Over the past several decades, significant progress has been made in 

reducing overall smoking rates and tobacco-related diseases. Despite 

these successes, there remain demographic and geographic disparities in 

smoking prevalence, tobacco-related health outcomes, and knowledge 

about lung cancer risk factors and mortality. 

Much cancer prevention research has demonstrated that knowledge is 

a central component of effective health promotion, and that gaps in 

knowledge (e.g., by age, socioeconomic status, geographic region, or 

race/ethnicity) can create or exacerbate health disparities.While 

accurate knowledge isn’t sufficient to affect behavior change, a baseline 

of knowledge and awareness is fundamental to the development of 

attitudes and intentions toward positive, health-enhancing behaviors. 

The vast majority of Americans (84%) have received the message that 

smoking increases cancer risk, and there appears to be only some 

variation in that knowledge by demographic characteristics or by 

geographic region.Although lung cancer is the number one cancer killer 

in the U.S., less than one-third of Americans report that lung cancer is 

the leading cause of cancer deaths each year. Moreover, differences are 

pronounced by geographic region, with only 20% of adults in some areas 

of the country knowing that lung cancer is responsible for more deaths 

each year than other cancers such as breast, colon, or prostate. 

In this HINTS Brief, we explore demographic and geographic factors 

associated with accurate knowledge about lung cancer mortality, risk 

factors, and the negative effects of tobacco use. 

Geographic Distribution of Smoking and Lung Cancer Knowledge 

U.S. Population 

Percentages, 

HINTS 2003 

Does Smoking 

Increase 

Chances of 

Cancer? 

Percent 

responding 

“a lot” 

High: 96% 

Low: 79% 

Which Type of Cancer 

Do You Think Will 

Cause the Most Deaths 

this Year in the U.S.? 

Percent 

responding 

“lung cancer” 

High: 35% 

Low: 21% 

• Tobacco use and tobacco-related diseases 

prevalent in certain geographic areas, and a

certain racial/ethnic populations and peopl

socioeconomic status. 

• Knowledge about the health consequences 

tobacco is not evenly distributed.There ar

geographic differences in knowledge about 

cancer risk factors and mortality. 

• Among smokers, disadvantaged groups are 

to endorse myths and misinformation abou

negative effects of tobacco. 

Among Smokers, Myths Are 

Persistent and Pronounced 

Gender Race and Income Associated with Myth 

While a majority of current smokers know that smoking 

cancer prevention strategy, they also are prone to endor

smoking-related myths. In a HINTS study, researchers as

extent to which current and former smokers agreed wit

reversing the negative effects of smoking, and how those 

beliefs varied by sociodemographic characteristics. 

When current and former smokers were asked whether 

that exercise could undo most of the negative effects of 

were more likely than females, and African-Americans an

were more likely than Whites, to endorse the myth.Tho

incomes generally reported more accurate knowledge, b

to disagree with the exercise myth compared to people 

than $25,000 per year. 

When asked whether they believed that vitamins could u

the negative effects of smoking, similar patterns emerged

African-Americans, Hispanics, and those with incomes le

per year being more likely to endorse the myth than fem

and those with higher incomes, respectively. College grad

to people with less than a high school education, were m

hold accurate knowledge, disagreeing with the vitamin m

In this HINTS Brief, we explore factors associated with accurate knowledge about tob
reduce a person's risk of getting cancer, only 51% of people with 

less than a high school education believe this to be true. 

nothing people can do to reduce their chances of getting c

18% of African-Americans and 14% of Whites believe this t

How Can This Inform Your Work? 

Tobacco use remains the leading cause of preventable death in the U.S. 

Smoking prevalence and knowledge about the negative effects of 

tobacco use are not patterned evenly in the population. Health 

communication practitioners have the opportunity to address the 

persistent demographic and geographic differences that contribute 

to cancer-related knowledge gaps and health disparities by targeting 

tobacco education and cessation programs where existing gaps 

reflect the greatest need. 

The geographic distribution of lower levels of knowledge about 

smoking and lung cancer mortality tracks closely with the 

geographic distribution of higher mortality rates from cancers of 

the lung, trachea, bronchus, and pleura. States ranked as having the 

highest total tobacco-growing acreage (NC, KY,TN, SC, and VA)

also have the highest rates of adult smoking in the U.S

Opportunities exist for regional programming. 

A majority of smokers identify smoking cessation as a 

prevention strategy. Despite possessing accurate knowl

area, socially disadvantaged smokers are more likely to 

myths about the ability of exercise and vitamins to rev

negative health effects of tobacco. Efforts are needed to 

among smokers, and especially smokers who are male, 

American, Hispanic, or have low levels of income or ed

Socially disadvantaged groups continue to fare worse t

disadvantaged groups on indices of knowledge about c

prevention, risk factors, and mortality.Targeted efforts ar

bridge knowledge gaps and eliminate disparities in canc

About HINTS 

http://hints.cancer.gov 

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 an

surveying 6,369 Americans. Subsequent surveys followed in 2005 and 2007. HINTS was created to monitor changes 

rapidly evolving field of health communication.The survey data can be used to understand how adults 18 years and 

different communication channels to obtain health information for themselves and their loved ones, and to create m

effective health communication strategies across populations. 

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings.They introduce population-level estima

specific questions in the survey and summarize significant research findings that are a result of analyzing how certain 

demographic characteristics influence specific outcomes. Many Briefs summarize research findings from recent peer-

journal articles using HINTS. 

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER 

(1-800-422-6237) • Visit http://cancer.gov 

• Order NCI publications at https://cissecure.nci.nih.gov/ncipubs/ 

References Used in This HINTS B

Finney Rutten LJ,Augustson EM, Moser RP, Burke Beckjord 

Smoking knowledge and behavior in the U.S.: sociodemogra

status, and geographic patterns. Nicotine and Tobacco Researc

Davis RM, Gilpin EA, Loken B, Viswanath K, Wakefield MA, 

The Role of the Media in Promoting and Reducing Tobacco Use. 

U.S. Department of Health and Human Services. NIH Pub. N

June 2008. 

October 2008