Chen, Long-Ren Liao, Sam Li-Sheng Chen, Amy Ming-Fang Yen, Ting-Ting Wang, Sherry Yueh-Hsia Chiu, Ching-Yuan Fann
Prevention Science
 
12.
Does Screening Participation Affect Cigarette Smokers' Decision to Quit? A Long-Horizon Panel Data Analysis
Anne Line Bretteville-Jensen, Erik Bi⊘rn, Randi Selmer
Nordic Studies on Alcohol and Drugs
 
eISSN:1617-9625